A movement in America proposes Medicare for All to expand healthcare coverage for all United States citizens.
Currently, federally funded Medicare is a health insurance program for people age 65 and older and some younger people with certain chronic health conditions.
Private insurance companies offer additional health care coverage to supplement Medicare.
Learn more about Medicare here.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare for All is a proposed national health program to provide healthcare for all people in the United States. Former Representative John Conyers Jr first suggested the idea in 2003, through bill H.R. 676 – Expanded and Improved Medicare for All Act.
The plan proposes that the federal government pay for a person’s medical care, including primary care and prevention, emergency care, mental health services, and prescription drugs. Private insurance companies would offer only supplemental coverage for non-essential healthcare.
The article describes two other similar plan proposals, filed in 2019, from Senator Bernie Sanders, and Representative Pramila Jayapal, below.
Senator Bernie Sanders filed the S.1129 Medicare for All plan of 2019 to establish a single-payer health system. The key points to the Senator’s bill include:
- establishing a health plan that provides comprehensive health care to all United States residents
- providing coverage for all United States residents, either from birth or from residency
- including services such as inpatient and outpatient hospital care, emergency services, medical services, prescription drug coverage, maternity and newborn care, and long-term care
- eliminating out-of-pocket expenses, such as insurance premiums, co-payments, or deductibles – although a person would pay some cost-sharing for prescription drugs, except for families below a certain income level
- expanding current Medicare coverage to include dental, hearing, and vision services
Representative Pramila Jayapal introduced another bill – H.R.1384 – Medicare for All Act of 2019. The plan’s key points include the following:
- establishing a national health insurance program that covers all U.S. residents
- providing coverage for medical and hospital services, as well as prescription drugs, mental health treatment, dental, vision, and long-term care
- eliminating cost-sharing expenses, such as a deductible or coinsurance
While these two plans are not the only systems proposed as ideas for Medicare for All, they represent a foundation for further discussions about expanded coverage through a comprehensive national health insurance plan.
According to the Kaiser Family Foundation (KFF), a non-profit organization that studies insurance and opinions regarding insurance, there are several proposals for how such a Medicare for All program would work. They include:
- Medicare for All single health program: This program type would establish a single insurance program for all U.S. residents. The plan might result in higher taxes for some but lower costs for healthcare. This is a comprehensive plan where every person would have the same health plan, although they could potentially get supplemental coverage through an employer.
- Medicare for All nationalized health program: This national healthcare plan would be an alternative to private insurance plans. A person could choose to participate in the public healthcare plan or keep their private insurance plan. This would be similar to the option of Medicare for most individuals older than age 65, but persons of all ages could purchase the Medicare-like insurance. Ideally, this plan would be more affordable to people in the U.S. and create competition in the healthcare marketplace that could drive down costs.
Other proposals include lowering the age when people could qualify for Medicare or increasing the qualifying income for Medicaid, a government-sponsored insurance program for those with lower incomes.
In 2018, more than 27 million people, about 8.5% of the population, in the U.S. did not have health insurance at any point in the year, according to the United States Census Bureau.
Private health insurance (not including programs such as Medicare, Medicaid, Veterans Health Administration, etc.) provided health coverage for 67.3% of people in the U.S. In comparison, 34.4% of the population had public health coverage.
Changes to the health insurance system introduced through the Affordable Care Act (ACA) in 2010 resulted in fewer people being without insurance.
However, in 2018, an estimated 87 million, or 45%, of the 194 million U.S. adults ages 19 to 64 were inadequately insured, according to The Commonwealth Fund, a foundation that conducts independent research into healthcare issues.
Concerns over continuing increases in insurance premiums, prescription drug prices, and other aspects of medical care have led lawmakers to explore other potential avenues for helping people in the U.S. obtain insurance coverage.
The KFF has been tracking potential support for a national health plan for many years.
They state that the views regarding a national health plan have remained pretty constant. Figures from 2016 show that 50% of people favored such a plan, while 43% were against it. By 2020, these numbers were 53% of people in favor of a national health plan and 42% against it.
A further survey conducted by KFF asked people in the U.S. for their opinion on a Medicare for All plan with various options, as shown below:
- 70% of people would oppose a plan if it led to delays in testing and treatment.
- 60% would oppose a plan if it led to paying more in taxes.
- 58% would oppose a plan if it led to the elimination of private health insurance companies.
- 71% would favor a plan if it guaranteed health insurance as a right for all people in the U.S.
- 67% would favor a plan if it eliminated insurance premiums and out-of-pocket costs.
Many people believed they could still keep their private insurance even if there were a Medicare for All option, according to KFF.
A Medicare for All plan would involve complicated logistics and many considerations, including costs (such as increased taxes), coverage (such as having to wait longer for tests and procedures), and how to encourage some healthcare providers to accept Medicare rates.