Welcome
Prescription to fix a Broken and Discrimatory System
Current System Places Undue Burden on the Uninsured and Under-Insured
The Problem
Usual and Customary Fees
New and Untested Medical Therapies
New and Untested Medical Therapies
In the early days of health insurance all costs were based upon the "Usual and Customary Fee"
Despite substantially lower current health insurance payments for specific services, the uninsured continue to be charged the highest Usual and Customary Fees
New and Untested Medical Therapies
New and Untested Medical Therapies
New and Untested Medical Therapies
New and untested medical therapies are frequently advertised and provided at extremely high cost. Typically no guarantee or results or documentation of scientific research is provide. Under the category of "Uncovered Medical Expenses" the sky is the limit as to what can be charged .
What Can Be Done
New and Untested Medical Therapies
What Can Be Done
Each state licences all heal care providers which includes physicians, hospitals, surgical and imaging centers and any other entity that can provides health care services. Legislation on the state level can be proposed and enacted that could level the playing field by limiting allowable fees for services provided.
Proposed Solutions
Legislation to Limit Patient Responsibility
Legislation to Limit Patient Responsibility
Legislation to Limit Patient Responsibility
The key element in legislation is to limit the financial patient responsibility regardless of the billed amount for a given service. There must also be a requirement to notify patients of this limit when they are billed.
Penalties For Excessive Billing
Legislation to Limit Patient Responsibility
Legislation to Limit Patient Responsibility
State Medical Boards have the authority to penalize any health care provider who despite the enactment of protective health care legislation, seeks to demand unreasonable fees for provides health care services.
Legislation for Uncovered Medical Services
Legislation to Limit Patient Responsibility
Legislation for Uncovered Medical Services
Protection regarding allowable billing with requirements for patient notification of documented outcomes of medical services can be written into state health care legislation.
Positive Unintended Consequence of Proposed Legislation
Fewer Payments by Health Care Insurance Companies
Fewer Payments by Health Care Insurance Companies
Fewer Payments by Health Care Insurance Companies
Many current health insurance policies have deductibles of $5,000 to $10,000. As a result of the current system of usual and customary fees, it takes little for a patient to reach those deductible limits. Since the billing for an MRI is not uncommonly $3,500, that plus an ER visit could easily reach the $5,000 mark. The first result of th
Many current health insurance policies have deductibles of $5,000 to $10,000. As a result of the current system of usual and customary fees, it takes little for a patient to reach those deductible limits. Since the billing for an MRI is not uncommonly $3,500, that plus an ER visit could easily reach the $5,000 mark. The first result of the proposed legislation is that for those same services a patient may be responsible for not much more than $400 and surely less than $500. Therefore that patient’s insurance company would not required to make any payments until another $4,500 worth of services at the Medicare rates had been provided.
Major Medical Look Alike
Fewer Payments by Health Care Insurance Companies
Fewer Payments by Health Care Insurance Companies
For a very large number of patients, the $5,000 deductible would then encompass a very large part, if not all of their typical medical services. Their health insurance would then be the equivalent of what was one commonly referred to as a Major Medical Insurance Policy. The cost of that policy could then be significantly reduced with no f
For a very large number of patients, the $5,000 deductible would then encompass a very large part, if not all of their typical medical services. Their health insurance would then be the equivalent of what was one commonly referred to as a Major Medical Insurance Policy. The cost of that policy could then be significantly reduced with no financial loss to the health care insurance company. Furthermore, the current discourages patients from having expensive recommended diagnostic studies early in the course of a potential serious medical condition. With the cost of those studies being only the Medicare rate, patients would more likely to undergo them at an early stages of a medical condition when resolution of that condition could be more readily accomplished.
Better Outcomes Lower Health Insurance Costs
Fewer Payments by Health Care Insurance Companies
Better Outcomes Lower Health Insurance Costs
Even if there were to be a modest decrease in the deductible, health insurance carriers should still be able to lower health care premiums. Also it is a well accepted fact that early diagnosis and treatment lead to lower overall medial costs. . Currently, insurance carriers have no role in encouraging early diagnosis and treatment. Their
Even if there were to be a modest decrease in the deductible, health insurance carriers should still be able to lower health care premiums. Also it is a well accepted fact that early diagnosis and treatment lead to lower overall medial costs. . Currently, insurance carriers have no role in encouraging early diagnosis and treatment. Their role does not come into play until the deductible is met. At that point the stage is set for them to deny what they may consider to be unnecessary, albeit recommended testing. Under the proposed legislation, total long term medical costs should be less and this should ultimately play a role in the determination of lower insurance premiums.
Why Not Just Wait for Medicare For All
Required Medicare Legislative Changes
Stabilize Viability of Health Care Services
Stabilize Viability of Health Care Services
First of all Medicare is paid for by taxes on all of us and those funds pay for Medicare for currently eligible recipients. Medicare For All will require a new set of payments that will necessarily be a steep jump from current Medicare costs which start at about $120 per month plus the cost of a supplemental plan and a prescription plan.
First of all Medicare is paid for by taxes on all of us and those funds pay for Medicare for currently eligible recipients. Medicare For All will require a new set of payments that will necessarily be a steep jump from current Medicare costs which start at about $120 per month plus the cost of a supplemental plan and a prescription plan. For that reason just extending the age group of those eligible will break the bank of available funds. Even if new participants enrolled in a Medicare Advantage plan, the base costs of Medicare for those not currently eligible for Medicare will require changes to the current system. In short it will not be as easy as is currently hoped for. See recent Washington Examiner article below.
Stabilize Viability of Health Care Services
Stabilize Viability of Health Care Services
Stabilize Viability of Health Care Services
Secondly, the issues with the current health insurance system will exacerbate any attempt to switch to Medicare for all. Many health care providers take full advantage of the excessive billing and the resultant payments that are allowed under the current system. Changes and adjustments will need to be made by most providers to cover the c
Secondly, the issues with the current health insurance system will exacerbate any attempt to switch to Medicare for all. Many health care providers take full advantage of the excessive billing and the resultant payments that are allowed under the current system. Changes and adjustments will need to be made by most providers to cover the costs of the provided health care. In some cases, the loss of funds may jeopardize the financial stability of the health care provider. Potential adjustments of payments based upon Medicare rates has been included in the proposed legislation. This would allow for regional adjustments beyond those factored into the Medicare rates to assure the availability of health care services in specific local areas.
Change Needed as Soon as Possible
Stabilize Viability of Health Care Services
Change Needed as Soon as Possible
Finally, given the issues noted, the best way to go from the current system toward a potential Medicare For All would be to put in place the changes in reimbursement that pave the way for universal health care. Beyond that, the provisions in the Emerging Medical Treatment Disclosure Act needs to be put in place, no matter what, to protect
Finally, given the issues noted, the best way to go from the current system toward a potential Medicare For All would be to put in place the changes in reimbursement that pave the way for universal health care. Beyond that, the provisions in the Emerging Medical Treatment Disclosure Act needs to be put in place, no matter what, to protect patients from expensive, useless and sometimes dangerous new or abandoned therapies. It is highly unlikely that any current health care provider will champion the changes in the two proposed legislations. It will be up to individuals within each state to petition local legislators to consider, refine and enact legislation of this sort. You could be that individual. Good luck!
Documents Provided
Introduction To the Problem
Discriminatory Excessive Medical Billing Practices
Current medical billing practices across the United States are discriminatory against the uninsured, the underinsured and most insured Americans with any sizeable deductible. This practice has crept into being starting with the genesis of health insurance companies offering health insurance providers the promise of more clients if they would join their health plan. The trade off was that the health insurance carrier would determine what would be paid to the provider for a given service and if that service would be covered. Over the past 30 to 40 years, the gap between the usual and customary fee of that time and the fee paid to providers has widened drastically. Not uncommonly, payment now is 25% of what was the usual and customary fee was in times past. Many new services were initially high priced but then became commonly available, such as MRI’s, and the realistic price dropped dramatically over the years but not the usual and customary fee.
However, current standard billing for medical services makes use of the usual and customary fee of times past hoping to receive as much as possible from the patient or the insurer. The uninsured, for example, are billed and expected to pay sums often four times what would have been paid by Medicare or a medical insurance carrier. For hospital bills the excessive billing can be extraordinary. In many cases, services are not allowed to be billed, e.g. needle insertion and monitoring of electrical nerve activity during back surgery for a total of $1,697 in Delaware. This is based upon Medicare or health insurance carrier contract arrangements with the provider. Then the sum total difference between insurance payment, say for back surgery, and billing of the uninsured can often be even greater.
With the advent of high deductibles, even the insured are being unfairly billed. With a $5,000 or $10.000 deductible medical insurance policy, an MRI may be charged directly to the patient at $3,500 until their deductible is met. However, when the deductible is then met, the provider must then accept the $231.96 e.g.in Delaware, for that service based upon their contract with carriers that pay Medicare rates. The provider cannot bill the patient for the difference between the usual and customary fee and the contracted fee. The patient is protected from the excessive usual and customary fee only after the deductible is met.
Clearly this discriminatory policy places a burden on those least able to pay for medical care. It is no small wonder that that medical debt leads to 643,000 bankruptcies per year. No attempt to resolve this issue has arisen as the providers are stakeholders in maintaining their ability to grab the early easy money.
Paradoxically, the insurance carriers are not benefiting from this situation. They need to maintain high deductibles to ward off the likelihood that they have to make any payments at all. This makes their policies less attractive and less competitive.
It is no secret that providers will go after patients who are unable to make full payment for the usual and customary fees that they charge to those not protected by a deductible-met insurance policy. Individual or small group providers put patients in payment plans or send them to collection while larger institutions including hospitals may attempt to place liens on patient’s possessions or homes.
The solution to this long standing and worsening situation can be remedied on a state level. All providers are state licensed. Billing rules are in the hands of the states as part of their power to grant or withhold licenses to provide medical services.
In its simplest terms, limiting patient’s financial responsibility to current accepted values for medical services would resolve this issue. Fortunately, Medicare has carefully assigned values to each and every accepted medical service and can be use as base for acceptable financial patient responsibility.
The complexities of the delivery of new or premium medical services can be accounted for with properly constructed legislation.
Apart from righting the unequivocal unfairness and discrimination of current practices, legislation to this end would likely begin to bring down the cost of medical insurance as well. Providers who have long been taking advantage of those less well medically insured, will need to realign their role to be caretakers and not extortionists of those to whom they provide services.
Detailed Discription of the Problem
Attached is proposed legislation to deal with the problem of excessive medical billing. The problem is under appreciated but one of the major causes of bankruptcy as a result of medical billing. With all the fighting on a national level regarding medical insurance, this issue has never seen light of day.
Excessive billing takes two distinct forms. The most common is that uninsured or under-insured patients are paying many times more than would have been paid by an insurance carrier and that is dealt with by the first proposed legislation, Excessive Medical Billing Relief Act”. The second is patients paying excessive amounts up front for proposed break through procedures that slip under the radar and are not regulated. These patients have no recourse and no way of knowing the validity of the procedure. That issue is covered under the proposed legislation, “Emerging Medical Treatments Disclosure Act”.
Each legislation relies upon the fact that billing is only done by state licensed providers and the states can implement regulations accordingly. Taken one state at a time, legislation of this sort could impact the entire nation.
A simple example of the first type of excessive billing is below:
This is an example of surgery for a ruptured Achilles tendon and the list of charges and payments for that surgery and of a coronary calcium CT scan. Attached is the de-identified list of charges. As you can note the total charges approved by Medicare were $3,054.87. Medicare paid $2,369.82. The secondary paid $606.92. However, the total charges that a patient would have been responsible for without insurance was $14,457.25.
This is clearly over four times the Medicare approved amount. This was a simple same day surgery and a brief CT scan. Imagine the cost difference for a hospitalized patient. Think of the burden this would have presented to someone who to start with could not afford medical insurance. Moreover, it is unlikely that any of the players here would be able to knock down the bill legally. Typically this would be billed three times and then sent to collection. After that the entities would have the option to write off the bill or accept partial payment but that is an uncommon occurrence. This is a real life example that shows just how unfair the current system is and how important it is to pass legislation to correct it.
Attached is also the billing done by a cardiologist taking advantage of a patient admitted emergently. The outcome of that billing is unknown but it speaks for itself. This is an example of out-of-network billing where the insurance company may be forced to cover the bill 50% or greater given the emergency nature of the hospital admission.
Medicare seems to be the best protection but there still are holes where patients may find themselves forced to sign a waiver and this act could also cover those patients.
It is hard to determine to what extent hospitals, imaging and surgical centers rely on the excessive payments in order to keep things running. About 10 years ago Medicare cut payments 30% for virtually everything done in a cardiologist's practice which most cardiology practices to sell the practices to hospitals. Included in the proposed legislation is a mechanism to adjust Medicare payment limits if the unintended consequence of this legislation would threaten the availability and/or viability of medical services. For example 130% of Medicare fees would bring payments back to 91% of the fees that were paid to cardiology practices 10 years ago.
Included also are provisions that protect physicians from errors made by billing staff of which they would be not only unaware but generally would have been incapable to have known given the complexity of current automated billing procedures. Attached also is a patient information sheet which would be required by the act.
A number of other provisions are included to minimize the burden on the providers of medical services required by this legislation. It should be possible to see the whole picture of this proposed legislation as formulated by the various proposals.
This simple proposed legislation hopefully has significant value as is and should not require a great deal of revision. In particular it was designed not to conflict with other existing legislation as much as is possible.
Regarding the second type of excessive medical billing, this issue was recently taken up by a major news story carried by Time magazine. Examples of billing $5,000 to $10,000 for various stem cell procedures that had no data on success. Providers that withdraw and re-inject stem cells within 24 hours do not come under the supervision of the FDA. This proposed legislation would require the providers to show outcome data or indicate if none exists at the risk of having the Department of Consumer Affairs require them to return the funds even if the procedure was already performed.
Looking at potential impacts beyond the obvious it would seem that either insurance premiums could be lowered, deductibles could be lowered or physician payments could be set back at a more realistic level. For example, if patients are no longer being forced to deal with out of network bills which are being paid by the insurance carriers at some percentage that can be 50% to 90% of the bill, then it may indeed be possible to shift those high payments to increase the base payments to contracted physicians, lower premium cost or deductibles. For clarity, if the patient is responsible only for Medicare or Medicare adjusted fees, then the insurance carriers should be able to "get away" by paying fees at that level and be thrilled to do so.
At this point what is needed is to enter these into discussion at state legislative level. Various stake holders need to be given access to evaluate the impact on their institutions or providers. Hopefully, stake holders that have been taking advantage of those most poorly insured should not raise objections even it had impact on their bottom line. It would be up to the state legislatures to assess potential cost savings realized by insurance carriers and direct them to apply those savings to an appropriate end.
This legislation is being presented in the interests of patients who have been otherwise forgotten in their attempt to handle medical bills and others that may have been given unrealistic expectations for expensive therapies that provided no cure.
This legislation is designed to be enacted by each state legislation making use of the state’s authority to license providers and medical facilities. It is recognized that a state by state process would be a slow solution to a national problem. It is, however, within the authority of the federal government to require states to enact legislation that would provide equivalent protection. That authority is derived from the ability to require such legislation in order to release federal Medicare and Medicaid funds. Given the results of the current presidential election and a projected stepwise approach to increase healthcare coverage, legislation of this type should provide a solution for the most serious gaps in current healthcare coverage.
Attachments:
Excessive Medical Billing Relief Act
Patient Information Regarding Proposed Excessive Medical Billing Relief Act
Emerging Medical Treatments Disclosure Act
Excessive Billing Examples
Excessive Medical Billing Relief Act
An Act to Prevent Excessive Medical Billing
WHEREAS, standard medical billing consists of charging unrealistically high amounts for medical services provided and then accepting a fraction of that amount based upon contract agreements from the insurance payors.
WHEREAS, patients with no medical insurance or inadequate medical insurance are frequently billed and required to pay excessive amounts for medical services compared to typical payments paid by Medicare.
WHEREAS, billing efforts by medical provider office staff or independent billing services may be unknown or unknowable to the medical provider due to the complexities of current automated medical billing techniques.
WHEREAS, prior approval of medical services by health insurance plans does not guarantee payment thus exposing patients to unanticipated billing for those services.
WHEREAS, these excessive costs contribute to the frequency of bankruptcy of patients so affected.
WHEREAS, hospitals, imaging centers, outpatient surgical centers, as well as other providers of health care commonly undertake aggressive collection efforts to retrieve compensation well above what would have been received from Medicare or medical insurance providers.
WHEREAS, adjustments of billing to normalize these costs often runs afoul of laws to prevent insurance fraud.
WHEREAS, for equivalent medical services, lower initial out of pocket costs toward meeting health insurance plan deductibles may allow health insurance plans to lower deductible limits without increasing the cost of the health insurance plan.
WHEREAS, the protection afforded by this legislation should lower out of pocket costs for early and appropriate diagnostic and therapeutic medical care leading to an overall savings of health care cost and promote improved medical outcomes.
WHEREAS, focused legislation to protect inadequately insured patients from such excessive billing would go a long way to normalize the cost of healthcare and decrease the incidence of healthcare related bankruptcies, therefore
BE IT ENACTED BY THE GENERAL ASSEMBLEY OF THE STATE OF (include state name):
Section 1. Patients with no medical insurance or inadequate medical insurance shall not be required to pay more than the approved Medicare fee for medical services provided in the state of Delaware by hospitals, imaging centers, outpatient surgical centers or any other provider of health care services.
Section 2. Inadequate medical insurance shall be considered present if uncovered medical services place the patient at risk for payments for medical services greater than what would be the approved Medicare fee. Uncovered medical services would include licensed medical provider prescribed services that were not approved or paid for by the patient’s health care insurance plan.
Section 3. Patients shall not be responsible for deductibles and co-insurance requirements of health care insurance plans for a given medical service in excess of the approved Medicare fee for such service.
Section 4. Medical services for which no Medicare fee has been established will not fall within the scope of this legislation.
Section 5. Patients who freely and knowingly seek uncovered or out of network medical services and under no duress have agreed to payment of excessive or premium fees will not be covered by the protection of this legislation for that medical service.
Section 6. Providers of medical services who bill patients in excess of Medicare approved fees must inform patients of the protection provided by this legislation and obtain written verification of such notification or forfeit the right to bill for those services. Billing for fees approved by a patient’s health care plan, which may be higher than the Medicare approved fee for a given service, will not require such notification. Providers billing for fees approved by a patient’s health care plan shall not be considered in violation of statutes that require uniform fee billing.
Section 7. If as a result of compliance with this legislation, health care providers bill patients and/or their health insurance plans, fees that vary for a given provided medical service, they will not be in violation of statutes that require level billing for any given service.
Section 8. Providers of medical services who, subsequent to enaction of this legislation, knowingly seek to collect fees greater than what would have been the approved Medicare fee from patients known to have no medical insurance or inadequate medical insurance, will be fined equal to the amount of the attempted collection effort. The act of seeking to collect fees shall be understood as fees designated to be patient responsibility before or after attempts to collect from any existent health insurance plans have been exhausted.
Section 9. Providers who are currently seeking to procure funds from treated patients in excess of Medicare adjusted fees must seek and desist. Liens taken out on the assets of treated patients, by providers who sought to procure funds in excess of Medicare adjusted fees, must abandon such liens.
Section 10. The Department of Consumer Affairs will be designated as the agency to which complaints shall be directed and will determine the occurrence of violations and will levy fines. The financially responsible medical providers shall be notified of any such complaints by the Department of Consumer Affairs. Such notification shall allow and provide for resolution of the complaint prior to levy of fines.
Section 11. The Department of Consumer Affairs may from time to time make across the board adjustments to the allowed Medicare fees consistent with the economic needs of the community to maintain the availability and viability of health care services. Any such adjustments shall be in the form of a percentage variation of the Medicare fees and such adjustments shall be made readily available to all health care providers.
Section 12. In order to assure the continued relevance and applicability of this act, should Medicare migrate to a fully outcome based reimbursement system, the median fee shall be utilized for the purpose of this act. Furthermore, should in the future a Medicare fee system cease to exist, the last such fee system will be utilized for the purposes of this act.
Section 13. This act shall take effect (enter date).
Patient Information of Afforded Protection
Patient Information Regarding Protection Afforded by the
Excessive Medical Billing Protection Act
1. If you do not have health insurance you cannot be held responsible for the cost of medical services provided to you that are greater than the adjusted Medicare associated fee for that service.
2. If your health insurance has limitations of payment for medical services provided to you, you can be held responsible only for the unpaid balance between that payment and the adjusted Medicare associated fee for that service.
3. If you receive a denial of payment from your health insurance for a medical service provided to you, you can be held responsible only for the adjusted Medicare associated fee for that service.
4. If you freely choose to receive premium medical services at known high costs and are placed under no duress to do so, you will not be covered by the protection of this act.
5. Medical services that do not have a Medicare associated fee will not be covered by this act.
6. Provisions of this act apply only to medical services provided by medical service providers licensed in this state
7. Medicare associated fees may be adjusted by your state, resulting in an adjusted Medicare fee for the purpose of this act, in order to assure the availability and viability of medical services.
8. Complaints and resolution of fees for provided medical services should be directed to Department of Consumer Affairs in writing at the address listed below. Copies of bills and payments should be provided when available to facilitate a timely resolution of your issue.
Emerging Medical Treatments Disclosure Act
Emerging Medical Treatments Disclosure Act
Whereas many new medical treatments are frequently made available to patients prior to certification or published independent research.
Whereas many of these treatments are not required to be reviewed by the FDA or other certifying agencies.
Whereas up front fees for many of these treatments are far in excess of standard treatments.
Whereas these treatments are provided by state licensed providers.
Whereas patients commonly have no access to unbiased outcome data on these treatments.
Whereas patients have no recourse when promised results did not occur, therefore,
BE IT ENACTED BY THE GENERAL ASSEMBLEY OF THE STATE OF (enter state name):
Section 1. State licensed providers who offer emerging medical treatments will be required to comply with the terms of this act.
Section 2. Emerging medical treatments will include treatments not evaluated and approved by the FDA or independent recognized specialty national medical organizations or otherwise considered standard medical practice.
Section 3. Prior to accepting advance payment or certification for future payment for such treatments, the providers must make accessible to the potential patient, all available outcome data for that treatment or indicate if no outcome data is available . They must also provide information regarding which oversight entities are responsible for evaluation of that treatment and make clear if no oversight entities are responsible for such evaluation and/or certification.
Section 4. In addition to the requirement of section 3 of this act, providers of emerging medical treatments must provide information on alternative approved medical treatments and success rates when known.
Section 4. Outcome data shall be provided in simplified form that then may be backed up by more complex data. It shall include the best estimation of success for that treatment to achieve the hoped for result. Estimations of partial success or extensions of a disease free state or prolongation of life expectancy will be considered adequate for this purpose.
Section 5. Providers who have accepted funds from patients and are not in compliance with the provisions of this act, shall upon patient’s request, return those funds to those patients whether or not the emerging medical treatment has been provided.
Section 6. Providers not in compliance with this act may be subject to action by the state medical board regarding licensure and/or fine.
Section 7. Patients whose funds were not returned in a timely manner when practitioners failed to meet the requirements of this act, shall notify the state Department of Consumer Affairs which shall be empowered to require such refunds.
Section 8. This act shall take effect on (give date).
Examples of Excessive Medical Billing
Examples of Excessive Medical Billing
Service Provided Charges Medicare Allowed
Coronary Calcium CT Scan $886.25 $206.89
Emergency Physician Visit $396.00 $62.96
Same Day Surgery for Achilles Tendon Rupture
Orthopedic Physician Visits $559.00 $104.41
Orthopedic Surgery Surgeon #1 $3,471.00 $648.04
Orthopedic Surgery Surgery #2 $3,471.00 $91.03
Anesthesia charge #1 $500 $91.03
Anesthesia charage #2 $1,791.00 $178.85
Surgical Center Charge $2,330.00 $1,252.41
Miscellaneous Other Charges $657.00 $356.26
Total $13,175.00 $2,784.99
Inpatient Patient Billing Examples of an Out-of-Network Physician
No Payments Recorded
Critical Care First Hour $7,500.00
EKG Rhythm strip interpretation $1,500.00
EKG report (same day) $1,500.00
Initial Hospital Care $5,000.00
Inpatient Consultation $6,000.00
Newspater articles
Washington Examiner Article
Hospitals warn Medicare public option would be an $800 billion hit to industry
by Cassidy Morrison
March 12, 2019 05:19 PM
Hospitals warned Tuesday that their industry would suffer an $800 billion cut if Democrats succeed in massively expanding Medicare.
The American Hospital Association and the Federation of American Hospitals published a report concluding that allowing the public to buy in to Medicare plans at cost would not only contribute to massive budget cuts to hospitals nationwide but would also jeopardize patients’ access to care.
Democrats have several proposals for extending Medicare. The most aggressive option, the Medicare for All Act introduced last Congress by Sen. Bernie Sanders, I-Vt., would enroll everyone in an expanded government-financed healthcare plan. Another less ambitious proposal would turn Medicare into a public option, allowing others beside seniors to buy into it.
The hospitals are prepared to fight the measures.
“It is not practical to disrupt coverage provided through employer-sponsored plans that already cover more than 150 million Americans,” Tom Nickels, AHA executive vice president, said in a press release. “America’s hospitals and health systems remain committed to working together with policymakers to help expand coverage and reduce costs for all Americans. However, a ‘Medicare for All’ approach would impede, not advance, our shared goals.”
The FAH study specifically examines the Medicare-X Choice Act, a proposal brought forth by Sens. Michael Bennet, D-Colo., and Tim Kaine, D-Va. Medicare-X would permit all Americans to the option of buying a public plan, which would cost less than private insurance. This plan is less sweeping than a single-payer system as it fits into existing healthcare system and would not mandate that all Americans can only select a public plan.
Kaine and Bennet envisioned Medicare-X being phased in incrementally and gradually so that the plan could be rolled out smoothly and would not disturb the marketplace as drastically as a single-payer initiative would. Hospital systems and healthcare providers disagree that the plan would work without trouble and are prepared to fight it.
According to the FAH study, Medicare-X would exacerbate problems that hospitals already face. It says that public programs, Medicare included, consistently reimburse healthcare providers at much lower rates than the costs of the health services administered. A shift of millions to a public option, the report says, would destabilize insurance markets and compound hospital expenses.