Members of Congress today unveiled two major efforts to overhaul the current Affordable Care Act health insurance rules.
Sen. Bernie Sanders, an independent from Vermont who caucuses with the Democrats, launched a version of the Medicare for All bill, which would create a completely government-run system for providing health insurance in the United States.
(Related: Single-Payer Takes Spotlight)
Sanders introduced the single-payer health finance bill with support from 16 Democratic cosponsors: Tammy Baldwin of Wisconsin; Richard Blumenthal of Connecticut; Cory Booker of New Jersey; Al Franken of Minnesota; Kristen Gillibrand of New York; Kamala Harris of California; Martin Heinrich of New Mexico; Mazie Hirono of Hawaii; Patrick Leahy of Vermont; Edward Markey of Massachusetts; Jeff Merkley of Oregon; Brain Schatz of Hawaii; Jeanne Shaheen of New Hampshire; Tom Udall of New Mexico; Elizabeth Warren of Massachusetts; and Sheldon Whitehouse of Rhode Island.
Over on the other side of the aisle, Sen. Lindsey Graham, R-S.C., launched a new version of H.R. 1628, the Republicans' Affordable Care Act change bill, together with Bill Cassidy of Louisiana; Dean Heller of Nevada; and Ron Johnson of Wisconsin.
Graham and Cassidy also brought in Rick Santorum, a Republican who represented Pennsylvania in the Senate, and a note from Alan Greenspan, a former Federal Reserve chairman.
Supporters of the Medicare for All bill have posted a package of documents, including a copy of the text of the bill and description of possible funding mechanisms, here.
Supporters of the Graham-Cassidy-Heller-Johnson have posted a package of documents related to the launch of their bill here.
Political analysts are not expecting either the Medicare for All team or the Graham-Cassidy team to have much luck with getting its proposal through Congress in time to have any effect on health coverage in 2018, but either package, or both, could shape future legislation.
The Medicare for All bill launch video (Video: Sanders)
The Affordable Care Act itself, for example, is made up partly of proposals that showed up in Congress for many years before they actually became law.
For a look at five points from the Medicare for All bill that might interest insurance agents and brokers, and five points of interest from the Graham-Cassidy bill, read on.
Medicare for All
Sanders and other bill supporters say they based their new bill on earlier Medicare for All bills introduced by Rep. John Conyers Jr., D-Mich.
The bill would:
1. Provide complete coverage for all medically necessary acute care and short-term care, including dental, vision and audiology care. It would not cover long-term care, but it would require states to spend at least as much on long-term care services as they do now.
2. Eliminate all cost-sharing for medically necessary care other than up to $200 in out-of-pocket costs per year for prescription drugs.
3. Ban the sale of private health insurance that duplicated Medicare for All program coverage. An insurer could, however, still cover services that were not medically necessary, such as cosmetic surgery.
4. Encourage patients to protest discrimination on the basis of "race, color, national origin, age, disability, or sex, including sex stereotyping, gender identity, sexual orientation, and pregnancy and related medical conditions" by filing lawsuits in any district court of the United States having jurisdiction over the parties.
5. Raise revenue for the program partly by:
Charging employers 75% of what they are currently paying for health benefits, or 7.5% of payroll, whichever was higher.
Charging families 4% of income for coverage.
Eliminating the current group health tax exclusion.
Raising marginal tax rates on households earning more than $250,000 per year, to a maximum of 52% of income for income over $10 million.
Taxing capital gains and dividends the same as income from work.
Capping itemized deductions at 28% for households making over $250,000 per year.
Expanding the estate tax, and increasing the tax rate to 55% for an estate with a value over $50 million, with a special 10% surtax for an estate with a value in excess of $500 million, or $1 billion for a married couple. That means the total estate tax for a billionaire couple could be 65%.
Getting rid of "grantor retained annuity trusts," or GRATs, and other types of trusts and valuation techniques now used to minimize estate taxes.
Imposing a 1% annual wealth tax on households in the top 0.1% in terms of wealth. (If the tax took effect today, it would apply to households with more than $21.5 million in wealth.)
Change rules that help some taxpayers avoid the current Affordable Care Act 3.8% Medicare surtax and the ACA net investment tax.
The Graham-Cassidy-Heller Johnson bill launch video (Video: Graham)
Sanders said in the bill launch video that Congress has to help Americans get covered.
"Our idea is to do what every other major country on earth is doing, and that is to guarantee health care to all people as a right, not a privilege,' Sanders said.
The Graham-Cassidy-Heller-Johnson Bill
Graham gave the Sanders Medicare for All bill a back-handed compliment today when he launched his own alternative.
He said the current problems in the individual health insurance market are giving advocates of a government-run, single-payer health insurance system momentum.
Graham said he believes a single-payer health insurance system would hurt the quality of care.
"There are three choices," Graham said. "Prop up Obamacare, Berniecare, or our bill. That's where you're at."
Graham introduced the bill together with Bill Cassidy of Louisiana, who has actively courted the support for Health Agents for America.
The Graham-Cassidy bill would:
1. Eliminate the Affordable Care Act provisions that effectively require some individuals to own major medical coverage and some employers to offer coverage.
2. Leave the ACA public health insurance exchange program in place.
3. Kill the current ACA cost-sharing reduction subsidy program, which helps low-income ACA exchange plan users pay their deductibles, coinsurance amounts and co-payments, and replace it, the premium tax credit subsidy and the ACA reinsurance program with new block grants for states, with the total amount starting at $136 billion in 2020 and rising to $200 billion by 2026.
4. Leave out the multi-state association health plan programs seen in some ACA change bills and proposals.
5. Kill many ACA taxes, such as the medical device tax, but leave in many other ACA taxes, such as the tax on highly paid health insurance company executives, the ACA 3.8% Medicare surtax and the ACA net investment tax.
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