Kaiser Family Foundation Analyzes Health Care Expansion Proposals As policymakers debate next steps for expanding health insurance coverage and lowering health costs, some have introduced legislation that would broaden the role of public programs, such as Medicare and Medicaid. In light of recent characterizations of such proposals, the Kaiser Family Foundation (KFF) assessment of what these bills do (and do not do) is particularly important. In the past two years, eight proposals were introduced, ranging from bills that would create a new national health insurance program for all U.S. residents, replacing virtually all other sources of public and private insurance (Medicare-forAll), to more incremental approaches that would create a new public plan option as a supplement to private sources of
coverage and public programs. KFF analyzed these eight legislative proposals, highlighting the implications for consumers, health care providers and payers, employers, states, the federal government, and taxpayers. Key policy differences relate to eligibility, the size and scope of the public plan, covered benefits and cost sharing, premiums, subsidies for premium and cost sharing, cost containment strategies, and the likely interactions with current public programs and private sources of coverage. The proposals also vary in their level of detail; some bills, according to their sponsors, are intended to serve as blueprints for reform, and are expected to
include greater specificity over time. Although these bills are unlikely to advance in the current Congressional session; they illustrate the range of options that will likely serve as prototypes for legislation that may introduced in the future. The public plan proposals fall into four general categories: Two proposals would create Medicare-For-All, a single national health insurance program for all U.S. residents. (Sen. Sanders, S.1804; Rep. Ellison, H.R. 676); Three proposals would create a new public plan option, based on Medicare, that would be offered to individuals and some or all employers through the Affordable Care Act marketplace. (The Choice Act
by Rep. Schakowsky, H.R. 635, and Sen. Whitehouse, S. 194); The Medicare-X Choice Act by Sen. Bennett, S. 1970, and Rep. Higgins, H.R.4094; and the Choose Medicare Act by Sen. Merkley, S. 2708 and Rep. Richmond, H.R. 6117); Two proposals would create a Medicare buy-in option for older individuals not yet eligible for the current Medicare program. (Sen. Stabenow, S. 1742; Rep. Higgins, H.R. 3748); and One proposal would create a Medicaid buy-in option that states can elect to offer to individuals through the ACA marketplace. (Sen Schatz, S. 2001 and Rep. Luján, H.R. 4129). Read the KFF issue brief for more information about each of these proposals.
New Medicare Advantage and Part D Plan Landscape Reveals Challenges Ahead In late September, the Centers for Medicare & Medicaid Services (CMS)—the federal agency that oversees the Medicare program—released an overviewof the upcoming year in Medicare Advantage (MA) and the Part D prescription drug program. Among the notable inclusions, CMS expects more people to join MA plans than ever before, shows a sharp increase in the number of plans available, and reveals the number of plans that will offer expanded supplemental benefits. In 2018, approximately one third of all people with Medicare were enrolled in MA plans. Determining whether MA is the right choice for any beneficiary’s individual circumstances can be a very complicated decision, and we remain concerned that many people with Medicare do not have easy access to all of the tools and information they need
to make those decisions. Previous research has made clear that people with Medicare often do not end up in the best plan for their needs, which can mean they spend more than they should or may even face having to switch doctors to stay in the plan’s network. Unfortunately, this difficulty will be worse due to the proliferation of MA plans and the new, complicated offerings that people will need to wade through. The CMS overview shows an increase from 3,100 MA plans offered nationally to 3,700, with over 91% of beneficiaries having to choose between 10 or more plans. In addition, CMS is allowing MA plans new flexibilities to offer certain supplemental benefits. While we support increasing the benefits people with Medicare receive from the
program, CMS has not provided enough guidance to ensure these benefits are explained thoroughly to people who might choose to enroll. We predict that many beneficiaries and their families will be confused by the number of options and will not get the proper support to make the best choice for their circumstances. One valuable resource is the State Health Insurance Assistance Program (SHIP). Each state or territory has a SHIP where beneficiaries can receive unbiased, on-on-one counseling to help them choose the best options. There is also good news in the overview: MA and Part D plan premiums have gone down slightly and access to both types of plans will be widespread. This means that beneficiaries who would benefit from these offerings will have access to
them. But premiums going down is not the whole story. Many people with Medicare struggle to afford their out-ofpocket costs, especially for their needed medications. We urge CMS to ensure that people with Medicare have access to the best tools and information to make important decisions about their coverage options.
Read the 2019 Medicare Advantage and Part D Prescription Drug Program Landscape. Find your local SHIP. Read more about our concerns with CMS guidance for MA and Part D plans.
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