Senator Bernie Sanders, an Independent from Vermont, speaks during a campaign rally for Senator Tammy Baldwin, a Democrat from Wisconsin, not pictured, in Milwaukee, Wisconsin, U.S., on Monday, Oct. 22, 2018. Sanders visited Wisconsin as part of a nine-state swing with to give a boost to progressive candidates ahead of the November 6 midterm elections. Photographer: Daniel Acker/Bloomberg Sen. Bernie Sanders, Independent-Vt. (Photo: Daniel Acker/BB)

Sen. Bernie Sanders has released the new version of his Medicare for All bill.

The Vermont independent has been introducing Medicare for All bills for years, and he is continuing to seek a broad transformation of the U.S. health care finance system.

If Sanders’ “Medicare for All Act of 2019″ bill were adopted and implemented as written, and worked as Sanders expects, it would replace all commercial major medical insurance, Medicaid, Medicare, dental insurance, vision insurance, short-term care insurance and long-term care insurance with a government-run health plan that would be much richer than most European single-payer health care systems, with a maximum of $200 per year in cost-sharing.

(Related: How Might ‘Berniecare’ Work?)

Sanders has also proposed that, during a three-year period, ordinary commercial health insurance, Medicare Advantage plans and Medicare supplement  insurance would still exist.

When Donald Trump became president, he and his appointees suddenly became responsible for managing health insurance under the framework Barack Obama and other former presidents had created.

Sanders’ transitional period coverage rules raise the question: What might Bernie Sanders’ (or other Medicare for All advocates’) version of the current Trumpcare framework look like?

Here are some possibilities, drawn from Sanders’ new proposal.

1. Consumers could sign up for traditional Medicare earlier.

Title X of the Sanders bill would create a transitional Medicare buy-in option.

Sanders would lower the buy-in eligibility age to 55 effective Jan. 1 of the first year following the date of enactment; 45 effective Jan. 1 of the second year after enactment; and 35 effective Jan. 1 of the third year after enactment.

A consumer who was eligible for the early Medicare buy-in program could choose between signing up for traditional Medicare coverage or for signing up for Medicare Advantage plans with prescription drug coverage.

Sanders would classify Medicare coverage as minimum essential coverage, or solid major medical coverage, for purposes of applying the Affordable Care Act (ACA) individual shared responsibility penalty.

Consumers could use ACA premium tax credit subsidies to pay for the Medicare buy-in coverage.

2. Sanders would, briefly, let officials at the U.S. Department of Health and Human Services (HHS) talk to people at health insurance companies.

Sanders mentions workers’ compensation carriers briefly.

He refers private health insurers only a few times.

He talks about private health insurers once in connection with efforts to set up the transitional Medicare buy-in program.

“In promulgating regulations to implement this section, the Secretary shall consult with interested parties, including groups representing beneficiaries, health care providers, employers, and insurance companies,” according to the text at the end of bill Section 1001.

3. Sanders would have the administrator of the Centers for Medicare and Medicaid Services (CMS) take a  simple, direct approach to holding down drug costs.

Sanders suggests that the CMS administrator should drug to negotiate drug prices with the drug makers.

If the administrator couldn’t do that, the administrator ought to set the reimbursement rate at either the amount the U.S. Department of Veterans Affairs pays for drugs or the rate a Medicaid plan would pay, whichever was less, according to bill Section 1002.

4. Sanders would cap Medicare out-of-pocket costs.

Even during the three-year transitional period, Sanders would cap a Medicare enrollee’s Medicare Part A hospitalization and Medicare Part B physician and outpatient services out-of-pocket costs at $1,500 per year, according to bill Section 1011.

The bill would set the Medicare Part A and Medicare Part B deductibles at zero, immediately.

5. Sanders would have Medicare start covering dental care and vision care.

Bill Section 1013 would immediately delete the Social Security Act provisions that keep Medicare from covering dental and vision services.

6. Issuers of Medicare supplement insurance policies would have to sell the policies on a guaranteed issue basis.

An insurer can now apply medical underwriting to people who apply for Medicare supplement (Medigap) insurance after their Medigap open enrollment period.

Sanders would ban Medigap medical underwriting.

Bill Section 1015 would prohibit an insurer from considering health status, claims experience, receipt of health care or medical condition when issuing or pricing Medigap coverage.

7. Private health insurance could exist.

Sanders would not impose any immediate changes on commercial health coverage during the transition period.

His bill’s main commercial health coverage provision, Section 1021, focuses on issues related to continuity of care for people who start out with private health coverage.

He says the HHS secretary must ”ensure that all individuals enrolled in, or who seek to enroll in, a group health plan, health insurance coverage offered by a health insurance issuer… are protected from disruptions in their care during the transition period.”

To provide that protection, the HHS secretary “shall consult with communities and advocacy organizations of individuals living with disabilities and other patient advocacy organizations to ensure the transition described in this section takes into account the continuity of care for individuals with disabilities, complex medical needs, or chronic conditions,” according to the bill text.

Resources

More information about the new Sanders Medicare for All Act bill is available here.

— Read Democrats Unveil `Medicare for All’ Billon ThinkAdvisor.

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