Health care was one of the most important issues, if not the most important issue, in the 2018 election campaign. It already looks like it will be a major issue, and possibly the biggest issue, in the 2020 elections.  Candidates have already announced their intentions for exploring a run for President.  We intend to have a series of blogs as different concerns arise during the campaign.  This is significant to health care providers as well as to the public, since it may have a major impact on both the payment for and delivery of health care going forward.

Our starting point will be the Medicare program which is now over 50 years old and has been evolving. The Medicare program is a good example of what questions should be asked about coverage and cost.  For instance, what health care does that program cover?  If one were to look at Part A and Part B, it does not cover many aspects of health care including vision, hearing, dental, drugs and long-term care.  It also requires significant copayments and deductibles from those covered by the Medicare program.  The program as now structured for most Americans is not available until they are 65 years old.

It is also necessary to look at the financing of that program. There are many aspects to the financing.  Even though most Americans are not receiving any benefits from that program until they are 65, most people are paying into that program (together with their employer) for their entire employment life, including periods of employment which may occur after they are a beneficiary of the Medicare program.  The financing of that program has changed over the years so that it now covers all W-2 earnings or its equivalent.  For non-W-2 earnings, the program has a provision in which, at a certain level, the individual is required to pay additional premiums.  Further, for Medicare Part B coverage, an individual either pays a premium directly after they enroll, or if they are also on Social Security, an amount is deducted monthly to cover participation in Part B program.  That amount is adjusted based upon the individual’s level of income the prior year.  The program still has a significant deductible and copayment requirements.  Many of the participants cover these requirements by purchasing supplemental insurance. For those who are eligible, those copayments and deductibles may be paid by the Medicaid program.  Based on the most recent Trustees’ report, the program is projected to be in serious financial distress in the near future.

As the program evolved, CMS developed Medicare Part C which is a managed care insurance product for Medicare patients. Part C (depending on where you are and the product available) may have no copayment or deductibles and may cover additional services such as vision, dental, and hearing.  Part C does not cover long-term care.

More recently, Part D was added to the Medicare program, which is also a product which covers prescription drugs.

In any of the health care financing and coverage programs proposed, one has to look at them to see what was covered, who is covered, when they are covered, what the copayments are, what the deductibles are, and how the program is going to be paid for.

An additional issue is the payment to the health care provider. The program is now experiencing the refusal of some providers to accept Medicare, because of its “low” reimbursement rates.  How providers will be paid is a major issue.

Under the Affordable Care Act (a/k/a “ACA” or “Obamacare”), there are different levels of coverage from a bronze, silver, gold and platinum level. Candidates proposing new health care financing and coverage programs will need to establish whether or not such a distinction in the level of care will be included or addressed by any new health care proposal.