Most Americans don’t want Congress to overhaul health care, despite ‘Medicare for All’ plans, GOP push to repeal Obamacare

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Ashley Turner pointed out in her article that maybe the voters don’t want a whole new healthcare system even though Bernie and the rest are touting Medicare for All.

KEY POINTS

  • A majority of Americans say they don’t think Congress should prioritize revamping the entire U.S. health care system, according to a new Kaiser Family Foundation poll.
  • Instead, voters would rather see lawmakers focus on protecting pre-existing conditions and tackling rising prescription costs and surprise medical bills.

As Democrats and Republicans battle over which health care proposal should replace the Affordable Care Act, a majority of Americans say they don’t think Congress should revamp the entire U.S. health care system, according to a new Kaiser Family Foundation poll.

Instead, voters would rather see lawmakers focus on a handful of changes, like protecting pre-existing conditions and tackling rising prescription costs and surprise medical bills.

Most Americans felt high drug costs are the most important issue for Congress to address, with 68% of those polled believing lawmakers should take targeted actions on rising prices. 64% believe Congress should focus on protecting pre-existing conditions, while half believe surprise medical bills should also be a “top priority.”

“Everybody is concerned about drug prices because they’re really feeling the pinch here,” Robert Laszewski, president of Health Policy and Strategy Associates, said. He said the dramatic rise in drug costs over the last 10 years has made the issue a prime focus for Americans.

Though pre-existing conditions are protected now under the Affordable Care Act, also known as Obamacare, Laszewski said voters became worried after Republicans proposed to replace it in 2017. The legislation included a provision that under certain conditions would have undone Obamacare’s ban on letting insurers charge more for people with those conditions. The bill failed to pass the Senate.

The recent poll shows Americans are more concerned about rising medical costs than access to health care, Ashley Kirzinger, associate director for the Public Opinion and Survey Research team at the Kaiser Family Foundation, said.

The health care debate has taken lawmakers by storm as the 2020 elections approach with both Democrats and Republicans promising to replace Obamacare. Though there have been some issues that have seen bipartisan support, like seeking to lower drug costs, lawmakers on both sides of the aisle have otherwise viciously attacked each other’s attempts to reform the health care system.

President Donald Trump and Republicans have pledged to repeal Obamacare, though top Republicans have said the GOP will wait until Republicans regain control of the House of Representatives to unveil a replacement proposal. Republicans currently hold control of the Senate but need 21 more seats in the House to win the majority.

Lawmakers believe Republicans’ failed attempt to overturn Obamacare in 2017 led to Democrats taking control of the House in last year’s midterm elections. The law is now in jeopardy once again after the Trump administration supported a lawsuit questioning its constitutionality.

More than half, 54%, of those polled by the Kaiser Family Foundation said they don’t want to see the Supreme Court overturn Obamacare.

Meanwhile, some progressive Democrats like presidential hopeful Sen. Bernie Sanders are looking to replace Obamacare with “Medicare for All,” which seeks to create a government-run health care plan that would cover every American. The proposal has support from fellow Democratic presidential candidates like Sens. Kamala Harris, D-Calif., Cory Booker, D-N.J., Elizabeth Warren, D-Mass., and Kirsten Gillibrand, D-N.Y., though Republicans and centrist Democrats have spoken against Sanders’ legislation.

As lawmakers jockey over which overhaul of the health care system is best, Americans would rather Congress just fix the basics.

Less than a third of the people surveyed think a complete overhaul of the health care system should be a top priority in Congress, according to the poll. More than a third, 31%, think that the implementation of Medicare for All should be Congress’ focus, while 27% think lawmakers should prioritize repealing Obamacare.

Though there has been talk from top politicians about completely redoing the health care system, lawmakers have also looked to fix the issues Americans want them to spotlight.

The Senate Finance Committee earlier this year held two hearings with the nation’s top pharmaceutical companies and pharmacy benefit managers in an attempt to discover the source of rising drug costs. Protecting pre-existing conditions is also a bipartisan issue, with Democrats touting protections under Obamacare and Republicans offering an alternative protection plan in case the health care law is overturned.

Lawmakers have also introduced legislation to stop patients from getting hit with surprise medical bills and the White House promised to make the issue a priority for the Trump administration to tackle.

Laszewski said protecting pre-existing conditions, Medicaid expansion, providing subsidies for those who can’t afford insurance and tackling rising drug costs are “crucially important” to Americans, but he noted that not every citizen is the same.

“Different people are impacted differently here,” Laszewski said. “We can’t just say all Americans are exactly alike.”

House Dems to hold a hearing on ‘Medicare for All’ next week

The House Rules Committee will hold a hearing on “Medicare for All” legislation next week, a step forward for the legislation that is gaining ground in the progressive wing of the party.

The hearing on Tuesday will examine a bill from Reps. Pramila Jayapal (D-Wash.) and Debbie Dingell (D-Mich.) that has over 100 co-sponsors in the House.

According to the Rules Committee, the hearing will be the first ever that Congress has held on Medicare for All legislation.

“It’s a serious proposal that deserves serious consideration on Capitol Hill as we work toward universal coverage,” Rep. Jim McGovern (D-Mass.), the chairman of the Rules Committee and a co-sponsor of the Medicare for All bill, said in a statement. Notably, the hearing will occur in a committee that is not one of the primary committees overseeing health care.

The main health care panels, the Ways and Means Committee and Energy and Commerce Committee, have so far declined to commit to holding a hearing on Medicare for All, illustrating the divide among House Democrats over the legislation.

But McGovern has been more supportive of the bill, ultimately bringing it to a hearing in the Rules Committee. The House Budget Committee is also expected to hold a hearing.

“Health care is a human right and I’m proud the Rules Committee will be holding this hearing on the Medicare for All Act as this Majority discusses ways to strengthen our health care system for everyone,” Jayapal said in a statement.

While Speaker Nancy Pelosi (D-Calif.) supports hearings on Medicare for All, she has declined to support the legislation itself and has raised doubts about the bill, including its price tag. She has also noted she wants to build on her signature legislation, the Affordable Care Act. Still, she has not outright opposed Medicare for All, saying that different ideas should be on the table.

Well, this Fox & Friends Twitter poll on “Medicare for All” didn’t go as planned Christopher Zara reported that in today’s edition of “Ask and Ye Shall Receive,” here’s more evidence that support for universal health care isn’t going away. The Twitter account for Fox & Friends a few weeks ago ran a poll in which it asked people if the benefits of Bernie Sanders’s “Medicare for All” plan would outweigh the costs. The poll cites an estimated cost of $32.6 trillion. Hilariously, 73% of respondents said yes, it’s still worth it—which is not exactly the answer you’d expect from fans of the Trump-friendly talk show.

Granted, this is just a Twitter poll, which means it’s not scientific and was almost certainly skewed by retweets from Twitter users looking to achieve this result. At the same time, it’s not that far off from actual polling around the issue. In March, a Kaiser Health tracking poll revealed that 6 in 10 Americans are in favor of a national healthcare system in which all Americans would get health insurance from a single government plan. Other polls have put the number at less than 50% support but trending upward.

If you’re still unsure, you can read more about Sanders’s plan and stay tuned for more discussion on “Medicare for All”.

Medicare for All? For Some? Many Plans for Universal Coverage. But nothing likely to happen soon, suggests former CMS chief Tom Scully

News Editor of MedPage Joyce Frieden brings some reality to the discussion. Talk has been heating up on Capitol Hill about how to get to universal coverage, with “Medicare for All” being a popular option. But what exactly does that phrase mean, and what other universal coverage plans are out there?

So far, four different types of universal coverage bills have been introduced, although “nothing is going to happen in the next 2 years,” Tom Scully, partner in the Welsh, Carson, Anderson & Stowe private equity firm here and a former administrator of the Centers for Medicare & Medicaid Services (CMS), predicted at a press briefing Thursday. However, Scully added that he hoped the introduction of the bills would be “based on substance and details.”

The Four Types of Plans

Karen Pollitz, MPP, a senior fellow for health reform and private insurance at the Kaiser Family Foundation, laid out the four types of plans aimed at getting closer to universal coverage.

Medicare for All. Under these plans, private insurance coverage would be replaced by a single federal program; the program would also replace most other public plans such as Medicaid. Benefits would be comprehensive, with some bills offering additional coverage currently not in Medicare, such as dental care, vision care, and long-term care. The program would be taxpayer-funded — requiring substantial tax increases — but would also require few or no premiums and copays. Healthcare would be under a global budget, and a national system for paying providers — at rates yet to be determined — would be set up. Examples of Medicare for All bills include one from Sen. Bernie Sanders (I-Vt.) and one from Rep. Pramila Jayapal (D-Wash.)

Federal Public Plan Option. Under this set of options, a federally funded health insurance plan would be offered alongside current public and private healthcare The plan would be designed to be affordable — with premium subsidies and cost-sharing subsidies — and would be available to both individuals and employer

The plan would cover all of the Affordable Care Act’s “essential health benefits,” and some bills include additional coverage. Examples of a public plan option include a bill from Sen. Jeff Merkley (D-Ore.), one from Rep. Jan Schakowsky (D-Ill.), and one from Sen. Michael Bennet (D-Colo.) Medicare Buy-In for Older Adults. These bills would allow older adults — either ages 55-64 or 50-64, depending on the bill — to buy into the Medicare program. One bill, sponsored by Rep. Brian Higgins (D-N.Y.) would allow buy-in from people who also have access to employer-sponsored health coverage, and would permit employers to pay part of all of the premiums for these employees. Both the Higgins bill and one from Sen. Debbie Stabenow (D-Mich.) would allow for eligible enrollees to receive subsidies for the buy-in plan from the Affordable Care Act (ACA) marketplaces. Enrollees could choose between traditional Medicare and Medicare Advantage plans

State Medicaid Buy-In Plan. Under this approach, outlined in a bill sponsored by Sen. Brian Schatz (D-Hawaii), states would have the option of allowing state residents to buy into the Medicaid program. The buy-in option would be available through the ACA marketplaces to people of all income levels and would cover the ACA’s essential health benefits. States would receive federal matching funds to cover any costs that are not recouped through premiums and copays. States could vary premiums by the same factors as ACA marketplace plans (age, geography, family size, and tobacco use)

How to Pay Providers?

Panelists at the briefing disagreed on the best way to pay providers under these proposals, most of which don’t offer many specifics on the issue. “The idea of Medicare fee-for-service for all is completely wacky,” Scully said. “The government is [already] moving away from fee-for-service price-fixing because it never works … Paying every doctor the same thing has been shown to be part of the problem.”

Instead, Scully suggested that the government should pay private insurers to run plans, as is done in the Medicare Advantage program. He noted that 85% of Medicaid spending goes to Medicaid managed care plans, with some liberal states such as Oregon being among the first to jump on the Medicaid managed care bandwagon. “Why? Because they’re better off having Kaiser do it,” Scully said. “It’s a better deal with more coverage, so the idea that we should have the government set prices centrally to me is totally counter-intuitive.”

Mark Miller, Ph.D., executive vice president of healthcare at Arnold Ventures, philanthropy here that works on healthcare and other issues, begged to differ. “I’m not arguing that the best method is fee-for-service, but a strong argument is that one thing Medicare has done right controls the prices paid for providers, and for hospitals and physicians in particular; private plans have failed at this,” said Miller, who is also the former executive director of the Medicare Payment Advisory Commission (MedPAC).

Linda Blumberg, Ph.D., a fellow at the Urban Institute, a left-leaning think tank here, said in a phone interview that the idea that price regulation hasn’t worked “is a fallacy because if you look at how the Medicare program works, it’s very successful and has price regulation at its core.”

She noted that studies performed by MedPAC have found that “when you change reimbursement rates, hospitals do adjust their underlying costs … They become more efficient when they’re constrained. That doesn’t mean you can turn down the dial from 200% of Medicare down to 50%, but looking at the enormous variation in pricing going on in the commercial market, we know we can do better than where we are. The system isn’t rational at the moment.”

A Public/Private Alternative

Blumberg and colleagues have developed a plan called Healthy America, which would replace the Medicaid and CHIP programs, as well as the ACA marketplaces, with a public option that would allow people to buy a comprehensive insurance plan that covers hospital care, physician care, prescription drug coverage, and a wide range of other healthcare services. In addition, “other private insurers — which I would expect largely to be managed care organizations — would contract with the federal government and be alternatives to the public option,” she said.

One problem with the ACA’s marketplaces is that in many geographic areas, there are not enough enrollees to make for a competitive marketplace, Blumberg said. So the Healthy America plan pulls in additional people through the Medicaid program and also offers no cost-sharing for very-low-income enrollees, “basically pulling a much larger population into this same pool” in order to increase private-plan competition. The researchers estimate the annual cost of the fully phased-in plan at about $98 billion.

Changing the healthcare system incrementally rather than switching everyone over to a Medicare for All plan offers several advantages, she said. “There are a lot of people who are quite satisfied with their employer-based insurance and also with their Medicare program and when you tell them you’re going to replace it with something new, it causes a lot of anxiety.” In addition, “the federal government costs needed to put a plan like this in place are reduced” compared with Medicare for All.

So, these are some options but what about what all the Democrat presidential hopefuls are touting for the 2020 election?

Next week let’s break down the real cost of health care under Medicare for All.

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