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February 23, 2018

'Medicare Extra': The new proposal for universal coverage from the think tank that 'foreshadowed' the ACA

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    The liberal Center for American Progress (CAP) on Thursday unveiled a new health reform proposal that would expand Medicare coverage to all U.S. citizens, while maintaining employer-sponsored coverage.

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    CAP has been closely aligned with the Democratic Party, and according to AP, a 2005 CAP proposal "foreshadowed" the Affordable Care Act (ACA). While the new proposal is more ambitious than what Democrats have embraced in the past, it is less sweeping than Sen. Bernie Sanders' (I-Vt.) "Medicare for All" plan, HuffPost reports.

    According to HuffPost, the proposal has very little chance of going anywhere in the current Republican-controlled Congress and White House, but industry observers say it could signal how Democrats—who have spent the last few years defending the ACA—could approach health reform in the 2020 presidential campaign.

    Plan details

    The proposal, called "Medicare Extra for All," would create a new public program similar to Medicare that would be open to all U.S. citizens. But Medicare Extra would offer more robust coverage that would include dental, hearing, and vision care, which currently are not covered under traditional Medicare. The proposal also would cover doctor and hospital visits, maternity care, prescription drugs, as well as no-cost preventive care, chronic disease care, and generic prescription drugs, and would give the government the authority to negotiate and set prices for each of those services.

    The proposal would eventually replace Medicaid and the ACA's exchange plans. Individuals enrolled through other federal programs—including traditional Medicare, TRICARE, Veterans Health Affairs, and the Federal Employees Health Benefits Program—would have the option to switch to Medicare Extra, but those federal insurance programs would remain in place.

    Insurers also would still be able to offer private coverage—called Medicare Choice—modeled on existing Medicare Advantage plans, and employers would still be able to work with private insurers to offer employer-sponsored coverage. Employees also would have the option of choosing Medicare Extra coverage, even if their employer continues to offer different coverage.

    CAP's plan does not include many financial details, but it envisions that low-income enrollees would not pay premiums or copays, while for others premiums and cost-sharing would be determined by income but premiums would not exceed 10% of their income.

    For providers, CAP estimated that payments would likely be lower than what commercial insurance currently pays, but higher than those offered by CMS. The CAP proposal stated, "For rural hospitals, these rates would be increased as necessary to ensure that they do not result in negative margins," adding, "For physicians, average rates for primary care would be increased by 20 percent relative to certain rates for specialty care on a budget neutral basis. This adjustment would correct Medicare's substantial bias in favor of specialty care at the expense of primary care."

    The proposal also would maintain and expand bundled payments for hospitals for 90-day episodes of care and include site-neutral payments.

    The proposal also does not include any cost projections, but the authors acknowledged that it would require a significant tax increase and could take up to a decade to fully implement (Cohn, HuffPost, 2/22; Baker, "Vitals," Axios, 2/22; Alonso-Zaldivar, AP/Chicago Tribune, 2/22; Sullivan, The Hill, 2/22; King, Washington Examiner, 2/22; Gregory, Health Exec, 2/22; Kliff, Vox, 2/23; Center for American Progress proposal, 2/22).

    Medicare 101: Cheat sheets for Parts A through D

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