The good news is that Democrats are trying to expand public health insurance to more Americans. The bad news is they have almost a dozen plans to expand coverage with the word “Medicare” in the title, creating a rhetorical nightmare. So I created this helpful nomenclature to simply describe what the different plans do.
These three areas are not the only places plans differ, but they represent the most important policy disagreements over which much of the political debate will likely take place: Whether or not everyone will have access to the new program, whether or not private insurance will be allowed to continue to exist, and how cost sharing will be involved are the big differences among Democrats right now. Names aside, these are the details that matter.
Universal - Everyone can access it if they want
Limited - Only certain people due to age, income, location or employment arrangement are allowed to take part
Buy in - An individual or company would need to actively choose to use the program
Opt-out - If an individual did nothing they would be automatically enrolled in a new public insurance program, but they could do something to choose private insurance instead.
Only - The new Medicare program will be the only basic health insurance for people; private insurers would be forbidden from offering duplicate coverage.
Free at point of service care - No copays, coinsurance or deductibles for coverage benefits
Nominal cost sharing - Nominal co-pays for some services
Traditional cost sharing - Co-pays, deductibles, and/or coinsurance similar to current Medicare and many employer-based plans.
- HR 676, the Improved and Expanded Medicare for All, is Universal Medicare Only with Free at point of service care
- The Center for American Progress’s Medicare Extra for All is Universal Medicare Opt-out with traditional cost sharing
- Rep. Brian Higgins’ Medicare Buy-in Option Act is an age limited Medicare Buy-in with traditional cost sharing
Here are most of the current plans to expand public insurance, and almost all have a title of Medicare. By 2020 there are likely to be at least a half dozen more:
- The House “Improved and Expanded Medicare for All” bill
- Sen. Sanders' slightly different “Medicare for All” bill in the Senate
- Sen. Bennet and Sen. Tim Kaine’s “Medicare-X Choice”
- Rep. Brian Higgins’ Medicare Buy-in Option for people over 50
- Sen. Debbie Stabenow’s Medicare at 55
- Rep. Carol Shea-Porter’s Medicare You Can Opt Into
- The Center for American Progress’s “Medicare Extra for All”
- Sen. Jeff Merkley and Sen. Chris Murphy’s “Medicare Choice Act” which would create Medicare Part E.
- Jacob Hacker's slightly different Medicare Part E plan
- Gerard F. Anderson's and Hugh R. Waters' original, slightly different Medicare Part E(veryone)
- I was apparently the only one trying to prevent this linguistic madness when I gave my plan Medical Insurance and Care for All (MICA) a distinctive and easy acronym.