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Medicare Extra for All - My Questions

White papers on health policy are seldom cause for me to get excited. As a rule, they are statements of principle, lacking the specifics of how exactly you implement it.

Not so with Center for American Progress's Medicare Extra for All plan, which was released yesterday. My first thought is that if you actually want to achieve universal coverage, there is nothing in this plan you could possibly strongly oppose. Much of the plan is a requirement of how you move from our current state to a world that, if not single-payer, is nearly publicly-funded. I'm not going to go through the details - Charles Gaba did so already, much better than I could. Go and read the piece at CAP, and then Gaba's piece and then come back...

After reading both pieces, I still had a few questions about how it would work, which I thought I would ask here. Some are practical, some are political.

  1. How much will this cost? Unlike most single payer plans (cough...Bernie Sanders...cough), CAP doesn't try to claim that we can have all this great health care for free. Their plan is basically to get everybody currently paying for health care (states and employers) to contribute roughly the same amount into the new pool. The TrumpTaxScam would then be reversed, with some of the revenue raised going to pay for the rest. My gut is that this will work without assuming massive savings in the health system, but we'll await their analysis to know for sure.

  2. The plan states that private insurers won't be able to offer similar plans any more in the non-group market, but they will now be able to offer product to the same group via Medicare Choice. Will insurers support this? Will they be willing to continue in the existing, ACA-based non-group market during the rollout?

  3. My interpretation is that companies that don't offer benefits will have to start paying a tax that scales based on size; pawning these costs off only society will no longer be permitted. CAP should confirm how this will work, and how much revenue will be raised. I think corporations will be less than stridently opposed to this; they would love to be out of the health insurance game, while just paying tax at roughly the same rate.

  4. What limits will be placed on premium differences by age? Personal choices (i.e. smoking)? Location?

  5. Will there be a mechanism for handling people who switch between employer-sponsored plans and Medicare plans intra-year? I can say from personal experience, this is really annoying.

  6. Will those who want to change plans intra-year be able to? Given that all plans will be fairly standardized now, it seems that this would be possible without too much selection bias.

A lot more to come on this - hopefully this plan garners a lot of intention. It isn't entirely revolutionary (borrows from Rep. Conyers and Stark plans, among others), but it is the closest I've seen to something that holistically plans our insurance system, heading toward true universal access and coverage.

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