Progressives believe that revisions to the ACA would not substantially improve health insurance. Centrists believe Medicare for All is fiscally unsustainable and could lead to unforeseen outcomes. Guess What! They both might be right.
Questions for Centrists: State health exchange markets created by the Affordable Care Act provides health insurance to roughly 5 percent of the working-age population. Employer-based health insurance remains the dominant provider of health insurance to this segment of the population. Do you favor reforms that would substantially expand the role of state exchanges in providing health insurance to more workers, especially workers at small firms? Would you acknowledge that a reform program that modestly increases the role of state exchanges but leave employer-based insurance as the dominant health insurance market will have a relatively modest impact on health insurance problems?
Many people have inadequate health insurance. Many health insurance policies have high deductibles and high out-of-pocket limits. Many health insurance policies only provide benefit in a narrow geographic area have narrow networks and often do not cover services rendered by an out-of-network provider working in an in-network facility. These problems with existing health care plans leave many people with unanticipated health care debt, cause some people to reduce retirement savings and cause other people to forego necessary medical procedures and prescribed medicines. What does your health plan do to improve coverage for people who currently have a comprehensive health plan?
Questions for Progressives:
The Medicare for All bill is entirely tax financed. Under Medicare for All, health care expenditures directly impact the budget. How would this program be insulated from budgetary pressures?
- The Medicare for All bill creates a universal Medicare care trust fund? What is the purpose and what are the limitations of this trust fund? Have there been simulations of the long-term solvency of the universal health care trust fund?
- Would general tax revenue and funds raised from bonds be automatically used to cover health care expenditures if funds in the trust fund did not cover all benefits?
- Won’t future Congresses consider adjustments to health care expenditures and provider compensation rates based on the annual budget? Shouldn’t Congress be more concerned about the overall deficit and the trend of the debt to GDP limit than the status of the trust fund?
- Could the Secretary of HHS in a fiscally conservative Administration reduce benefits and compensation rates?
- What would happen to Medicare for All benefits when there is a government shut down or a debt limit problem? Who gets paid first people who need health care or people who own government debt?
The current bill exempts Medicare for All from the Hyde amendment. What would prevent a future Administration and Congress from applying the Hyde Amendment to Medicare for All; thereby eliminating all insurance payments for abortion services?
People who want to learn more about how these issues are playing out in the 2020 contest should go here.