Medicare for All

Medicare for All / en Sat, 26 Apr 2025 18:52:43 -0500 Fri, 06 Sep 19 10:40:00 -0500 Resources for September 10, 2019, AHA Advocacy Day Briefing .row { padding-top: 20px; } Among other issues, they discussed protecting patients from surprise medical bills while opposing rate-setting as the solution; preserving payments for legitimate differences between care sites and resisting additional "site-neutral" cuts; and delaying the Medicaid Disproportionate Share Hospital program cuts. Below are resources available to AHA members to assist you in conversations with your lawmakers. &nbsp; Your browser does not support the video tag. <div class="container"> <div class="row"> <div class="col-md-3"> <a href="/system/files/media/file/2019/09/aha-rpb-message-card-2019.pdf"><img alt="Message Card for Meetings on Capitol Hill thumbnail" data-entity-type="file" data-entity-uuid="d061640b-83a9-4972-9cf2-3b7e23721047" src="/sites/default/files/inline-images/thumbnail-message-card-300x388.jpg" width="300" height="388"></a> </div> <div class="col-md-3"> <a href="/system/files/media/file/2019/10/packet-surprise-billing-1019.pdf"><img alt="Factsheets and Talking Points on Surprise Billing Legislation thumbnail" data-entity-type="file" data-entity-uuid="a8452646-764c-4137-9fec-a4a328e77de8" src="/sites/default/files/inline-images/thumbnail-surprise-billing-packet-300x388.jpg" width="300" height="388"></a> </div> <div class="col-md-3"> <a href="/system/files/media/file/2019/09/fact-sheet-medicaid-dsh-0919.pdf"><img alt="Factsheet on Medicaid DSH thumbnail" data-entity-type="file" data-entity-uuid="3332f4cb-0060-4c52-8585-719ea7fd39af" src="/sites/default/files/inline-images/thumbnail-fact-sheet-medicaid-dsh-300x388.jpg" width="300" height="388"></a> </div> <div class="col-md-3"> <a href="/system/files/media/file/2019/09/fact-sheet-site-neutral-0919.pdf"><img alt="Factsheet Site-neutral Payment Provisions thumbnail" data-entity-type="file" data-entity-uuid="d6fa7818-9ace-4f2d-994a-cc35289ad145" src="/sites/default/files/inline-images/thumbnail-fact-sheet-site-neutral-provisions-300x388.jpg" width="300" height="388"></a> </div> </div> <hr> <div class="row"> <div class="col-md-3"> <a href="/system/files/media/file/2019/09/fact-sheet-medicare-for-all-0919.pdf"><img alt="Factsheet Medicare for All thumbnail" data-entity-type="file" data-entity-uuid="e29d5ff7-6379-4516-b67e-e74b973b10fe" src="/sites/default/files/inline-images/thumbnail-fact-sheet-medicare-for-all-300x388.jpg" width="300" height="388"></a> </div> <div class="col-md-3"> <a href="/system/files/media/file/2019/09/rural-advocacy-agenda-0919.pdf"><img alt="Rural Advocacy Agenda thumbnail" data-entity-type="file" data-entity-uuid="f497c2ee-4996-4a2e-a38f-144f9f9be460" src="/sites/default/files/inline-images/thumbnail-rural-advocacy-agenda-300x388.jpg" width="300" height="388"></a> </div> <div class="col-md-3"> <a href="/system/files/media/file/2019/09/special-bulletin-cms.pdf"><img alt="Special Bulletin on CMS’s Hospital OPPS Proposed Rule for 2020 thumbnail" data-entity-type="file" data-entity-uuid="17bfb993-dbf2-458e-9ae7-f29e5beb43b8" src="/sites/default/files/inline-images/rpb-doc-thumbnails-special-bulletin-opps.jpg" width="300" height="388"></a> </div> </div> <hr> <div class="row"> <div class="col-md-3"> <a href="/system/files/media/file/2019/09/guide-working-with-congress-2019.pdf"><img alt="A Guide to Working with Congress – Building Strong Relationships with Your Lawmakers thumbnail" data-entity-type="file" data-entity-uuid="7f5f8c68-0236-4bf8-b548-ee3b2dab5921" src="/sites/default/files/inline-images/thumbnail-congress-guide-300x388.jpg" width="300" height="388"></a> </div> <div class="col-md-3"> <a href="/system/files/media/file/2019/09/senate-areas-of-jurisdiction-2019.pdf"><img alt="Committees of the U.S. Senate – Areas of Jurisdiction thumbnail" data-entity-type="file" data-entity-uuid="6a6698b4-0b65-4196-8eba-2721040fffd3" src="/sites/default/files/inline-images/thumbnail-senate-jurisdiction-300x388.jpg" width="300" height="388"></a> </div> <div class="col-md-3"> <a href="/system/files/media/file/2019/09/house-areas-of-jurisdiction-2019.pdf"><img alt="Committees of the U.S. House – Areas of Jurisdiction thumbnail" data-entity-type="file" data-entity-uuid="a5d321a9-0ae4-4623-806a-6fa65cc8968a" src="/sites/default/files/inline-images/thumbnail-house-jurisdiction-300x388.jpg" width="300" height="388"></a> </div> </div> </div> Fri, 06 Sep 2019 10:40:00 -0500 Medicare for All Fact Sheet: Medicare for All <h2>The Issue</h2> “Medicare for All” these days – a catch-all label that has become a part of the political dialogue – represents a variety of health coverage proposals that would do everything from establish a national health insurance program with no competition to create a public, Medicare-like option for sale on the individual exchanges. While these proposals vary, they all could do more harm than good to patient care. <h2>AHA Position</h2> The AHA is committed to the goal of affordable, comprehensive health insurance for every American. However, “Medicare for All” is not the solution.&nbsp;The better path supporting access to health coverage for all Americans lies in continuing to build on the progress we’ve made in increasing coverage over the past decade. Alternative Solution -&nbsp;Better Care for America. Click below for more. Thu, 05 Sep 2019 14:05:52 -0500 Medicare for All Study: Half of rural hospitals could close under Medicare public option /news/headline/2019-08-07-study-half-rural-hospitals-could-close-under-medicare-public-option Offering a government insurance program reimbursing at Medicare rates as a public option on the health insurance exchanges could place as many as 55% of rural hospitals, or 1,037 hospitals across 46 states, at high risk of closure, according to an <a href="https://www.navigant.com/insights/healthcare/2019/the-potential-impact-of-a-medicare-public-option">analysis</a> released today by Navigant Consulting Inc. The authors estimate that 28% of rural hospitals would be at high risk of closure if only uninsured and current individual market participants shifted to the public option, and that more than half of rural hospitals would face high risk of closure if employers shifted 25% to 55% of their covered workers from commercial coverage to the public option. “To keep hospitals whole from the financial consequences of any of these scenarios, Medicare would have to increase hospital payment levels for a public option between 40% and 60% above present Medicare rates, costing between $4 billion and $25 billion annually (depending on the severity of the employer shift),” they said. Wed, 07 Aug 2019 15:06:34 -0500 Medicare for All House hearing on ‘Pathways to Universal Health Coverage’ /news/headline/2019-06-12-house-hearing-pathways-universal-health-coverage The House Ways and Means Committee today held a <a href="https://waysandmeans.house.gov/legislation/hearings/pathways-universal-health-coverage">hearing</a> on “Pathways to Universal Health Coverage,” which debated various options to expand access to health coverage, ranging from Medicare for All to improving existing coverage.&nbsp; &nbsp; In a <a href="/lettercomment/2019-06-12-aha-comments-medicare-all-house-ways-and-means-committee">letter</a> to committee Chairman Richard Neal (D-Mass.), AHA said, “America’s hospitals and health systems are committed to the goal of affordable, comprehensive health insurance for every American and believe we should build upon and improve our existing system to increase access to coverage and comprehensive health benefits. However, we have concerns with ‘Medicare for All’ and believe that the variety of proposals that often are used interchangeably under that name are not the solution. … The better path to achieving comprehensive coverage for all Americans lies in continuing to build on the progress made over the past decade.” &nbsp; For example, the letter notes AHA support for efforts to expand Medicaid in non-expansion states; provide federal subsidies for more lower- and middle-income individuals and families; reinstitute funding for marketplace cost-sharing subsidies and reinsurance mechanisms; and robust efforts to enroll consumers in coverage. &nbsp; Ranking Member Kevin Brady, R-Texas, also expressed concern with Medicare for All. &nbsp; “Since doctors and hospitals lose money on nearly every treatment they provide in Medicare, experts predict that Medicare-for-All will cause a chronic shortage of doctors, and hospital overcrowding will be an epidemic,” he said. &nbsp; Testifying at the hearing were a patient advocate and representatives from Manatt Health, the Washington Health Benefit Exchange, Institute for Healthcare Improvement, Galen Institute and Kaiser Family Foundation. &nbsp; Wed, 12 Jun 2019 14:25:54 -0500 Medicare for All AHA Comments on Medicare for All to House Ways and Means Committee /lettercomment/2019-06-12-aha-comments-medicare-all-house-ways-and-means-committee The �� Association appreciates the Committee holding this hearing on “Pathways to Universal Health Coverage.” America’s hospitals and health systems are committed to the goal of affordable, comprehensive health insurance for every American. and believe we should build upon and improve our existing system to increase access to coverage and comprehensive health benefits. However, we have concerns with “Medicare for All” and believe that the variety of proposals that often are used interchangeably under that name are not the solution. Wed, 12 Jun 2019 08:54:38 -0500 Medicare for All House holds hearing on CBO report on single-payer health system /news/headline/2019-05-22-house-holds-hearing-cbo-report-single-payer-health-system The House Budget Committee today held a <a href="https://budget.house.gov/legislation/hearings/key-design-components-and-considerations-establishing-single-payer-health-care">hearing</a> on the Congressional Budget Office’s recent report on key design components and considerations for policymakers interested in establishing a single-payer system. The <a href="/news/headline/2019-05-01-cbo-report-looks-policy-considerations-single-payer-health-system">report</a>, which did not analyze the budgetary effects of any specific bill or proposal, found that establishing a single-payer system would be a major undertaking that would involve substantial changes in the sources and extent of coverage, provider payment rates, and financing methods of health care in the United States. &nbsp; <a href="/news/headline/2019-02-27-medicare-all-bill-introduced-house">Rep. Pramila Jayapal</a>, D-Wash., and <a href="/news/headline/2019-04-10-sanders-unveils-medicare-all-bill">Sen. Bernie Sanders</a>, I-Vt, have each introduced legislation called Medicare for All that would establish a national health insurance program to provide universal coverage to U.S. residents. Reps. Rosa DeLauro, D-Conn., and Jan Schakowsky, D-Ill., also have introduced <a href="/news/headline/2019-05-03-house-senate-bills-would-expand-medicare-more-americans">legislation</a>&nbsp;called Medicare for America that would create a national health insurance program for most Americans. Among others, Sens. Chris Murphy, D-Conn., Jeff Merkley, D-Ore., and Dianne Feinstein, D-Calif., have introduced legislation that would allow Americans to buy Medicare coverage on the state and federal exchanges, and employers to cover their employees through a Medicare plan. &nbsp; In <a href="/testimony/2019-05-22-aha-statement-key-design-components-and-considerations-establishing-single">comments</a> submitted for the hearing, AHA said, “America’s hospitals and health systems are committed to the goal of affordable, comprehensive health insurance for every American. However, ‘Medicare for All’ is not the solution. Instead, we should build upon and improve our existing system to increase access to coverage and comprehensive health benefits.” Wed, 22 May 2019 15:21:37 -0500 Medicare for All AHA Statement on Key Design Components and Considerations for Establishing a Single-Payer Health Care System /testimony/2019-05-22-aha-statement-key-design-components-and-considerations-establishing-single The Honorable John Yarmuth Chairman Committee on Budget United States House of Representatives 204-E Cannon House Office Building Washington, DC 20515 &nbsp; Dear Chairman Yarmouth, &nbsp; On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners – including more than 270,000 affiliated physicians,&nbsp;2 million nurses and other caregivers – and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) appreciates the Committee holding this hearing on the Congressional Budget Office’s&nbsp;(CBO) Key Design Components and Considerations for Establishing a Single-Payer Health Care System. &nbsp; America’s hospitals and health systems are committed to the goal of affordable, comprehensive health insurance for every American. However, “Medicare for All” is not the solution. Instead, we should build upon and improve our existing system to increase access to coverage and comprehensive health benefits. &nbsp; Our detailed comments follow. &nbsp; THE IMPORTANCE OF HEALTH COVERAGE &nbsp; Meaningful health care coverage is critical to living a productive, secure and healthy life.&nbsp;Studies confirm that coverage improves access to care; supports positive health outcomes, including an individual’s sense of their own health and wellbeing; incentivizes appropriate use of health care resources; and reduces financial strain on individuals and&nbsp;families.i&nbsp;&nbsp;Coverage has broader community benefits as well, from ensuring adequate resources to maintaining critical health care infrastructure to being associated with decreased crime. We, therefore, appreciate Congress’ focus on opportunities to close the remaining coverage gaps and achieve comprehensive health coverage for every&nbsp;American. &nbsp; Despite recent coverage gains, approximately 9 percent of the U.S. population remains uninsured, a number that has increased over the past two years. The remaining uninsured tend to be young adults, disproportionately Hispanic, and workers in lower-income jobs. Many of the uninsured are likely eligible for but not enrolled in subsidized coverage, including through Medicaid, the Health Insurance Marketplaces or their employers. For example, millions of the lowest income uninsured could be covered if all states expanded Medicaid. &nbsp; MAY 2019 CBO REPORT&nbsp; &nbsp; We appreciate the CBO looking at the possible components of a single-payer system and their potential impact on health care in the United States. As the report makes clear, establishing a single-payer system would be a “major undertaking that would involve substantial changes in the sources and extent of coverage, provider payment rates, and financing methods of health care in the United States.”&nbsp; &nbsp; The report notes there are several potential ways that providers could be paid under a single-payer system, including fee-for-service, bundled payments, global budgets or capitated payments. The report also notes there are multiple ways payments could be determined, including administered rates and negotiated rates. The report raises the point that this change in provider payments would have “important implications” for “providers’ revenues.” We detail additional information on the potential impact to hospitals and health systems below. &nbsp; Similar to considerations raised in the report, we believe close attention needs to be paid to payments that are made to hospitals that have a higher percentage of low-income patients and to graduate medical education (GME) payments. This funding provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations and provide critical community services, such as trauma and burn care. Additionally GME funding ensures there are an adequate supply of well-trained physicians. &nbsp; The CBO report details possible implications of paying providers Medicare rates in a single-payer system and states “such a reduction in provider payment rates would probably reduce the amount of care supplied and could also reduce the quality of care.”&nbsp;The instability of changes to the health care system with a “Medicare for All” type system could have the unintended impact of jeopardizing access to care for everyone. We would urge caution in moving forward with any system that would decrease availability of care or add to the length of time for availability of service – particularly in rural or undeserved areas. &nbsp; GOVERNMENT-RUN, SINGLE-PAYER MODEL IS THE WRONG APPROACH &nbsp; While the AHA shares the objective of achieving health coverage for all Americans, we&nbsp;do not agree that a government-run, single-payer model is right for this country. Such&nbsp;an approach would upend a system that is working for the vast majority of Americans,&nbsp;and throw into chaos one of the largest sectors of the U.S. economy. &nbsp; Indeed, payment under existing public programs, including Medicare and Medicaid, historically reimburse providers at less than the cost of delivering services. For example,&nbsp;Medicare paid only 87 cents for every dollar spent by hospitals caring for Medicare patients in 2017 – a shortfall of $53.9 billion. Chronic underpayment can lead to access issues for seniors as some providers, especially physicians, may limit the number of&nbsp;Medicare patients they take or stop seeing them altogether. Indeed, hospitals and health systems only are able to stay open today to the extent commercial coverage makes up for the losses sustained providing care to beneficiaries of public programs.&nbsp;Congress’ own advisory group, the Medicare Payment Advisory Commission&nbsp;(MEDPAC), reported in its March 2018 report that hospitals had a negative 9.6 percent&nbsp;Medicare margin in 2016, on average, and projects that hospital Medicare margins will decline to negative 11 percent in 2018, the lowest such margin ever recorded. &nbsp; Results from a recent study give some idea of the financial impact a single-payer program based on Medicare rates could have on the health care system. The study found that a proposal to create a government-run, Medicare-like health plan on the individual exchange could create the largest ever cut to hospitals – nearly $800 billion – and be disruptive to the employer-sponsored and non-group health insurance markets, while resulting in only a modest drop in the number of uninsured as compared to the 9 million Americans who would gain insurance by taking advantage of building upon the existing public/private coverage framework. This coverage proposal would enroll significantly fewer people than a single-payer model, and yet the reimbursement cuts would be catastrophic. &nbsp; Even if the proposed single-payer program increased reimbursement rates above&nbsp;Medicare’s rates, our members’ experience suggests that the government does not always act as a reliable business partner. Delays in payment and retroactive changes to reimbursement policies leave providers at risk of inadequate payment. Politicization means that providers cannot always trust that the rules of today will be the rules of tomorrow, which presents a challenging – if not impossible – environment for large, complex organizations. Recent examples of the uncertainty of working with government include the defunding of critical elements of the Health Insurance Marketplaces, including outreach and education, and raids on the Medicare and Medicaid programs to offset spending on other priorities. &nbsp; We also are deeply concerned that a single-payer model would seriously distract from the important delivery system reform work underway. Hospitals and health systems have invested billions of dollars in technology and delivery system reforms to improve care, enhance quality and reduce costs. Moving to a single-payer model could stymie these efforts by, at best, diverting attention and, at worst, being deemed irrelevant if the government can simply ratchet down provider rates to achieve spending objectives. &nbsp; Finally, moving to a single-payer model would be highly disruptive not only to health coverage, but also to the broader economy. Approximately 90 percent of Americans are currently enrolled in comprehensive coverage with high rates of satisfaction. Not only would this move more than 250 million people into some new form of coverage, it could radically alter the coverage of the more than 55 million people currently enrolled in the Medicare program, including the tens of millions who have voluntarily opted to enroll in&nbsp;Medicare Advantage, which would no longer exist. &nbsp; WAYS TO PROMOTE BETTER CARE FOR AMERICA &nbsp; Health coverage is too important to risk such levels of disruption. The better path to achieving comprehensive coverage for all Americans lies in continuing to build on the progress made over the past decade. To advance our objective of covering all&nbsp;Americans, we support: &nbsp; <ul> <li class="MsoNormal">Continued efforts to expand Medicaid in non-expansion states, including providing the enhanced federal matching rate to any state, regardless of when it expands. This would give newly expanded states access to three years of 100 percent federal match, which would then scale down over the next several years to the permanent 90 percent federal match. </li> <li class="MsoNormal">Providing federal subsidies for more lower- and middle-income individuals and families. Many individuals and families who do not have access to employer-sponsored coverage earn too much to qualify for either Medicaid or marketplace subsidies and yet struggle to afford coverage. This is particularly true for lower-income families who would be eligible for marketplace subsidies except for a “glitch” in the law that miscalculates how much families can afford. We support both expanding the eligibility limit for federal marketplace subsidies to middle-income families and fixing the “family glitch” so that more lower-income families can afford to enroll in coverage. </li> <li class="MsoNormal">Strengthening the marketplaces to improve their stability and the affordability of coverage by reinstituting funding for cost-sharing subsidies and reinsurance mechanisms and reversing the expansion of “skinny” plans that siphon off healthier consumers from the marketplaces, driving up the cost of coverage for those who remain. &nbsp;</li> <li class="MsoNormal">Robust enrollment efforts to connect individuals to coverage. The majority of the uninsured are likely eligible for Medicaid, subsidized coverage in the marketplace or coverage through their employer. We need an enrollment strategy that connects them to – and keeps them enrolled in – coverage. This requires adequate funding for advertising and enrollment efforts, as well as navigators to assist consumers in shopping for and selecting a plan.</li> </ul> &nbsp; We also must ensure the long-term sustainability of Medicare, Medicaid and other programs that so many Americans depend on for coverage.&nbsp; &nbsp; CONCLUSION &nbsp; The AHA appreciates the Committee holding this hearing and we look forward to working with Congress on this important issue. We believe we should come together and build upon and improve our existing system to increase access to coverage and comprehensive health benefits. &nbsp; i �� Association, “The Importance of Coverage,” November 2018./system/files/media/file/2019/04/report-coverage-overview-2018.pdf Wed, 22 May 2019 09:04:42 -0500 Medicare for All CBO report looks at policy considerations for single-payer health system /news/headline/2019-05-01-cbo-report-looks-policy-considerations-single-payer-health-system Establishing a single-payer system would be a major undertaking that would involve substantial changes in the sources and extent of coverage, provider payment rates, and financing methods of health care in the United States, according to a <a href="https://www.cbo.gov/publication/55150">report</a> released today by the Congressional Budget Office. The report focuses on key design components and considerations for policymakers interested in establishing a single-payer system, but “does not address all of the issues that the complex task of designing, implementing and transitioning to a single-payer system would entail, nor does it analyze the budgetary effects of any specific bill or proposal,” CBO notes. Among other topics, the report includes high-level discussions about hospital ownership, provider employment and payment rates, but does not make any recommendations. &nbsp; Wed, 01 May 2019 15:25:26 -0500 Medicare for All House holds hearing on Medicare for All /news/headline/2019-04-30-house-holds-hearing-medicare-all The House Rules Committee today held a <a href="https://rules.house.gov/hearing/hr-1384-medicare-all-act-2019">hearing</a> on the Medicare for All Act of 2019. <a href="/news/headline/2019-02-27-medicare-all-bill-introduced-house">Introduced</a>&nbsp;in February by Rep. Pramila Jayapal, D-Wash., the <a href="https://www.govinfo.gov/content/pkg/BILLS-116hr1384ih/pdf/BILLS-116hr1384ih.pdf">legislation</a> would establish a national health insurance program, make it unlawful for a private health insurer or employer to provide the same benefits as the new program, and pay for hospital services under a global budget, among other provisions. &nbsp; In a <a href="/testimony/2019-04-30-aha-statement-house-rules-committee-re-medicare-all-act-2019">statement</a> submitted for the record, AHA said, “America’s hospitals and health systems are committed to the goal of affordable, comprehensive health insurance for every American. However, ‘Medicare for All’ is not the solution. Instead, we should build upon and improve our existing system to increase access to coverage and comprehensive health benefits.” &nbsp; Testifying at the hearing were witnesses from the Center for Popular Democracy, Center for Economic and Policy Research, Commonwealth Fund, National Medical Association, Galen Institute and Mercatus Center, and a physician advocate for a national health insurance program. Tue, 30 Apr 2019 14:42:58 -0500 Medicare for All Statement of the AHA for the Committee on Rules of the U.S. House of Representatives “Medicare for All Act of 2019” /lettercomment/2019-04-30-statement-aha-committee-rules-us-house-representatives-medicare-all-act On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners – including more than 270,000 affiliated physicians, 2 million nurses and other caregivers – and the 43,000 health care leaders who belong to our professional membership groups, the �� Association (AHA) appreciates the opportunity to submit for the record our comments on the Medicare for All Act of 2019 and other proposals to expand access to health coverage through a government-run, single-payer program. America’s hospitals and health systems are committed to the goal of affordable, comprehensive health insurance for every American. However, “Medicare for All” is not the solution. Instead, we should build upon and improve our existing system to increase access to coverage and comprehensive health benefits. Our detailed comments follow. <h2>The Importance of Health Coverage</h2> Meaningful health care coverage is critical to living a productive, secure and healthy life. Studies confirm that coverage improves access to care; supports positive health outcomes, including an individual’s sense of their own health and wellbeing; incentivizes appropriate use of health care resources; and reduces financial strain on individuals and families.1 Coverage has broader community benefits as well, from ensuring adequate resources to maintaining critical health care infrastructure to being associated with decreased crime. We therefore appreciate Congress’ focus on opportunities to close the remaining coverage gaps and achieve comprehensive health coverage for every American. Despite recent coverage gains, approximately 9 percent of the U.S. population remains uninsured, a number that has increased over the past two years. The remaining uninsured tend to be young adults, disproportionately Hispanic, and workers in lowerincome jobs. Many of the uninsured are likely eligible for but not enrolled in subsidized coverage, including through Medicaid, the Health Insurance Marketplaces or their employers. Millions of the lowest income uninsured could be covered if all states expanded Medicaid. <h2>Government-run, Single-payer Model Is the Wrong Approach</h2> While the AHA shares the objective of achieving health coverage for all Americans, we do not agree that a government-run, single-payer model is right for this country. Such an approach would upend a system that is working for the vast majority of Americans, and throw into chaos one of the largest sectors of the U.S. economy. Indeed, payment under existing public programs, including Medicare and Medicaid, historically reimburse providers at less than the cost of delivering services. For example, Medicare paid only 87 cents for every dollar spent by hospitals caring for Medicare patients in 2017 – a shortfall of $53.9 billion. Chronic underpayment can lead to access issues for seniors as some providers, especially physicians, may limit the number of Medicare patients they take or stop seeing them altogether. Indeed, hospitals and health systems only are able to stay open today to the extent commercial coverage makes up for the losses sustained providing care to beneficiaries of public programs. Congress’ own advisory group, the Medicare Payment Advisory Commission (MEDPAC), reported in its March 2018 report that hospitals had a negative 9.6 percent Medicare margin in 2016, on average, and projects that hospital Medicare margins will decline to negative 11 percent in 2018, the lowest such margin ever recorded. Results from a recent study give some idea of the financial impact a single-payer program based on Medicare rates could have on the health care system. The study found that a proposal to create a government-run, Medicare-like health plan on the individual exchange could create the largest ever cut to hospitals – nearly $800 billion – and be disruptive to the employer-sponsored and non-group health insurance markets, while resulting in only a modest drop in the number of uninsured as compared to the 9 million Americans who would gain insurance by taking advantage of building upon the existing public/private coverage framework. This coverage proposal would enroll significantly fewer people than a single-payer model, and yet the reimbursement cuts would be catastrophic. Even if the proposed single-payer program increased reimbursement rates above Medicare’s rates, our members’ experience suggests that the government does not always act as a reliable business partner. Delays in payment and retroactive changes to reimbursement policies leave providers at risk of inadequate payment. Politicization means that providers cannot always trust that the rules of today will be the rules of tomorrow, which presents a challenging – if not impossible – environment for large, complex organizations. Recent examples of the uncertainty of working with government include the defunding of critical elements of the Health Insurance Marketplaces, including outreach and education, and raids on the Medicare and Medicaid programs to offset spending on other priorities. We also are deeply concerned that a single-payer model would seriously distract from the important delivery system reform work underway. Hospitals and health systems have invested billions of dollars in technology and delivery system reforms to improve care, enhance quality and reduce costs. Moving to a single-payer model could stymie these efforts by, at best, diverting attention and, at worst, being deemed irrelevant if the government can simply ratchet down provider rates to achieve spending objectives. Finally, moving to a single-payer model would be highly disruptive not only to health coverage, but also to the broader economy. Approximately 90 percent of Americans are currently enrolled in comprehensive coverage with high rates of satisfaction. Not only would this move more than 250 million people into some new form of coverage, it could radically alter the coverage of the more than 55 million people currently enrolled in the Medicare program, including the tens of millions who have voluntarily opted to enroll in Medicare Advantage, which would no longer exist. <h2>Ways to Promote Better Care for America</h2> Health coverage is too important to risk such levels of disruption. The better path to achieving comprehensive coverage for all Americans lies in continuing to build on the progress made over the past decade. To advance our objective of covering all Americans, we support: <ul> <li>Continued efforts to expand Medicaid in non-expansion states, including providing the enhanced federal matching rate to any state, regardless of when it expands. This would give newly expanded states access to three years of 100 percent federal match, which would then scale down over the next several years to the permanent 90 percent federal match.</li> <li>Providing federal subsidies for more lower- and middle-income individuals and families. Many individuals and families who do not have access to employersponsored coverage earn too much to qualify for either Medicaid or marketplace subsidies and yet struggle to afford coverage. This is particularly true for lowerincome families who would be eligible for marketplace subsidies except for a “glitch” in the law that miscalculates how much families can afford. We support both expanding the eligibility limit for federal marketplace subsidies to middleincome families and fixing the “family glitch” so that more lower-income families can afford to enroll in coverage.</li> <li>Strengthening the marketplaces to improve their stability and the affordability of coverage by reinstituting funding for cost-sharing subsidies and reinsurance mechanisms and reversing the expansion of “skinny” plans that siphon off healthier consumers from the marketplaces, driving up the cost of coverage for those who remain.</li> <li>Robust enrollment efforts to connect individuals to coverage. The majority of the uninsured are likely eligible for Medicaid, subsidized coverage in the marketplace or coverage through their employer. We need an enrollment strategy that connects them to – and keeps them enrolled in – coverage. This requires adequate funding for advertising and enrollment efforts, as well as navigators to assist consumers in shopping for and selecting a plan.</li> </ul> We also must ensure the long-term sustainability of Medicare, Medicaid and other programs that so many Americans depend on for coverage. <h2>Conclusion</h2> While we agree with the Committee that there is more work to be done, we believe we should come together and build upon and improve our existing system to increase access to coverage and comprehensive health benefits. <hr /> 1. �� Association, “The Importance of Coverage,” November 2018. <a href="/system/files/media/file/2019/04/report-coverage-overview-2018.pdf">/system/files/media/file/2019/04/report-coverage-overview-2018.pdf</a> Tue, 30 Apr 2019 13:56:37 -0500 Medicare for All