How Proposals for Public and Hybrid Health Care Plans Differ (Updated)
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Who Runs the Plan? |
Who Qualifies for the Plan? |
Can People Choose a Different Plan? |
What Do Enrollees Pay? |
What Do Enrollees Get? |
How Much Do Providers Get Paid? |
Medicare for All (S. 1804) |
Medicare |
All people |
No |
Taxes (no premiums) |
Enhanced ACA benefits with low cost sharing |
Medicare payment rates |
Medicare Part E* (S. 2708) |
Federal gov’t |
All non-elderly people except those Medicaid- or Medicare-eligible |
Depends: Employers choose for workers; yes for others |
Federal gov’t-set premiums based on costs, decreased for low-income enrollees and employer contribution (current law) |
Enhanced ACA benefits with gold-plan-level cost sharing |
Negotiated rates which fall between Medicare and average private rates |
Medicaid Option* (S. 2001 / H.R. 4129) |
States |
All non-elderly people in such States |
Yes |
State-set premiums, decreased for low-income enrollees |
ACA benefits and reduced cost sharing |
Medicaid payment rates, Medicare rates for primary care |
House Public Health Insurance Option (H.R. 3962, 2009) |
Federal gov’t |
People buying coverage on their own and small businesses |
Yes |
Federal gov’t-set premiums based on costs; decreased for low-income enrollees (current law) |
ACA benefits and cost sharing reductions (current law) |
Negotiated rates which fall between Medicare and average private rates |
Medicare Rates Applied to Private Plans* |
Individual market plans; federal gov’t regulates rates |
People buying coverage on their own |
Yes (although Medicare rates apply to all plans) |
Private insurance-set premiums, decreased for low-income enrollees (current law) |
ACA benefits and cost sharing reductions (current law) |
Medicare payment rates |
Medicare X (S. 1970 / H.R. 4094) |
Federal gov’t |
People buying on their own and small businesses in underserved areas initially |
Yes |
Federal gov’t-set premiums based on costs; decreased for low-income enrollees (current law) |
ACA benefits and cost sharing reductions (current law) |
Medicare payment rates (with plus up for rural areas) |
Midlife Medicare* |
Medicare |
People ages 50 to 64 without access to employer coverage |
Yes initially but no once in Midlife Medicare, except in limited cases |
Federal gov’t-set premiums, decreased for low-income and increased for high-income enrollees |
Similar to Medicare benefits and cost sharing |
Medicare payment rates |
Medicare for Individuals with Disabilities* |
Medicare |
People qualifying for Social Security Disability Insurance |
Yes |
Medicare premiums, increased for high-income enrollees (current law) |
Medicare benefits and cost sharing (current law) |
Medicare payment rates |
Public Reinsurance Program for Private Plans* |
Employers and insurers; federal gov’t runs reinsurance |
People with very high costs enrolled in participating plans |
Yes (although reinsurance applies to all plans) |
Private insurance-set premiums, decreased for eligible low-income enrollees (current law) |
ACA benefits and cost sharing reductions as applicable (current law) |
Medicare payment rates paid through employers and insurers |
* Same or similar idea described in articles in the Health Reform 2020 issue of The American Prospect. View the collection online here. |
What’s the Difference between Health Reform Proposals?
A new—and markedly different—set of proposals has emerged in the wake of attempts to repeal the Affordable Care Act. Rather than scaling back the role of government, these ideas expand the social safety net to improve health care accessibility and affordability. Many of these proposals are featured in the January 2018 edition of The American Prospect (co-produced with The Century Foundation) and will likely be debated by candidates for the presidency in 2020. However, these public and public–private health care proposals differ on key dimensions, such as who runs them, who qualifies for them, and how much enrollees pay. This table (updated with the introduction of Medicare Part E in the Choose Medicare Act on April 18, 2018) compares major public plan and hybrid plan proposals.
Download This Table as a PDF
How Proposals for Public and Hybrid Health Care Plans Differ (Updated)
Tags: affordable care act, health insurance, Trumpcare