Democrats are pushing for a Medicare program that would cover all Americans, a change that would rattle the healthcare industry. Uncertainty over how quickly to proceed may slow their efforts.
The debate over healthcare reform has died down in recent months after the Trump administration systematically dismantled some of the key components of the Affordable Care Act, but legislators are keeping the heat on with Medicare-for-all plans that would amount to a huge shake up in the healthcare industry.
The question for Democrats is when to bring them to the forefront and work for a healthcare change that would rival what happened with Obamacare.
Democrats will promise great benefits to consumers and make healthcare reform the No. 1 topic again, but if Medicare displaces private health plans an alarming number of healthcare professionals are likely to flee for early retirement or change careers, according to an industry thought leader.
There are currently four proposals with variation on the idea of making Medicare available to all Americans, the most prominent from Sen. Bernie Sanders (I-VT), which proposes Medicare for All by transitioning the country to a single-payer health system, which has the support of 15 senators.
Sens. Michael Bennet (D-CO) and Tim Kaine (D-VA) are still proposing their Medicare X plan, which calls for making Medicare available as an option but not the only payer.
The liberal Center for American Progress is proposing Medicare Extra for All, and Sens. Chris Murphy (D-CT) and Jeff Merkley (D-OR) recently offered another new Medicare buy-in plan called the Choose Medicare Act.
In addition, Sen. Brian Schatz (D-HI) and Rep. Ben Ray Luján (D-NM) are still supporting their State Public Option Act, which would create a Medicaid-based public healthcare option on the insurance marketplace.
Democrats see opportunity
With the ACA significantly weakened but no indication that the Republicans will be able to fully repeal and replace it, Democrats are seeing the opportunity to push the single-payer system many of them favored all along, says Sally C. Pipes, president and CEO, Thomas W. Smith Fellow in Health Care Policy at Pacific Research Institute.
The variety in the bills, however, shows that Democrats aren't sure how much they can seek a complete change in how Americans pay for healthcare.
"Some of the Democrats are concerned about pushing for full single-payer when they don't know what it's going to cost or how it's going to be paid for, so they're taking a stepping stone approach," Pipes says. "They're putting the public option back in, which was in the original House bill for the Affordable Care Act, before it went to the Senate."
The likelihood of any version of Medicare-for-all passing in the next two years is dubious, Pipes says.
Major reform is unlikely to happen at the national level under the Trump administration, though there could be movement on the state level while the Democrats keep the federal legislation warm on the back burner, Pipes says.
Impact not understood
Having lived with a single-payer system in her native Canada, Pipes opposes such a wholesale change in the American system. She notes, however, that out of 1,850 adults in the U.S. who were surveyed in a recent poll, 51% supported the idea of a single-payer plan.
"My worry is that the American people don't understand what single-payer means when the government is the only payer for your healthcare, what the tax increases would be, and the long waiting lists for healthcare," Pipes says. "The average wait to see a specialist in Canada is 21.2 weeks, over five months, having grown from 9.3 weeks in 1993. When you look at these various bills, the same things would happen in the United States if we go that way."
Those long waiting lists would come partly as the result of a Medicare-for-all plan driving healthcare professionals out of the business, Pipes says.
Physicians will not want to work for Medicare wages, she says, which are about 20% below what they typically get for treating private insurance patients.
Hospitals also will be stressed by the reduced revenue. That will make it difficult to pay nurses and other healthcare workers competitive wages, causing many of them to leave the industry also, Pipes says. Access to care and quality of care would suffer, she says.
"Doctors retiring early, the best and the brightest kids not going into medicine, and care being rationed because the government only has so much to spend even when they keep increasing taxes," Pipes says. "That's what would happen if these plans go through, especially a plan like the Sanders proposal that would go right to single-payer."
No agreement in D.C.
Republicans, particularly Ted Cruz (R-TX), have said they are not giving up on the goal of repealing and replacing Obamacare, but Pipes is doubtful that would happen any time soon because they don't want to stir up that debate before the midterm elections.
That leaves the Democrats an opening to push the issue to the forefront again and at least keep public interest alive until 2020 when they might have a better chance with a new administration, she says.
The fact that there are numerous Medicare-for-all bills indicates the current state of affairs with healthcare, says CEO John Baackes of L.A. Care Health Plan, which covers more than 2 million Medi-Cal members.
Legislators and consumers alike are still grasping for a way to improve a system that everyone seems to agree is not working in its current iteration.
"It is evident our policymakers are still not of one mind on how to organize and pay for healthcare. To a certain extent, these bills are the result of a growing populist movement and a natural reaction to the Republicans' ACA repeal-and-replace efforts," Baackes says. "One could argue they are gaining momentum, but it should not be assumed it is forward movement."
Baackes says there is not sufficient detail from any proposal to determine the impact they would have on healthcare providers.
"I appreciate the ongoing exchange of ideas to make healthcare accessible to everyone as long as they are accompanied by a responsible plan for funding," he says.
Gregory A. Freeman is a contributing writer for HealthLeaders.