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By Sarah Cliff and Dylan Scott Updated June 21, 2019 at 16:20 EDT Graphics by Javier Zaracin and Kristina Animashauna /; Photos via Getty Images
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Share Share All: We read 9 Democratic plans to expand health care. Here's how they work.
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Democratic candidates ran and won on the promise of providing all Americans with access to public health care. In the House of Representatives, the new Medicare-for-all bill has more than 100 co-sponsors, but there are still real divisions among Democrats. Some of the party's 2020 presidential candidates support the same salary, while others favor a higher salary. They will immediately begin to blur the differences in conversation.
For a more complete version of what Democrats think about insuring all (or at least more) Americans, check out half of the proposals in Congress, all of which offer different types of health care.
"The Democrats have taken care of health care," Hawaii Sen. Brian Schatz said last year. "We now control one house of Congress. We have the opportunity and the responsibility to show what we can do when we are in charge of both teams. It is our responsibility to listen to the experts and figure out the best way forward."
We've spent the month reading Congress' plans for expanding Medicare (and some for Medicaid expansion as well) and recommendations from major think tanks that play a major role in shaping liberal policy. We spoke to lawmakers and congressional staffers who wrote the plan, as well as policy experts who analyzed it.
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These plans are a set of ideas that Democrats will come up with as they combine their vision for the future of American health care. While the party cannot currently agree on a single plan, they have many options to choose from and many decisions to make.
The nine programs are in two categories. There are some that would replace private insurance and cover all Americans through the government. Then there are others that allow all Americans to buy public insurance (such as Medicare or Medicaid) if they choose, or continue to buy private insurance.
We learned that the plans appear to represent the majority of Americans participating in public health plans. All of them would give the government a bigger role in everything from setting health care costs to deciding what benefits are included in insurance plans. Experts say the entire bill could actually create a more efficient health insurance system to serve Americans with higher health care costs.
"If you're really sick and have a lot of addictions, it's not easy not to benefit from that money," says Karen Pollitz, a senior fellow at the Kaiser Family Foundation, who wrote a report comparing various Democratic expansion plans. public distribution.
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But the Democratic agenda is very different from how they tackle major decisions like expanded public health programs and drastic expansion of government. Some are eliminating private health insurance altogether, moving all Americans to the government, while others are still involved in companies that provide insurance for employees.
Some bills call for significant tax increases to pay for the benefit expansion, while others require those on public insurance to pay the costs.
And while Democrats are under no illusions that they will pass Medicare for-all in this Congress, they see the next two years as key to determining where consensus lies within the party. House Democrats have already heard about Medicare-for-all.
"We want the public to hear about this issue, we want to see movement on this issue," said one House aide working on the legislation. "The Senate is still Republican, but now Democrats have an opportunity to build support, hold a public debate and help bring this idea together and educate members," he said.
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Some Democratic plans cover all Americans, while others provide coverage for many but leave some people uninsured.
In a sense, this is a fundamental question. Even with the Affordable Care Act, 30 million Americans do not have health insurance. The left believes that health care is a human right, and mainstream Democrats are not behind them. The whole reason Democrats are willing to renew health care soon after the ACA is to solve this problem.
Medicare-for-all (Senate and House): Every American would have a government insurance plan after a minimum stage.
Medicare for America (DeLauro and Schakowsky): This health care program, informed by the work of the Center for American Development and Yale professor Jacob Hacker, will reach all people with chronic health conditions through health insurance. "Private and public—at least for the next few years. Ultimately, it plans to achieve a level of coverage similar to Medicare for All in Congress by enrolling all infants in a government health plan and taking steps to reduce the role of employer-provided insurance."
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Medicare and Medicaid buyouts (congressional plans): Millions of Americans could be covered, but experts don't expect the various buyouts to be universal. After all, they are still special programs.
A Better Life in America (Urban Institute's Linda Blumberg, John Holahan, and Stephen Zuckerman): This leftist plot among three Urban Institute colleagues is clear.
Global distribution system in an attempt to address certain political issues. However, according to Urban's estimates, this would reduce the number of uninsured by 16 million in the first year.
Much of the remaining uninsured would be undocumented immigrants. The plan's authors said the plan could be changed to accommodate those residents, but they don't think there will be the political will to do so.
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Democrats are divided on whether expanding Medicare should give way to employer-sponsored plans or eliminate them entirely.
About half of all Americans get health insurance through work, and different Democratic health care plans make different decisions about whether that will continue.
Currently, the US health system gives employers a lot of power to provide insurance: these benefits are completely tax-free. This means that corporate dollars are stretched more when they buy employee health benefits than when they pay workers wages.
However, it creates a level playing field. Fortune 500 companies are actually the biggest federal subsidy to insure their employees if the person doesn't get insurance through their job and makes a lot of money to get subsidies like the Affordable Care Act if the tax laws aren't handled properly.
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Medicare-for-all (Senate and House): The Medicare-for-all plan would make major changes and eliminate employer funding. That way, all Americans who get insurance from work would switch to the same government health plan.
Medicare for America: This program allows employers to continue providing coverage to their employees as long as they meet government standards. At the same time, it would give employers an attractive and simple option: stop providing insurance and instead pay a payroll tax equal to what they spend on health care.
The success of the program depends largely on how American providers offer this new Medicare program. Contributions will be made at around 10 percent of household income, while poorer families would pay less. Out-of-pocket costs would be set at $3,500 for an individual, $5,000 for a family, and low-income families would again get a break. It is not known how quickly these benefits will attract people to their work practices in the new Medicare program.
Medicare for America makes another policy decision that undermines employer-sponsored coverage: It automatically enrolls all infants in the public plan. This means that a new generation of Americans may not be covered by their parents' workplaces, and the ever-increasing number of employers who provide the Medicare program.
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The question of workplace insurance is a very important question in the purchase plan. Overall, the bill would allow most Americans to purchase a public health insurance plan under Medicare. Anyone who buys insurance in the individual market is eligible to buy a Medicare plan on every purchase bill.
But they differ significantly in how they allow people to opt out of their job insurance for the new state plan.
Medicare Select Act (Merkley and Murphy): Merkley explained that his bill, along with Murphy's, may be a path to single-payer Medicare. As part of Medicare purchases, employees can switch from their company's insurance to the new plan, but only if their employer decides to allow it. Otherwise, they would be imprisoned.
(However, the bill includes a provision that would allow workers to continue in the state program after enrollment, even after leaving the job.)
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We asked Merkley why they left the decision up to employers and not employees. He pointed to a successful workers' compensation program in Oregon that was presented similarly. He also worries about bad choices, employers who send sick workers
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