The Center for American Progress, or CAP, a Washington think tank, has unveiled the latest alternative to the U.S. government's currently run healthcare programs — proposing a structure that would guarantee universal coverage, but also would allow employer-based insurance.
It also would offer participants certain services and therapies for free, like preventive care, treatment for chronic diseases and generic drugs.
"Healthcare is a right," CAP stated. "No American should be left to suffer without the healthcare that they need." It said the U.S. was alone among developed nations in not guaranteeing universal health coverage.
CAP's pitch to Capitol Hill comes as the Trump administration is seeking to make its own changes to Medicare, Medicaid — the government's insurance program for the poor — and the Affordable Care Act, or ACA.
The think tank's proposed "Medicare Extra For All" program was modeled on the federal government's healthcare program for seniors 65 years or older, but it would be available for Americans of all ages, regardless of income or health or insurance status.
The program would incorporate Medicare, Medicaid, the Children's Health Insurance Program and the ACA's insurance marketplace under one umbrella.
Newborns and individuals turning 65 years old would automatically be enrolled in Medicare Extra. But seniors and other Americans enrolled in the original Medicare, Medicare Advantage, the military's TRICARE, Veterans Affairs medical care and the Federal Employees Health Benefits programs would have the option to stay with those plans, which would remain in place.
In addition, individuals who are eligible for the Indian Health Service program could supplement those services with Medicare Extra if they choose.
But the CAP-proposed program would preserve employer coverage as an option for companies that want to keep it for their workers, although those employees would be able to still opt into the Medicare Extra coverage — an offering that would not be available under the single-payer "Medicare-for-All" proposal unveiled last fall by Sen. Bernie Sanders, I-Vt.
By the eighth year of the program, large employers would have the option to sponsor Medicare Extra for all employees and the tax benefit for employer-sponsored insurance would be limited for high-income employees.
The policy institute said Medicare Extra beneficiaries' out-of-pocket spending would be limited and certain types of coverage would be guaranteed, such as primary and preventive services, inpatient and emergency hospital services, ambulatory care, prescription drugs and medical devices, laboratory work, reproductive services, maternity and newborn care, mental health and substance-use disorder therapy, and habilitative and rehabilitative services. Early and periodic screening, diagnostic and treatment services for children also would be included, as well as dental, vision and hearing services for all beneficiaries.
Until the Medicare Extra program is launched, drugmakers would pay rebates like those under the Medicaid program on medicines for low-income beneficiaries covered under Medicare plans.
The Congressional Budget Office has estimated that such a policy could reduce federal spending by $134 billion over 10 years.
CAP also called on Congress to give the Medicare Extra program the ability to negotiate prices for prescription drugs, medical devices and durable medical equipment directly with manufacturers — cutting out the middlemen.
To aid those negotiations, the policy institute said multiple nonprofit, independent evaluators would be needed to vet data submitted by manufacturers, conduct studies and make periodic value assessments.
If negotiated prices were within the range recommended by all evaluators, Medicare Extra would include the product on a preferred tier with limited cost sharing.
If prices for existing products rise faster than inflation, manufacturers would pay rebates on products covered under Medicare Extra — "just as they do under the current Medicaid program," CAP noted.
The White House, however, has blamed government rebates for dampening competition and artificially driving up the prices of prescription medicines.
CAP suggested having Congress create an independent body within the Centers for Medicare and Medicaid Services, or CMS, to administer the Medicare Extra.
The group also proposed renaming CMS to the Center for Medicare.
To ensure Medicare Extra is immune from partisan political influence, the think tank said the legislation creating the program should leave "little to no discretion to the administration on policy matters."
According to the organization, the administration of Medicare Extra should resemble the current Medicare program and not Medicaid.
While the policy institute said Medicare Extra could be financed by a combination of healthcare savings and tax revenue options, it had not worked out the details.
Time for a change
CAP — a strong proponent of former President Barack Obama and the 2016 Democratic presidential candidate Hillary Clinton — was an early backer of the ACA, calling it a "historic accomplishment" by expanding health insurance coverage to 20 million Americans. The law has proved to be remarkably resilient, despite repeated acts of overt sabotage by the Trump administration and repeated attempts by the Republicans to repeal it, the group noted.
But the organization said it was "imperative to chart a path forward for the long-term future of the nation's healthcare system."
"Costs and deductibles remain much too high," CAP said, noting that 28% of nonelderly U.S. adults, or 41 million Americans, remain underinsured.
"The ACA was a giant step, and the sustained political fight over the law showed that the American people want to expand coverage, not repeal it," CAP said. "It is now time to guarantee universal coverage and health security for all Americans."