Latest Liberal Health Care Proposal: ‘Medicare Extra for All”

“While Republicans have been busy tearing the Affordable Care Act to shreds, the Center for American Progress has been working on a proposal to go in the opposite direction. 

     It’s not the single-payer approach advocated by Senator Bernie Sanders, I-VT, and it keeps, rather than discards, the roles played by employer-provided health care and the insurance industry. But it is more ambitious than just that, providing employers and individuals a choice but not an obligation to join Medicare Extra. 

     Under the proposal, the report says the Medicare Extra would use Medicare’s money-saving payment system ‘as a framework to pool working-age people and their families, low-income people now covered by Medicaid and seniors.’

     At a moment, there is no cost estimate for the plan, although its authors say one is in progress. And a nonpartisan expert who reviewed the medicare Extra plan independently has said it could give Democrats a middle way to bring about coverage for all. Medicare Extra’s main features include automatic eligibility for coverage for all U.S. citizens and lawful residents, as well as free preventive care, treatment for chronic disease and generic prescription drugs. Dental, vision, and hearing services would be included. 

    Low-income people would have no premiums or copays, while income would decide premiums and copays for all others. Employers could not participate or not, while employees could choose Medicare Extra or stick with their employer’s plans; tax-free status of employer-provided health care would remain, subject to a limit. 

     Last but not least, the government would negotiate prices for prescription drugs, medical devices and medical equipment. Taxes would be higher, of course, and the government would play a more prominent role in health care, but some of the options identified in the report as possible ways to pay for it to include a rollback of some of the recently GOP tax cuts for corporations and upper-income people, raising Medicare taxes on upper-income earners and tax increases on tobacco and sugary soft drinks.”

(2/22/2018. Marlene Satter.) 

Wealthiest Medicare Beneficiaries Will Pay Larger Share of Medical Costs Starting in 2019

The Wall Street Journal (2/22, Tergesen, Subscription Publication) reports that beginning in 2019, Medicare beneficiaries with high incomes must pay a larger share of their medical costs. This article says this is another attempt to transfer more Medicare costs to the wealthiest seniors. The piece adds that as of next year, beneficiaries who have incomes of $500,000 or more and couples with the income of &750,000 or more will be placed into a new category and asked to pay 85% of what their parts B and D benefits cost. At present, they are paying 80% of those costs.

Trump Administration Aims to Reduce Regulatory Burden

The executive order does not require employers to take immediate action. However, employers should continue to monitor any developments that may affect their compliance with federal law in various areas, including banking, employment benefits, health, environmental protection, transportation and workplace safety.

The Memorandum

The memorandum (memo) directs federal agencies to place a freeze on any rule, guidance or regulation that has not yet become effective as of Jan. 20, 2017. Specifically, the memo asks federal agencies to:

  • Refrain from sending to the Office of the Federal Register (OFR) any regulation that has not been reviewed by a newly appointed department or agency head;
  • Withdraw any regulations sent to the OFR if they have not yet been published; and
  • Postpone for 60 days the effective date of any regulations that have been published by the OFR but have not yet become effective.

An exemption from this directive applies to any emergency situation and other urgent circumstances relating to health, safety, financial or national security matters. However, state agencies are required to notify the OMB director (Director) of any regulations that, in their view, should be exempt from this directive. The notification must also include the agency’s explanation for why an exemption should be allowed.

The Executive Order

As mentioned above, the executive order requires federal agencies to identify two regulations for elimination for every regulation they propose to implement. However, the order allows for an exemption for any regulation that is related to military, national security and foreign affairs as well as regulations regarding agency organization, management and personnel.

The order also directs federal agencies to maintain a neutral budget expenditure, meaning that federal agencies will not be allowed to exceed their budgets for the cost of proposing, adopting, implementing, enforcing or repealing any regulation. To this end, federal agencies have been directed to offset the cost of any new regulations by eliminating the costs of existing regulations.

The key person for implementation of this order is the OMB Director. The order gives the Director a great deal of discretion to authorize additional exemptions and to define key terms such as “cost.” The Director has also been charged with the responsibility to issue guidance on the processes and standards the agencies will need to follow to comply with this order.

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