While the concept of “Medicare for all” has gained traction in the national healthcare debate, the phrase oversimplifies a complex problem that befuddles health policy makers and industry leaders — how to improve healthcare access and affordability for more Americans.
Speaking at the University of Miami’s Watsco Center for the annual Business of Health Care Conference on Friday, a panel of trade group leaders representing the nation’s hospitals, doctors, nurses, health insurers and healthcare financial managers agreed that America’s healthcare system needs to be simpler to navigate and more affordable.
But they all disagreed that a universal expansion of Medicare, the national health insurance program for Americans 65 and older, would accomplish those objectives.
Matt Eyles, president of America’s Health Insurance Plans, a lobbying and trade group representing health insurers, said “Medicare for all” sounds to him like an analogue for the GOP’s on-again, off-again “repeal and replace” mantra for the Affordable Care Act.
“It’s a great slogan but there’s not a lot of substance behind it,” he said, noting that such a change would disrupt the health insurance benefits that an estimated 180 million Americans receive through their employers, and the public coverage that an estimated 75 million others receive through Medicaid.
Barbara McAnany, a practicing physician and president of the American Medical Association, the nation’s largest trade group for doctors, agreed with Eyles about the concept of Medicare for all, calling it “a three-word sound bite for a very complex system.”
Among her concerns about a Medicare-for-all system, McAnany said, is that the program on average covers about 80 percent of the cost of delivering healthcare. She said doctors and hospitals rely on commercial insurers to make up the shortfall.
“If we lost commercial insurers,” she said, “to fill in the gap of what Medicare doesn’t cover, every healthcare provider from physician practice to hospital to health system would be struggling.”
Maryjane Wurth, vice president of the American Hospital Association, said her group estimates that hospitals and health systems would lose about $800 billion over 10 years under a Medicare-for-all system.
It’s not often that health insurers, doctors and hospitals find agreement in a healthcare debate. But the panel concurred on another issue: that the U.S. Department of Justice should support the ACA instead of taking the position that the entire law should be invalidated because the individual mandate has been reduced to zero for those who choose not to buy health insurance.
Justice Department attorneys said in a March 25 letter to the Fifth Circuit Court of Appeals that a December 2018 U.S. District Court decision invalidating the entire ACA should be affirmed and upheld.
Eyles noted that the ACA has created significant consumer protections that did not exist before the law was adopted in March 2010, such as mandating coverage of pre-existing health conditions, and prohibiting insurers from imposing lifetime limits on coverage.
Halee Fischer-Wright, a physician and chief executive of the Medical Group Management Association, said striking down the ACA would also create instability — a factor that she said would drive up costs for healthcare providers and for consumers.
“Uncertainty gets priced into healthcare,” she said.
Though the panel did not discuss at length the financial difficulty that Americans with health insurance face due to high deductibles, out-of-pocket co-insurance rates and provider networks with fewer doctors and hospitals, they also agreed that expanding coverage was better than leaving Americans uninsured.
“In this country, access begins with an insurance card,” McAnany said. “It doesn’t guarantee there will be someone there to accept it, but at least it’s a key in the door.”