Analysis of the 2022 Senate Medicare-for-All legislation

From PNHP: What’s in the Bill? Benefits: Covers all medically-necessary services including primary and preventive care, mental health care, reproductive care including abortion (with a ban on the Hyde Amendment), vision and dental care, prescription drugs, and home- and community-based long-term services and supports. Patient Choice: Provides full choice of any participating doctor or hospital. Providers may not dual-practice within and outside the Medicare system. Patient Costs: Provides first-dollar coverage without premiums, deductibles, or copays for medical services, and prohibits balance billing. Does require small copays for some brand-name prescription drugs. Eligibility: Covers everyone residing in the U.S. regardless of immigration status. Cost Controls: Prohibits duplicative coverage, negotiates drug prices with manufacturers, and funds hospitals through global operating budgets. Timeline: Provides for a four-year incremental transition to Medicare for All. What’s different in this year’s version? The 2022 bill includes some major improvements from the 2019 version, bringing it closer to the PNHP’s gold standard as established by the Physicians Proposal. Global budgeting of hospitals and other institutional providers: Global budgets would fund hospitals with annual lump sum payments which can be used for patient care — not for profits, advertising, or executive bonuses — with separate funding for capital projects. PNHP estimates that global budgets would save $220 billion per year; they would also prevent hospital closures by providing facilities in rural and other underserved communities with stable funding, which can be quickly supplemented during public health emergencies. Global budgets also promote health equity by funding services and capital projects based on community health needs (i.e., mental health, obstetrics, and HIV care), not what’s most profitable for hospitals (i.e., elective surgeries). Standardized fee-for-service payments to providers: Establishes a national fee-for-service schedule for individual and group providers, similar to language in the House bill (H.R. 1976). Expanded benefits: Provides transportation for seniors with functional limitations, and expands mental health care by covering licensed marriage and family therapist and licensed mental health counselor services. Office of Health Equity: Establishes an Office of Health Equity to monitor and eliminate health disparities, and promote primary care. How could the bill be improved? Cover all long-term care (LTC): While community-based LTC supports would be covered by Medicare for All, institutional LTC remains within Medicaid, preserving the state-based variations that contribute to inequities, injustice, and complexity. PNHP recommends moving all LTC services into Medicare for All. Shorten transition period: The four-year transition period gradually expands Medicare’s benefits and lowers the eligibility age, along with a “buy in” scheme that includes commercial Medicare Advantage plans. The transition period is needlessly complex, delays access to care for the most vulnerable patients, and could exacerbate inequalities. PNHP recommends a one-year transition. Eliminate prescription drug costs and strengthen price negotiations: While drug co-pays are lower than the 2019 bill, even modest cost-sharing is a proven barrier to care. PNHP recommends eliminating all patient cost-sharing. While the bill does authorize Medicare to negotiate drug prices, it lacks certain safeguards if negotiations fail, such as direct procurement of drugs. PNHP recommends competitive drug licensing, direct procurement of drugs, and other safeguards if price negotiations fail. Ban (and buyout) investor-owned health facilities: This bill does not explicitly ban for-profit health facilities and agencies, which provide lower-quality care at higher costs than nonprofits. PNHP recommends an orderly conversion of investor-owned, for-profit providers to not-for-profit status.