Public Health Care Trends Driven By Frustration, NAHU CEO Says

By Susan Rupe

Frustration with the current health care system is opening the door for a gradual broadening of our current public programs, NAHU’s CEO said at the association’s virtual Capitol Conference on Monday.

Janet Trautwein gave an update on efforts to establish single-payer health care as well as several other public options.

Why do we have these proposals now?

“In general, there’s a lot of frustration that cost of coverage so much higher than it was in the past,” she said. “Largely, it’s because of the high cost of medical care. But it’s also frustration over cost-sharing – how high deductibles are compared to in the past. People are asking, ‘Is there a different way to do this?’”

The conference kicked off Monday with a lobbyist tell members that legislation on prescription drug prices has the best chance for success.

Frustration with the current system has led to full-blown single-payer proposals as well as to proposals for incremental additions to current government-run programs, Trautwein said. These proposals include Medicare for All, a buy-in to Medicare, a buy-in to Medicaid and a public option.

“What’s interesting and different and scary is that all of these programs would likely be permitted to use government-set prices in competition with private insurance,” she said. “Many providers have expressed concern over this. If everyone is paying Medicare rates, providers wouldn’t be able to stay in business. When you have a public option proposal offered alongside a private option, it creates a really unlevel playing field and it’s dangerous for the private system.”

Several bills establishing government-run health programs already have been introduced in Congress. Trautwein gave a rundown on all of them.

Medicare for All Act. Most recently introduced in the House in 2019, this bill would replace private health insurance with a single-payer program for all U.S. residents. This would replace all current coverage, including the current Medicare system, Trautwein said. Coverage would be mandatory, and private or supplemental health insurance would not be permitted. Government would set the pricing for health care providers. The bill would cover a comprehensive set of services, including dental, vision and long-term care, with no cost-sharing. Physicians would not be permitted to take on private-paying patients outside of the federal program.

Medicare buy-in proposals. Introduced during the previous House session, H.R. 1346/S 470 has not yet been reintroduced during the current session. It would permit a Medicare buy-in for those ages 50-64 for Parts A, B and D. Affordable Care Act premium tax credits and cost-sharing reductions would be available to reduce premiums and cost-sharing expense. The House version of this bill added a public plan Medicare Supplement. Those who are eligible for Medicaid cannot buy in to this plan. Trautwein said it is unclear whether health insurance brokers have a role in this proposal.

Changes to Medicare eligibility. Proposed by the Biden campaign, this plan is different from a buy-in, Trautwein said. It creates an actual change to the Medicare eligibility age. Workers would be able to opt out of employer-sponsored coverage in favor of this program. Trautwein said it is unclear what the cost of accepting coverage at a younger age would be, and it’s unclear whether coverage would be offered on the health insurance exchange or whether participants would be eligible for a tax credit.

Public option proposals. Several of these have been announced, and all would create an unlevel playing field by establishing a government-set premium rate that would be lower than private insurance, Trautwein said. At the federal level, some proposals envision a public option run entirely by the Centers for Medicare & Medicaid Services. Other federal proposals envision programs run by other entities, such as carriers that already participate in the Medicare program. Some proposals are aimed at only the individual market, others include the small-employer market and a few extend to the large-employer market.

Medicaid buy-in. Also known as the State Public Option Act, this proposal would allow states to create a buy-in for Medicaid. It would use modified community rating, deductibles and coinsurance according to ACA rules. It would apply to the individual market. Primary care providers would be paid Medicare rates instead of Medicaid rates. Rates paid to other providers are not specified.

Susan Rupe is managing editor for InsuranceNewsNet. She formerly served as communications director for an insurance agents' association and was an award-winning newspaper reporter and editor. Contact her at [email protected]. Follow her on Twitter @INNsusan.