I’ve spoken with many concerned constituents over the past few weeks about what measures I will take if the Trump-led Republican efforts to repeal the Affordable Care Act (ACA) are successful. The health of millions of Americans is at risk as an estimated 29.8 million Americans will lose their insurance and nearly 36,000 will die yearly as a result of the ACA repeal.
As a national leader on health care reform, many people will look to Massachusetts for solutions to America’s impending health care crisis. Some people have suggested that we should implement a Massachusetts version of the ACA – similar to our 2006 health care law – but that wouldn’t fix the growing burden of rising health care costs for families, businesses, and municipalities.
Each and every legislative session, we have several bills before the legislature aiming to increase affordability and access to health care services. Some of the bills try to expand subsidies so that low-income populations have access to health care, while others aim to improve regulations to prevent health insurance companies from denying people the coverage they are entitled to under their health plans.
Although these are all good proposals, they will not fix affordability and accessibility issues as long as we have a profit-driven health care model because the billion-dollar health care industry will continue to find ways to skirt any patchwork laws we pass. Health care insurance lobbyists spend hundreds of millions of dollars each year to find ways to satiate their shareholders, and they will continue to look for loopholes that will maximize their profit at the expense of working families.
That’s why we need a comprehensive overhaul of our health care system, one that will shift the focus from caring about shareholders to caring about quality patient care, and that’s why I refiled my “Medicare for All” bill for the 2017-18 legislative session.
This bill will establish a health care system in Massachusetts that will guarantee that every resident will have access to affordable, high quality health care with choice of provider, while also saving money for families, businesses, and municipalities by reducing waste, lowering administrative costs, and eliminating the pursuit of profits.
With this health care reform, small businesses would be able to grow without having to keep up with rising employee premiums, employees would have the opportunity to move freely between jobs without fear of losing health insurance, and many families would not be faced with the stress of paying for health insurance or paying for other necessities of life like food and housing.
Moving to a “Medicare for All” system will help us achieve the health care reform goals that many of us share, including universal coverage, controlling costs, reducing medical debt and medical bankruptcy, and simplifying our delivery system.
We deserve a health care system where all people can get the care they need to maintain and improve their health when they need it regardless of income, age, or socio-economic status, and I urge all residents to join me in fighting for “Medicare for All.”
What can we do as your constituents and supporters to help make this a reality?
through a 10-10.44% payroll tax (divided between the employer and employee and exempting the first 30k of payroll per employer), a 10% tax on “unearned income,” an undetermined transfer from the general fund, and receipt of federal funding. Is there a fiscal analysis that shows the specific amounts expected from each source? How much of the solvency of this proposal is dependent on the assumption that the Trust will be more efficient than current health insurance companies?
VT passed similar legislation that loosely defined the benefits and funding sources of a single pay system, but then the whole proposal fell apart when it was time for the specifics. I understand this is a proposal that would certainly be tweaked through the legislative process, but can the “high quality” and “expanded” health care really be delivered with a realistic estimation of savings, specified funding sources, federal funding, and transfers from the general fund?
because VT didn’t want to piss off hospitals by leveraging the full size of the system to negotiate for the lower prices on procedures, etc.
A single payer system won’t save much dough if it operates like the existing system.
So, no, it didn’t ‘fall apart’ at the specifics. It fell apart because a lot of the powerful interests in VT that were on board at the start — including hospitals and doctors — weren’t going to continue to stay on board if it meant hurting their interests, and VT residents were getting sticker shock with a policy that didn’t take the hospitals on.
The policy at that point was stuck between a rock and a hard place.
The sad thing is that the policy still would have saved money for most VT residents (while providing true universal access), but most people have some weird cognitive dissonance freakout when they see big tax numbers and aren’t taking the time to calculate how much money it would have saved over their premiums.
But, yeah, we shouldn’t do a single payer system in MA if we’re not willing to create a system that allows the single pool to flex its muscles and negotiate lower prices.
Their expectation, based in part in prior performance, is that the taxes will go up, and then the premiums will creep up to where they were, resulting in more total out-of-pocket. That’s not cognitive dissonance, it’s mistrust in future outcomes.
There’s a lot of misinformation out there about the Vermont experience. It was set up to fail from the beginning and then they dropped it in order to avoid any sort of difficult political discussions. People regularly post here about how it can’t work anywhere if it couldn’t work in VT – but that’s looking at the end result without understanding the real experience.
My argument was that it wasn’t a failure of politics but a failure of policy. An argument with which argue disagrees above, but even if he is right, Partners will be a bigger beast to tame than the sole health care provider in VT that agreed to nationalization at the start of the process.
MA is a wealthier state with a more complex health care delivery system. This could make it a better guinea pig-but I would rather we contain costs via an all payer systems like MD supplemented with an opt-in public option. I could see rolling out those policies simultaneously without causing the disruptions the VT experiment caused. I also think NY and CA are better markets for a trial run.
That said Sen. Eldridge knows this has no chance of passage and introduces this at the start of every term to move the debate forward. Much as Conyers and Dingell did in the House. I applaud him for it and would co-sponsor and vote for this proposal were I in the legislature. The status quo is not enough, and too many legislators think Romneycare is the end point rather than the midpoint.
Some insurers were left in place as well as self covering businesses.
I think this is the wrong fight at this time for a number of reasons. Here are just a few reasons to start:
First, This is a non-starter. For many reasons having to do with state politics at many levels, from Beacon Hill to the health care industry, to the medical profession, to all the tech industries (med devices, pharma, biotech) that support health care, to widespread popular anti-tax sentiments, and much more, this isn’t going anywhere. And all it would do, if it got any traction at all, is divide a lot of forces that need to be united against Trump’s and/or the Republican Congress’s cynical plans on healthcare for the foreseeable future.
Second, to whit, the ACA (ObamaCare), which provides needed health care for tens of millions nationwide is seriously threatened by Trump and the Republican Congress. Despite some issues, MA is a leader in showing how well the ACA can work, even when the Republicans were trying to starve it of funds and fixes over the last several years. If MA were to even try to pull out, this would be used by Repubs as evidence that even the most liberal states don’t want it. We need to be fighting FOR the ACA for the foreseeable future, not against it.
Third, Medicare seems about to come under unprecedented attack and to be targeted for privatization. Per the above, we need to have everyone working together and to be focused on fighting to preserve and strengthen Medicare.
Fourth, Per the Medicare (and related Medicaid) battles that loom, not to mention the endless battles that have been fought around these now for two generations, public funding of health care services (just like other publicly funded services in America) is a very tendentious proposition (and even increasingly so in nations that have been happily doing it this way since day one). Public funding is inherently a political football because it represents huge amounts of money, which strain state and federal budgets. Can you imagine what the Republican congress would have been doing and now planning to do to a single payer system if we currently had one? Health care services would be in perpetual disarray, unable to count on consistent public/political support.
Fifth, Going it alone is not a viable strategy on a state-by-state basis, especially at a time when Trump and the Republican Congress are looking to vastly reduce all sorts of federal funding that states have relied on for decades. The huge uncertainties in budgeting for a lone-state single payer system in this environment alone will foreclose any real consideration of such an approach.
Sixth, as alluded to above, single payer systems do not magically solve most of the major issues facing health care systems. Every single health care system in the world to which we often compare ourselves is struggling with major issues of uneven quality and unsustainable cost pressures. The comparisons that show US health care much worse than many Western countries is only because the South (really the original Confederate states) has health care problems that are equivalent to “third world” levels. These have to do with a variety of cultural issues, social determinants of health (poverty, poor schooling, poor housing, etc.) and with these states being controlled by legislators and leaders who have no interest in providing or improving health care services for large portions of their populations.This greatly skews our national statistics. Most of the rest of the country, with the exception of some underserved rural areas, has outcomes equal to or better than any other western country.
Seventh, the solutions to health care access, quality and cost issues here in the US, because of our particular history and experience in this sector, will continue to be addressed by working to bring to bear the strengths of both the public and private sectors. This is what the ACA is designed to do, by requiring and subsidizing coverage and by moving the financing system to one that pays for improved outcomes (better health!) rather than episodes of care. Much of the rest of the world has, in fact, been hoping that the ACA is on to something, because they are all looking for mechanisms to rein-in unsustainable cost increases for care with maintaining and improving quality, which their mostly publicly financed systems are increasingly unable to adequately address. For more on this see my essay in Medium on why ObamaCare should not be repealed or replaced:
https://medium.com/@jonsax/why-obamacare-should-not-be-repealed-and-or-replaced-275d627ed094#.ssvzbstx9
From the bill: Health care spending per person in Massachusetts is higher than in any other state, and therefore higher than in any other country in the world.
The ACA is just the implementation of our state’s plan in many ways, a plan originally conceived by the Heritage Foundation, that relies on citizens being required to purchase health insurance from corporations that have a fiduciary obligation to return a profit to the shareholders.
You can’t keep costs down when you have have middleman and shareholders all wanting their “take”.
MA has always had very high costs because of factors preceding the ACA, in particular, the dominance of just a few major health care provider organizations.These are not for-profit enterprises and do not return profits to any shareholders. This is one of the many things that would not change just because you changed who was paying the bills.
And the need for the requirement for everyone to have insurance is the only way to have a system that can have a chance to pay for itself, especially if, in the case of the US now under the ACA, you no longer allow insurers to make their money by denying and delaying care and cherry-picking healthy subscribers. The need for everyone to contribute is why single-payer systems require everyone to pay taxes to share and cover the costs of care.
Allow for the public option and put a cap on profits for the corporations that want a piece of this, private insurance will die on the vine, and that’s okay with me.
Prior to the passage of the Ma Health Care Law, 94% of residents were covered, now being somewhere between 96 to 98%. It was not the heavy lift that other states face. Mississippi e.g.
The legislature went with the least likely plan to bring universal care at the lowest cost. Dr. William Hsaio was engaged to make the report, and took no fee, using it to hire a staff to help with the report.
If you don’t want to read the whole study, I believe there is a summary at the end.
http://www.leg.state.vt.us/jfo/healthcare/FINAL%20REPORT%20Hsiao%20Final%20Report%20-%2017%20February%202011_3.pdf
…but I think your third point could be construed as an argument for exactly the opposite. In other words, the fact of Medicare being threatened should be taken as precisely the reason to double down and say not only are we going to defend to the hilt what we have, but we are going to reject the prevailing wisdom and fight to expand it.
Up to 150% of the poverty line. I’d be eligible for it today if I weren’t married as are many of my friends who are tutoring/subbing or teaching private/parochial en route to a teaching career. The mistake was letting states opt out of it-and perhaps many Trump voters would’ve seen the benefits better if we hadn’t allowed the Scotts and Walkers of the world to opt out.
Basically you have to be married or in a solidly middle class job not to qualify for some kind of subsidy-and usually your employer is providing you with a better benefit at that point. By limiting the choices to three types of plans and three types of risk pools ACA really has laid the arhictecture for an eventual opt in public option which we would’ve pushed under a President Clinton and can still push at the state level today.
The ACA enabled the states to choose either creating their own “health connectors,” or have the feds create one for them. In either case, there is the option to enroll in the ACA. The Supreme Court, however blocked another aspect of the ACA, which was the requirement that the states adopt the expansion of Medicaid to cover all people at or below 133% of poverty level, with the feds paying 95-100% of all new coverage costs and only slightly less in out years (feds currently pay only about 50%). That ruling is what left the most people without coverage because 19 states have refused to expand Medicaid, and those 19 are among the states with the worst Medicaid coverage and least healthy populations.