There's a diary on the Rec list right now discussing Medicare for All.
In the comments, someone claimed that “No one in America or anywhere else is advocating an end to private insurance.”
Setting aside the “or anywhere else” part (really? You claim to know the beliefs of all 7.5 billion people on the planet?), this statement is simply false on the face of it, at least so far as private health insurance goes. As I’ve explained before, not only do both the MFA bills (House and Senate) eliminate virtually all private health insurance (I said virtually all, not all), doing so is one of the CHIEF SELLING POINTS of the proposal for many MFA advocates.
To the best of my knowledge, this is an accurate depiction of what types of private healthcare services would and wouldn’t still be allowed to be covered by private insurance under both bills:
Now, I agree that “Extended Services” and “Other” leave a lot of wiggle room, but the point is that yes, the vast majority of services and expenses would be paid for 100% via the federal government. Again, that’s supposed to be a selling point, so I’m not sure why some MFA supporters are running around insisting that private insurers will still be able to offer hospital room upgrades, extra rehab visits and higher-quality wheelchairs.
Anyway, I posted a comment in response to the above effect, but I was in no way attacking MFA, I was presenting factual information about what the bill(s) would and wouldn’t do, and was asking others to stick to the facts.
HOWEVER, none of this is the point of this diary. This is (these come from multiple comments from multiple people):
...You are Mr. ACA around these parts. Can we be honest about that too? You have a horse in the race. Aren’t you personally better off if M4A dies?
...Doesn’t the need for your site go away if the ACA goes away? Same with donors who support your work?
...You have a financial interest in following a path of ACA-like incremental changes, you are not completely unbiased when you provide your opinions.
...The truth is that Brainwrap is earning his living because the ACA exists.
...Do you work for ACA in some capacity?
...That is a dodge. Are you trying to avoid the question? Do you have any contracts with any entity that receives money related to the ACA, including, but not limited to, insurance companies, the federal government, or state governments?
...But you stated above you do receive pay for promoting ACA or Medicare for America, right?
...Do you still do contract work for ACA or Medicare for America orgs?
First: I find it noteworthy that only one person in the mini-thread which followed asked me about the actual point I was making (supplementary coverage under MFA). It was a reasonable question which I hope I responded to to their satisfaction.
As for the smears, innuendo and accusations listed above (some of which were stated in a “when did you stop beating your wife?” style) I shouldn’t feel compelled to respond, but since I hear this crap from some folks here at dKos fairly often (usually from the same handful of people), I wanted to clear up a few things:
- No, I don’t work for or get paid by any insurance carriers.
- No, I don’t work “for ACA”. ACA is the Affordable Care Act. It’s a law, not a company.
- No, I don’t work for the federal government (someone once thought I was the HHS Secretary).
- I've never done “contract work for the ACA” or “Medicare for America orgs”.
- For that matter, “Medicare for America” didn't even exist until December 2018. To the best of my knowledge, the only “org" connected to the bill is the Center for American Progress, which came up with the original proposal last year (then called Medicare Extra for All) which eventually became Med4Am.
- Yes, I strongly supported the MEFA approach at the time, and still strongly support Med4Am now. And no, I haven’t been paid to say so; the framework is very close to how I’d approach universal coverage. I started promoting the MEFA framework the moment I heard about it over a year ago because I loved the concept.
- No, I don’t have a “financial interest” in “incremental changes”. If MFA were to somehow pass the House, Senate, get signed into law by Trump, and go into effect starting on January 1, 2020, I’d have more to write about, analyze and blog about for the next 3-5 years during the transition period than I could possibly keep up with.
- Of course a more realistic “best case” scenario would be a blue trifecta in 2020, taking office in 2021, with the law being implemented in 2022 and ramping up over the next 4 years through 2025, which means I’d still have plenty to write about for another 6 years at a minimum.
- Even after MFA was potentially fully ramped up...are people under the impression that once a country shifts to single payer, every healthcare story magically dries up? Do Canada, the UK, Japan, France, Australia, etc. not have healthcare analysts, bloggers, advocates, journalists and so on? I guess Theresa Boyle, health reporter for the Toronto Star doesn’t exist? I suppose these listings for healthcare analysts in Japan are phantoms?
- Someone insisted that because the name of my website is “ACA SIgnups” that must mean that I do nothing but count the number of people who sign up for the ACA, and couldn’t possibly change the name to something else. I’m sure Nate Silver will be devastated if DC or PR become states, because we’ll suddenly have more than 538 Electoral Votes, thus forcing him to close up shop on FiveThirtyEight.com, right?
- In all seriousness, people do want to know how I manage to make a living at what I do, so for the record, here you go:
- Small one-time donations from individuals (via PayPal or GoFundMe)
- Small monthly donations from individuals (via PayPal or Patreon)
- Banner ads (via RWJF & Google AdSense for the most part)
- Once in a blue moon I’ll write a freelance piece for a third-party outlet, like this one I wrote for Cracked. They paid me $200.
Oh, and yes, I do still have my web design business, although I’ve lost over half of my business since I started doing the ACA/healthcare analysis/advocacy work five and a half years ago.
Any questions? Thank you.
As an aside, I should also add this: Many Daily Kos regulars helped me out back in spring 2014 after that first crazy, rollercoaster ride of an open enrollment period. You saved my financial ass in 2014, and helped me keep the site going into 2015, and to all of you, I want to say thank you once again.
UPDATE: Wow, thank you (to 99% of the commenters) for the support!
Someone asked for a simple explanation of the differences between MFA and Med4America. I’ll write up something more detailed later, but here’s the main differences:
WHO WOULD BE COVERED BY THE NEW PROGRAM:
- MFA would be mandatory for 100% of the population, period...no exceptions.
- Med4Am would be mandatory for around 50% of the population, optional for the other 50%.
- Caveat: Med4Am would then gradually expand into the other 50% thanks to auto-enrollments at birth and for those turning 65
TIMEFRAME:
- MFA would be phased in to 100% of the population over 2-4 years.
- Med4Am would be phased in to 50% of the population over 5-6 years, then gradually expand as newborn babies were auto-enrolled & employers/employees chose to switch to it.
TRANSITION PROCESS:
- MFA would be age-based: EVERYONE within either 2 or 4 age brackets would be automatically moved to MFA regardless of their current situation over either 2 or 4 years (employer plan, ACA plan, Medicaid, etc)
- Med4Am would be situation-based: First everyone currently on Medicare would be moved, then everyone on the ACA market, then everyone currently uninsured, then everyone on Medicaid/CHIP.
COST TO ENROLLEES:
- MFA would supposedly have ZERO costs of any sort for anyone for anything covered (the debate over what wouldn’t be covered, of course, is what led to my comment in the first place)
- Med4Am would have ZERO costs of any sort for anything covered for those earning under 200% FPL (around $25K for an individual; $51K for a family of 4). For those earning more than that, it’d be on a sliding scale (NO deductibles):
- 200-300%: 0 — 2% of income, $0 — $1K maximum out of pocket for a family
- 300-400%: 2 — 4% of income, $1K — $2K max family OOP
- 400-500%: 4 — 6% of income, $2K — $3K max family OOP
- 500-600%: 6 — 9% of income, $3K — $5K max family OOP
- Over 600%: 9% of income, $5K max family OOP
As for the issue of employer-provided insurance: Under Med4Am, employer insurance would have to be at least Gold-level coverage (80% of expenses covered) if they wanted to keep offering it. If they chose to move their employees over to Med4Am, they’d have to pay an 8% payroll tax instead. Alternately, employees can also chose to make the move to Med4Am even if their employer doesn’t want to.
HOW IT’S PAID FOR:
- Med4Am: The legislative text itself specifies:
- Repeal of the 2017 GOP Tax Bill
- A 5% surtax on personal income over $500,000 (including capital gains)
- Increasing the Medicare payroll tax on incomes over $200K (single) or $250K (joint) from 0.9% to 4.0%
- Increasing the Net Investment tax from 3.8% to 6.9%
- Termination of tax-free Health Savings Accounts
- Termination of tax-free Flexible Spending Accounts
- Doubling of the federal tobacco/cigarette tax
- Increase in the alcohol excise tax
- Adding a tax on sugary drinks
There are other differences as well, but I think this covers the main ones.
NOTE: The exact specifics above could change slightly in the upcoming version of Med4Am, but I believe it should be pretty close.
UPDATE x2:
I wasn’t originally intending this to turn into a full-out MFA/Med4Am diary, but since it’s become that in the comments, here’s the links to the actual legislative text of the current House MFA bill, Senate MFA bill and House Med4Am bills:
Note that the current Med4Am version includes deductibles and tops out at 9.69% of income for premiums; the upcoming revised version eliminates deductibles and tops out at 9.0% of income.
Note that the current Bernie MFA version doesn’t include Long-Term Support Services; he’s supposedly adding this to an upcoming revised version.
There may be other changes to each as well.
As for the “no duplication of services” issue, here’s the full wording from the Senate version:
SEC. 107. PROHIBITION AGAINST DUPLICATING COVERAGE.
(a) In General.—Beginning on the effective date described in section 106(a), it shall be unlawful for—
(1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or
(2) an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.
Here’s the part which leaves some wiggle room for “supplemental” insurance:
(b) Construction.—Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, including additional benefits that an employer may provide to employees or their dependents, or to former employees or their dependents.
OK, so anything covered by MFA can’t be covered by any private insurance. Let’s see what is covered by MFA:
SEC. 201. COMPREHENSIVE BENEFITS.
(a) In General.—Subject to the other provisions of this title and titles IV through IX, individuals enrolled for benefits under this Act are entitled to have payment made by the Secretary to an eligible provider for the following items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition:
(1) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
(2) Ambulatory patient services.
(3) Primary and preventive services, including chronic disease management.
(4) Prescription drugs, medical devices, biological products, including outpatient prescription drugs, medical devices, and biological products.
(5) Mental health and substance abuse treatment services, including inpatient care.
(6) Laboratory and diagnostic services.
(7) Comprehensive reproductive, maternity, and newborn care.
(8) Pediatrics.
(9) Oral health, audiology, and vision services.
(10) Short-term rehabilitative and habilitative services and devices.
Notice that it doesn’t specify, for instance, how many hospital days are covered, or whether private rooms are covered. For vision services, it doesn’t say whether that includes designer frames or contact lenses, or just bare bones “Lennon” glasses. For all of these it just says “comprehensive” services as long as they’re “medically necessary or appropriate”.