'Medicare for America' bill adds to the rich debate Democrats are having on what comes next

Two liberal veteran House members, Reps. Rosa DeLauro and Jan Schakowsky, have reintroduced their take on healthcare reform, Medicare for America, sort of a public option on steroids. It's a strong step beyond the Affordable Care Act, without going all the way to Medicare for All, and has the support of some heavy-hitting liberals and groups outside of Congress.

The legislation does one great thing: It automatically enrolls in a new public program everyone who is already covered by Medicare, Medicaid, and CHIP, as well as the uninsured and everyone purchasing private coverage on their own. Because it's automatic enrollment, it is universal (though it's unclear in the materials presented thus far if if would extended to undocumented workers). That's a significant step beyond other less ambitious plans that would expand subsidies or Medicaid eligibility.

It would allow employer-based insurance at what is currently defined in the ACA as the gold level to continue, but people with that coverage would have the option of jumping into the public program. Significantly, it adds prescription drugs, dental care, vision care, and hearing services, which are now mostly left out of Medicare and Medicaid proper. It also, according to the fact sheet for the act, "comprehensively covers long-term services and supports for Americans living with disabilities and seniors, which Medicare and private insurance do not."

Coverage would not be free, unlike under Medicare for All, but would be much more generous than the ACA. People enrolled in the public plan who make less than twice the federal poverty level (about $50,000 for a family of four) would not have to pay premiums or any other out-of-pocket costs, while premiums and co-pays would be required on a sliding scale above that income floor. There would be a cap on premiums of no more than 8% of income, for either an individual or a family, and no deductibles for anyone in the program. To keep drug prices down, the government would negotiate prescription drug prices for the whole program.

DeLauro and Schakowsky have a financing plan to pay for the program "by sunsetting the Republican tax bill, imposing a 5% surtax on adjusted gross income (including on capital gains) above $500,000, and increasing the Medicare payroll tax and the net investment income tax. Medicare for America also increases the excise taxes on all tobacco products, beer, wine, liquor, and sugar-sweetened drinks." It would also require states to keep paying as they currently do under Medicaid and CHIP, and creates a formula for the states that haven't expanded Medicaid to ensure they pay their share.

While Medicare for All is a critical left flank in the debate on health care that is necessary to provide a starting point for a discussion of everything that's possible for a new American healthcare system, Medicare for America has to be recognized as a substantial fallback plan, and a way to preserve private insurance, since doing so remains a major political concern. It maintains the employer link to private insurance, which is less than ideal, but would make that insurance uniformly high-quality and lower-cost.

from Daily Kos http://bit.ly/2DNxxYW