The Journal of the Arkansas Medical Society Med Journal April 2020 | Page 7
THE
PURCHASING POWER OF MANY
M
edicare For All” has become one
of the most popular topics in
American politics. Notably, when
I have asked most of my resident
physicians (who will be significantly impacted
by its mandates), I have discovered a dearth of
understanding of this topic. Given the potential
ramifications of this program for changing the
American health care landscape, I believe a re-
view of its significant provisions is beneficial
for all physicians.
Medicare as we know it now was established
in 1965, primarily as universal health care for
people over 65 years age. In 1972, Medicare
coverage was extended to persons with dis-
abilities. Medicare For All is not Medicare as we
currently understand the program. Currently,
there are two competing models of the Medi-
care For All program in the 116th Congress,
House Resolution 1384 and Senate Bill 1129.
Both HR 1384 and SB 1120 establish a national
health insurance program that is administered
by the Department of Health and Human Ser-
vices (HHS). Both programs provide insurance
for all U.S. residents; specify automatic enroll-
ment of individuals upon birth or residency in
the U.S.; and cover comprehensive health care
including hospital services, prescription drugs,
mental health and substance abuse treatment,
dental and vision services, abortion, and home
and community long-term care. Senate Bill
1129 specifies that state Medicaid programs
must cover certain institutional long-term care
services. Both bills prohibit cost-sharing (e.g.,
deductibles, coinsurance, and copayments
and other charges for covered services) but
SB 1129 allows co-payments for prescription
drugs up to $200 annually for households with
incomes >200% of the federal poverty limit.
Both bills mandate that private health insur-
ers and employers may only offer coverage
that is supplemental to, and not duplicative of,
benefits provided under the Medicare For All
program. Under each bill, all health insurance
exchanges and certain specified federal health
programs terminate upon Medicare For All pro-
gram implementation – the exception being
coverage provided through the Department of
Veterans Affairs or the Indian Health Service.
HR 1384 calls for transitioning to Medicare
For All over a two-year period: individuals <18
years age or >55 years age or already enrolled
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