During the October 15th, 2019, Democratic debate in Ohio, Senator Elizabeth Warren was asked to explain how she would pay for her Medicare for All Healthcare plan.
As a committed supporter of Senator Kamala Harris, I was hoping Harris would have the opportunity to talk about her Medicare-for-All proposal – alas, it did not happen that night.
Except for three significant differences, the Harris Medicare-for-All Healthcare plan is the closest to the Sanders M4A plan and, in my opinion, provides a more logical transition to true Universal Healthcare that’s more likely to be supported by a majority of voters.
To be clear: the Harris plan is not a “Medicare for all who want it” plan. It’s a public government single-payer Universal Healthcare Plan.
With all the phrases and slogans floating around during the primary, there has been a common assumption among some Democratic voters that only Senators Sanders and Warren are proposing a “real” Medicare-for-All plan.
As you read on, you’ll see why this is not true.
You’ll also notice I do not mention details on the Warren Healthcare plan.
The reason is simple: Senator Warren doesn’t offer details on her healthcare plan that I can compare to plans proposed by Harris or Sanders.
Some assume Warren’s plan is essentially the same as Sanders’ M4A however I don’t want to make that assumption without proof.
History: The Phrase “Medicare-for-All” Dates Back To Ted Kennedy’s 2006 Bill
Though Medicare-for-All has become a slogan most associated with the Sanders campaign, the actual phrase dates back to the “Medicare-for-All Act” that Ted Kennedy and John Dingell introduced in 2006.
Also keep in mind, Senator Ted Kennedy started introducing plans for National Healthcare as far back as 1971.
Kamala Harris’ Medicare-for-All plan has some features in common with the Kennedy-Dingell plan while building upon aspects of the current Medicare system for a more seamless transition to full Universal Healthcare.
The 35-Word Elevator Pitch for The Harris Plan:
An expansion of the current Medicare system providing everyone with healthcare either through the new public Medicare system or the option to choose a Medicare plan offered by heavily-regulated private insurers within the Medicare system.
The 3 Significant Differences Between The Harris & Sanders Plan:
1. Unlike the Sanders plan, the Harris plan has a higher threshold for tax increases starting with households earning $100,000 plus she has committed to a $2 federal fee imposed on every $1,000 trade transaction made by investors and big banks.
The Sanders plan increases taxes starting with households earning $29,000 and proposes that Wall Street “pays their fair share” yet offers no specifics about imposing a fee on Wall Street trades.
2. The Harris Plan has a 10-year transition period to full, single-payer Universal Healthcare thus avoiding many of the same problems encountered with the ACA/Obamacare 4-year transition.
The Sanders plan allows for a 4-year transition.
3. The Harris Plan allows for heavily-regulated, private insurers to offer Medicare plans within her Medicare-for-All system.
This means, if an individual voluntarily chooses a private insurer plan approved under Harris’ Medicare-for-All system, the federal government pays the private company to insure them.
By allowing private insurers a role, the Harris plan provides individuals with a choice and has the potential to provide employers and unions with negotiating options for private group plans within the Medicare-for-All system.
The Sanders plan eliminates all private insurance plans except for elective/cosmetic treatment not offered under his M4A plan.
Will I need a Medigap/Supplemental Insurance Plan Under the Harris or Sanders Medicare-for-all plans?
No. A resounding no.
Both the Harris and Sanders Medicare-for-All plans entirely eliminate the need for the type of Medigap/Supplemental plans offered to seniors under the Medicare system as we know it today.
Currently, Medicare only covers 80% of seniors’ approved healthcare costs leaving the remaining 20% to be paid out of pocket or through a Medigap/Supplemental policy seniors can purchase from a private insurer to cover that 20% gap.
Under the plans proposed by Harris and Sanders, Medicare-for-All will cover 100% of approved healthcare costs with very few exceptions.
By eliminating the 20% gap, current Medigap/Supplemental plans offered by private insurers become obsolete.
Quick Note: Current Medicare Advantage plans are completely different from Medigap/Supplemental Plans.
Those too young to be eligible for the current Medicare system often confuse private insurer Medicare Advantage plans with Medigap/Supplemental plans.
They’re completely difference plans:
- Medigap/Supplemental Plans cover the 20% “gap” created by traditional Medicare (Parts A, B and D) that we currently have. As a result, seniors who choose traditional Medicare often purchase a private Medigap/Supplemental plan to cover the 20% gap.
- Various Medicare Advantage plans (Part C) currently available from private insurers cover the 20% gap in one plan and other benefits. As a result, seniors who opt for a Medicare Advantage plan do not need to purchase a Medigap/Supplemental plan.
Keep in mind, with a Medicare Advantage plan the Federal government pays the private insurer on a per-member, per-month basis to insure seniors who voluntarily choose Medicare Advantage (Part C).
If talk of Medicare Parts A, B, C and D sounds confusing it’s because it is. However, with a Medicare-for-All system in place, it’s safe to say Parts A, B, C and D will likely go away.
Why does the Harris plan allow for Medicare plans from private insurers within her single-payer government plan?
People like to have choices. The best proof is the rapidly-growing popularity of private insurer plans like Medicare Advantage among seniors.
In 2019 alone, 34% of seniors eligible for Medicare have opted for a Medicare Advantage plan from a private insurer.
The Congressional Budget Office (CBO) estimates that Medicare Advantage enrollment will to continue to grow over the next 10 years to approximately 47% of seniors.
While the Sanders plan completely bans private insurance companies under his M4A system (except private plans for elective/cosmetic care), the Harris Plan allows private insurers to have a government-regulated role within her Medicare system.
As Harris wrote in her July 2018 Medium.com piece:
“Essentially, we would allow private insurance to offer a plan in the Medicare system, but they will be subject to strict requirements to ensure it lowers costs and expands services. If they want to play by our rules, they can be in the system. If not, they have to get out.”
In my opinion, since the Harris Medicare-for-All plan greatly expands Medicare benefits, it’s highly likely that, even given the ability to choose a private-insurer plan, the majority of people will choose the public plan.
Since the Harris Plan allows private insurers, will we have the same issues related to current private-insurer Medicare Advantage plans?
The short answer: No. Because, under the Harris Plan, there is no need for the current types of Medicare Advantage plans.
Whatever plans private insurers would be able to offer within the Harris Medicare-for-All system are yet to be known.
However, it’s hard to imagine what benefits private insurers might offer that won’t be included in her public plan.
With that said, it’s worth mentioning the cause of the current issues with Medicare Advantage plans: the trump Bipartisan Budget Act.
Signed into law on February 9, 2018 (before the 2018 midterms in November), it includes more flexible CMS rules that allow Medicare Advantage plans from private insurers a truly unfair advantage over traditional Medicare while generating profits for these companies.
Though the Harris plan allows a role for private insurers, what we currently know as Medicare Advantage becomes obsolete along with all the loopholes.
Add to this, under the Harris Medicare-for-All plan, private insurers who qualify to participate within Medicare will be far more heavily regulated, and held to much stricter consumer protection standards, than they are today.
How Does The Harris Plan Expand the Current Public Medicare System?
Harris’ plan provides every individual in the U.S. with access to comprehensive healthcare with zero deductibles and zero co-pays.
Her plan expands the current Medicare system to cover services like:
- Dental, vision and hearing aids
- Mental health and substance abuse treatment
- Comprehensive reproductive healthcare services
- Comprehensive Maternal & Child healthcare to reduce deaths particularly among women and children of color
- Meaningful Healthcare Reform for Rural Areas
- Empowers the Secretary of Health to negotiate lower prescription costs for participants to help ensure prices are comparable to other countries
How Does Kamala Harris Pay For Her Medicare-for-All Plan?
Senator Harris supports all of the options proposed by Senator Sanders except one: Sanders’ proposal to tax households making $29,000 and above an additional 4% income-based premium.
As Kamala Harris has said, “I believe this hits the middle class too hard. That’s why I propose that we exempt households making below $100,000, along with a higher income threshold for middle-class families living in high-cost areas.
To pay for this specific change, I would tax Wall Street stock trades at 0.2%, bond trades at 0.1%, and derivative transactions at 0.002%. Think of it like this: that’s a $2 fee on a $1,000 trade by investors and big banks. I would also end foreign tax shelters by taxing offshore corporate income at the same rate as domestic corporate income.”
See: https://kamalaharris.org/medicare-for-all/
Why is Harris’ 10-Year Transition Plan Better Than Sanders’ 4-Year Transition Plan?
The longer 10-year transition period helps to lower the costs of the full transition to Universal Healthcare while avoiding many of the problems encountered with the ACA/Obamacare 4-year transition.
How Harris’ 10-Year Transition Works:
- On day one, the uninsured and newborns are automatically enrolled into Medicare-for-All. (For newborns, there will be an opt-out provision for families who keep employer-sponsored insurance during the 10-year transition.)
- Employers can continue to provide private health coverage to employees during the 10-year transition. Or, employers can take the opportunity to provide healthcare for employees through the Medicare Transition Plan, with a shared responsibility payment. Employees will also have the option on their own to buy into the Medicare Transition Plan during the transition period.
- Union workers will have the option to join Medicare-for-All during the 10-year transition period, or continue working with their employers to offer a private Medicare plan option (or supplemental benefits in addition to the Medicare plan).
- Seniors will be able to keep their current Medicare with immediate coverage for dental, vision, hearing aids and other additional benefits not currently covered by traditional Medicare.
- Individuals and families currently in Federally-designated programs (such as Medicaid or the Affordable Care Act exchanges) can transition into Harris’ Medicare Transition Plan and get enhanced benefits with limited cost-sharing requirements and financial assistance for those who qualify based on income.
Senator Harris sums up her Medicare-for-All proposal as follows:
“At the end of the ten-year transition, every American will be a part of this new Medicare system. They will get insurance either through the new public Medicare plan or a Medicare plan offered by a private insurer within that system.
Seniors will see stronger Medicare benefits than they have now. We will cover millions more people who don’t have health insurance today. And we will reduce costs, save our country money, and ensure that no American has to sacrifice getting the care they need just because the cost is a barrier.” medium.com/...
In closing, I’ve done my best to make apples-to-apples comparisons and show the three (3) main differences between the Harris Plan and the Sanders Plan.
Still, it’s important to note that the end point for both of their plans is single-payer Universal Healthcare.
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Primary Sources:
https://kamalaharris.org/healthcare/
https://kamalaharris.org/medicare-for-all/
https://www.sanders.senate.gov/download/options-to-finance-medicare-for-all?inline=file
Other Sources:
https://www.washingtonpost.com/opinions/2019/07/30/despite-what-sanders-says-harris-may-have-best-claim-medicare-for-all/
https://www.kff.org/medicare/fact-sheet/medicare-advantage/
https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp