They took a hit during the Affordable Care Act and came back swinging. But the health insurance industry and the agents who sell its products are fighting back against another movement that threatens to put them out of business — single-payer health care, otherwise known as Medicare For All.
Nine separate proposals have been announced with the goal of getting more Americans enrolled in health coverage. Some of those proposals are some form of a Medicare buy-in for small employers and for low-wage consumers who have difficulty obtaining affordable coverage.
But the two proposals generating the most attention are separate Medicare For All bills sponsored by Sen. Bernie Sanders, I-Vt., and Rep. Pramila Jayapal, D-Wash. Both bills would eliminate employer-based health insurance and all private health insurance while transitioning all Americans to one government health plan. Cost-sharing — premiums, copays and deductibles — would disappear. Insurance would cover the current essential health benefits, as well as dental, vision, prescription drugs and women’s reproductive health services. The Sanders bill would take coverage even further by picking up the tab for long-term care.
Both bills would require a tax increase to fund what is thought to be a $33 trillion cost for implementing coverage for all. The Sanders bill calls for higher taxes on the wealthiest Americans, increased income and estate taxes, establishing a new wealth tax on the top 0.1 percent of earners, and imposing new fees on large banks. Jayapal has not yet released the details of how her bill would be funded.
A study by the Political Economy Research Institute at the University of Massachusetts estimates the industry will lose 800,000 jobs if Medicare For All becomes reality.
The health broker community is voicing its concerns about whether such a sweeping overhaul of health insurance is needed as Washington and the health insurers are still trying to stabilize the ACA marketplace.
The Partnership For America’s Healthcare Future is made up of 28 members representing a cross-section of the health care community. Members range from the American Medical Association to the National Association of Health Underwriters to the Blue Cross Blue Shield Association. PAHCF’s mission is “to improve what’s working in health care and fix what’s not. We support building on the strength of employer-provided health coverage and preserving Medicare, Medicaid, and other programs that so many Americans depend on, so we can deliver affordability, expand options, improve access, and foster innovation.”
Lauren Crawford Shaver, PAHCF executive director, spoke at the recent NAHU Capitol Conference on the belief the “Medicare For All is choice for none.”
“We want every American to have access to care but we don’t see Medicare For All as achieving that goal,” she said during the conference. “We also want to build on the strengths of our current system. Let’s fix the things that are not working, let’s not start over.”
She told NAHU members that single-payer health care would be a one-size-fits-all system that would give consumers less choice and control over their doctors, treatments and coverage. It would mean higher taxes, longer wait times and lower quality of care.
Janet Trautwein, NAHU CEO, has spent the past two years studying single-payer health care systems around the world through the London School of Economics. She told InsuranceNewsNet that although Medicare For All is gaining attention, the reality is that it won’t become law as long as President Donald Trump occupies the White House.
“He would veto something like that,” she said. “But it’s really interesting — the reason the single-payer issue has been so much in the news lately is because of all the progressive Democrats who have declared for president, most of them are Medicare For All advocates. So it kind of gives you a disproportionate view of the likelihood of it passing because they are the ones getting all the news. But most of the newly elected members of Congress are more for doing something on fixing the ACA. Although some of the things they want to fix are not really some of things Republicans agree on.”
However, if voters elect a Democratic president in 2020, “the more likely we are to see some type of public option — a Medicare buy-in for those ages 50 to 64,” she said.
Trautwein said most Democrats in Congress are not in favor of Medicare For All. “But when you start expanding the public programs you have, or you start creating an unlevel playing field with the private sector, you have some public program creep, so to speak,” she said. “It’s much more likely to happen eventually if we have a public option or a Medicare buy-in because your risk pool would be divided differently, with the number of people on public programs being much greater than those on private plans.”
Medicare For All might steam if the current health insurance marketplace stabilizes, Trautwein said. “If we could get things like reinsurance passed and some other things that would make the current individual market more affordable and offer more choices than what we have now, that would be a huge help toward there being any compelling reason to do anything else.”
What Would Happen To Brokers?
Medicare For All has no role for private health insurance or brokers. So what would happen to brokers if the proposal becomes law?
“This would be absolutely detrimental to our industry,” said Ronnell Nolan, president/CEO of Health Agents for America. “The initial hit would affect not only the brokers but the businesses that serve our industry — it all trickles down and it would be a significant ripple effect. We see it as detrimental to our industry and the consumers we represent.”
Trautwein said that in some countries that have single-payer coverage, brokers can sell supplemental insurance that covers things that the government plan does not or can help consumers move up to the front of the line in accessing care. But whether that option would be available in the U.S. under Medicare For All is unknown.
The leaders of both agent associations said their members are conducting outreach to their elected representatives as well as educating consumers on what Medicare For All could mean.
“We believe in the free market. We believe Medicare For All will take the freedom away from how people receive health care and how it’s delivered,” Nolan said.
“The sales pitch — free access, no deductibles, no copays — is a lot of smoke and mirrors,” Nolan said. “Washington will decide what’s covered, how much to pay doctors and hospitals. So I don’t think people realize what they’re really going to lose and they will be paying more in taxes.”