More Democrats than ever have signed on to a proposal that would shift every U.S. resident onto Medicare, but a large proportion remain uncertain about heading into a completely government-run system as an immediate sequel to Obamacare.
The Medicare for All Act that has been introduced would move everyone in the U.S. onto Medicare, even if they have private healthcare coverage. It is backed by Sen. Bernie Sanders, I-Vt., and an unprecedented 16 Democratic senators. Among them are possible 2020 presidential hopefuls Sens. Cory Booker, D-N.J., Kamala Harris, D-Calif., Elizabeth Warren, D-Mass., and Kirsten Gillibrand, D-N.Y. Most Democratic lawmakers in the House have co-sponsored a similar bill.
But a large proportion of Democrats have indicated they are unconvinced voters are prepared for the change. A poll from the Kaiser Family Foundation found that 53 percent of respondents say they favor a “single-payer plan,” but support falls off when arguments are made about the government having more involvement in healthcare and when questions are asked about financing through higher taxes.
Sen. Tim Kaine, D-Va., recently said that he had “concerns” about moving toward a government-run system.
“Chief among my concerns is, with more than 100 million Americans getting health insurance through an employer-provided plan, and 80 percent of those are generally happy with their plan, I don’t think they’re going to feel good when we tell them, ‘We’re going to do a single-payer system, but don’t worry, you’ll like it just as much,'” he said at a recent hospital policy conference. “For some reason, I just don’t think they’re going to believe us when we say that.”
He and other Democrats have proposed making gradual moves in that direction, some of which they view as repairs to Obamacare. Democratic leaders often say that Obamacare “isn’t perfect” and that it “needs changes.”
If Democrats were to take control of the Senate in November, they would face a divide over charting a path on healthcare. Here are five proposals Democrats have introduced, from adding funding to Obamacare to expanding the government’s role in carrying out coverage.
1. Create a public option
A public option proposal for Obamacare was rejected during a Senate Finance Committee vote. The provision would have offered a government-run healthcare plan for people to buy into as an alternative to private health insurance. Under the latest Democratic proposal, which has Kaine’s backing and is known as “Medicare X,” people would be able to buy into the program in the initial years if they buy coverage on the Obamacare exchanges, and then more people would gradually be allowed in.
2. Require insurers to sell Obamacare plans
The Consumer Health Insurance Protection Act, introduced by Warren, would force insurers that sell plans through Medicare Advantage and Medicaid to also sell plans on the Obamacare exchanges. Warren has said the government partnership offerings are lucrative for insurers, and that having her law in place would allow people to have more options for coverage, which would reduce prices and allow consumers to make choices based on hospitals or doctor networks.
3. Extend subsidies to people with higher incomes
Under Obamacare, people making more than 400 percent of the federal poverty level do not qualify for subsidies. That percentage equates to an income of $48,240 for an individual and $94,400 for a family of four. Whenever premiums rise, people who fall into this category feel the brunt of the increases and do not have the government assistance of lower-income people. Roughly 6.7 million people in the U.S. do not receive premiums, the majority of whom buy their coverage off exchange. Under a bill by Harris, Warren and Democratic Sens. Dianne Feinstein, D-Calif., Patrick Leahy, D-Vt., Tammy Baldwin, D-Wis., and Maggie Hassan, D-N.H., people would pay no more than 9.69 percent of their income for medical coverage.
4. Extend subsidies to young people
Baldwin’s Advancing Youth Enrollment Act would give higher federal subsidies to people between the ages of 18 to 34 so that the cost of private Obamacare plans for them would be lower. Under the proposal, young adults would see the maximum percentage of income they must pay toward health insurance under Obamacare decrease by 2.5 percentage points for people between the ages of 18 to 30. Each year after, until the age of 34, they would see a gradual phaseout of 0.5 percentage points a year. Young, healthy people are a highly-coveted group in health insurance because they help to spread out risk and lower costs.
5. Fund reinsurance
Providing reinsurance dollars is one area both parties have indicated they would support. A reinsurance bill was introduced in the fall by Sens. Ben Nelson, D-Fla., and Susan Collins, R-Maine, and gained some support, but failed to be included in the omnibus spending bill because of language that would have prohibited government funds from paying for abortions. Reinsurance allows for the government to pay for much of the medical claims of the sickest, most costly enrollees, which brings down the costs of premiums for everyone who is covered. Obamacare used to include reinsurance, but by law it expired in 2016 because costs had been expected to fall.
