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As Public Option Bills Considered in Congress, ACP Reiterates Support for Universal Coverage

Advocate Masthead

Reintroduced Medicare-X bill would phase in a public option during the next four years

March 5, 2021 (ACP) – As the Senate considers new legislation that would allow tens of millions of Americans to sign up for a Medicare X plan for the first time, the American College of Physicians is reminding the nation's leaders that universal coverage is a crucial strategy to improve medical care in the United States.

Several public option bills are expected to be introduced during the current congressional session, including one sponsored by Senators Michael Bennet (D-CO) and Tim Kaine (D-VA), said Brian Buckley, ACP senior associate for legislative affairs. The new legislation, known as the Medicare-X Choice Act of 2021, will allow individuals to purchase a health plan similar to Medicare in the health insurance exchange provided by the Affordable Care Act. The Washington Post quoted Kaine as saying that “we think the bill we're introducing is the closest match to what came from the Biden campaign.” (The president also supports a public option – a way for more people to get government-backed insurance.)

“The proposed ‘public option’ is consistent with ACP policy, although we support several changes to provisions in the bill that has been introduced,” Buckley said. “ACP staff will be in discussions with the bill's sponsors to share our views concerning the legislation as well as our recommendations to improve the bill.”

The Kaine/Bennet bill would phase in a public option during the next four years until it is available everywhere in 2025. Consumers would be able to buy into “Medicare-X” in the individual or small-group markets. Among many other provisions, the legislation “includes an expansion of marketplace tax subsidies to ensure people don't pay more than 8.5 percent of their income on monthly premiums,” the Washington Post reports.

“Many sections of the Medicare-X legislation are consistent with ACP policy,” Buckley said. “We are pleased that the bill would implement several measures that would lower health care costs and improve care by covering essential health benefits, improving premium tax credits and affordability, establishing a reinsurance program to cover the cost of high-cost patients, ensuring prescription drug negotiation in Medicare and expanding Alternative Payment Models that use telehealth and integrate social services such as food, housing and transportation assistance.”

However, ACP wants to see revisions to parts of the bill that would establish provider network and reimbursement rates for physicians who participate in the Medicare-X plan. “This legislation would mandate that physicians who participate in Medicare and/or Medicaid must also accept Medicare-X plan patients and must serve plan holders on similar terms and conditions as any other federal or state health plan holder,” Buckley said. “ACP recommends that physician participation in a public plan should be voluntary.”

As Buckley noted, the Medicare-X plan would reimburse physicians at 100 percent of Medicare fee-for-service rates with flexibility for the Secretary of Health & Human Services to reimburse up to 150 percent of Medicare rates for hospitals and physicians in rural areas. “ACP recommends that in either a single-payer or public choice model, payment rates to physicians and other clinicians – as well as to hospitals and other facilities that offer health care services – must be sufficient to ensure access to needed care and should not perpetuate disparities in current payment methods. Current Medicare payment rates generally are insufficient to achieve these objectives.”

Congress may consider public option legislation later this year or in 2022, Buckley said. “Senators Bennet and Kaine are now trying to build support for their Medicare-X plan so that it will be attached to legislation to improve the Affordable Care Act,” he said. “ACP will advocate to include a public option that is consistent with ACP policy in future legislation.”

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Back to the March 5, 2021 issue of ACP Advocate