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Today the United States Senate is a study in contrasts: on the same day that one Senator introduces a bill seeking universal health insurance coverage, another pair of Senators introduce yet another bill to gut the Affordable Care Act and roll back insurance coverage for millions.

At one end of the spectrum, Senator Bernie Sanders is unveiling his Medicare for All bill, which seeks to provide comprehensive health insurance coverage for everyone in the country.  This, in part, is a recognition that millions of Americans remain uninsured, or underinsured, in our patchwork system of health insurance coverage.

At the other end of the spectrum, Senators Graham and Cassidy are unveiling the latest version of ACA “repeal and replace,” a last ditch effort before current budget reconciliation instructions expire at the end of the month, after which 60 votes (instead of 50 and a tie breaker by the Vice President) would be required for passage.  As we noted in last week’s Alert, Cassidy-Graham would have devastating consequences, including deep cuts to Medicaid, rolling back of crucial consumer protections, and millions of people losing coverage.      

We urge Congress to reject efforts to scale back gains in health coverage and instead look to ways that improve and expand on what we have now.  It’s time to move forward, not backward.

Drawing from the Center’s decades of experience serving Medicare beneficiaries, troubleshooting problems, and pushing for fixes, we are well acquainted with the Medicare program’s virtues as well as some of its drawbacks.  From our perspective, there are concrete steps that should be taken to ensure that the Medicare program better meets the needs of those that it serves – now and in the future.  In this vein, Judith A. Stein, Executive Director of the Center, recently wrote an op-ed published in The Hill called “Looking to Medicare as a model for health care coverage? Improve Medicare first.” (published on 9/8/17).  Here we present a slightly edited version:

In a September 2017 editorial, the New York Times reviewed proposals to improve health care coverage as efforts to repeal the Affordable Care Act (ACA) are stalled – at least for now. As noted in the editorial, “[t]he Republican campaign to repeal Obamacare, for all its waste of time and energy, has at least gotten people to talk seriously about proposals to improve the health care system.”

When looking to expand access to health care coverage, it’s natural to look to Medicare, the country’s well-tested, flagship health insurance program. Medicare is not only more cost-effective than private insurance, it’s also beloved by beneficiaries, their families, and the general public.  Thus, proposals presented by some would aggregate our current, multi-pronged coverage system into a single-payer model, which some call “Medicare-for-All.” Other proposals would allow people under age 65 to buy-into Medicare. 

Considering several of these proposals, a recent article in the New Republic asked: “[i]f the plan is to transition to something like Medicare-for-All, shouldn’t the strategy begin with making Medicare great?”

Yes! We agree, before moving more people into Medicare, it needs to be improved and simplified. With all of its virtues, Medicare also has flaws. There are still significant gaps in coverage – vision, hearing and routine dental, not to mention long-term care.  Traditional Medicare does not include a cap on out-of-pocket expenses or its own prescription drug benefit.  Medicare Advantage adds costs to the system and significantly limits enrollees’ provider choices. Assistance for low-income individuals is limited.  And, all too often, payment and quality measures lead many providers to prematurely terminate, or avoid providing medically necessary care entirely, for people with longer-term, chronic and debilitating conditions.

Traditional Medicare must include the same benefits and the same limits on cost-sharing as private Medicare Advantage. People who choose traditional Medicare ought to have the same cap on out-of-pocket costs and the same “one-stop-shopping” opportunities as people in private Medicare Advantage. Like their counter-parts in Medicare Advantage, people who choose traditional Medicare should be able to obtain prescription drug coverage without having to purchase a separate Part D plan. If supplemental, Medigap insurance continues to be necessary to help with cost-sharing, it should be available and affordable for all people with Medicare, including people with disabilities and pre-existing conditions, which it is not the case in many states.

As health policy discussions (hopefully) turn towards expanding, rather than contracting, health coverage, the Center for Medicare Advocacy will work to improve Medicare for all those it currently serves, and may serve in the future. This is a critical first step before adopting Medicare as a basis for health coverage expansion.  

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