Bill Overview
Title: Medicare for All Act of 2022
Description: 2022 This bill establishes a national health insurance program that is administered by the Department of Health and Human Services (HHS). Among other requirements, the program must (1) cover all U.S. residents; (2) provide for automatic enrollment of individuals upon birth or residency in the United States; and (3) cover items and services that are medically necessary or appropriate to maintain health or to diagnose, treat, or rehabilitate a health condition, including hospital services, prescription drugs, mental health and substance abuse treatment, dental and vision services, and home- and community-based long-term care. The bill prohibits cost-sharing (e.g., deductibles, coinsurance, and copayments) and other charges for covered services, with the exception of prescription drugs. Additionally, private health insurers and employers may only offer coverage that is supplemental to, and not duplicative of, benefits provided under the program. Health insurance exchanges and specified federal health programs terminate upon program implementation. However, the program does not affect coverage provided through the Department of Veterans Affairs, TRICARE, or the Indian Health Service. Additionally, state Medicaid programs must cover certain institutional long-term care services. The bill also establishes a series of implementing provisions relating to (1) health care provider participation; (2) HHS administration; and (3) payments and costs, including the requirement that HHS negotiate prices for prescription drugs and establish a formulary. Individuals who are age 18 or younger may enroll in the program starting one year after enactment of this bill; other individuals may buy into a transitional plan or an expanded Medicare program at this time, depending on age. The bill's program must be fully implemented four years after enactment.
Sponsors: Sen. Sanders, Bernard [I-VT]
Target Audience
Population: All United States residents
Estimated Size: 334000000
- The bill proposes a national health insurance program to cover all U.S. residents, effectively impacting anyone living within the U.S.
- The program includes comprehensive health services coverage beyond what Medicare currently provides, such as dental and vision.
- It affects the entire U.S. population by removing cost-sharing for medical services, except for prescription drugs.
- It impacts private health insurers and their subscribers by allowing only supplemental, not duplicative, private insurance coverage.
- The program is expected to terminate existing federal programs like health insurance exchanges, but it will not affect programs like VA, TRICARE, or Indian Health Service.
Reasoning
- Targeting a diverse range of demographics is essential to understand the broader societal impact of the policy.
- Balancing the sample to include various occupations and income levels showcases different perspectives on healthcare needs and access.
- Considering the current cost of healthcare services, this policy can dramatically affect individuals depending on their current insurance status and medical needs.
- Since the policy eliminates deductibles and copayments, individuals with high current out-of-pocket expenses for medical services might experience a significant improvement in wellbeing.
- People not heavily reliant on medical services might see less impact immediately, hence a varied sample population is necessary.
- The budget constraints are considered against the enormous scale and population impacted, requiring efficiency in implementation and potential economic adjustment periods.
Simulated Interviews
Retired Teacher (Florida)
Age: 65 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 15/20
Statement of Opinion:
- I'm currently on Medicare and it has been a lifesaver, but my prescription costs are too high.
- If Medicare for All covers my drug costs, it will be a huge relief.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 6 |
Software Developer (California)
Age: 35 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- I appreciate having private insurance through work because it covers what I need.
- I'm skeptical about how a government program will match my current coverage.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 8 |
| Year 2 | 7 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 9 | 8 |
| Year 20 | 9 | 8 |
Freelancer (New York)
Age: 28 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 6/20
Statement of Opinion:
- I've been going without insurance because it's so expensive.
- This policy could really help me avoid the huge medical bills I've been dealing with.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 8 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 9 | 4 |
| Year 20 | 9 | 4 |
Small Business Owner (Texas)
Age: 55 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 3/20
Statement of Opinion:
- I worry about how much we spend on insurance for our employees.
- If this policy reduces my costs, I can reinvest in my business.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Graduate Student (Illinois)
Age: 23 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- I'm currently covered by my university but it's pretty limited.
- This policy might offer more comprehensive coverage for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
Stay-at-home Parent (New Jersey)
Age: 40 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 15.0 years
Commonness: 5/20
Statement of Opinion:
- Healthcare costs for kids are really high, even paying for checkups.
- A policy that covers everything would be a big financial relief.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 9 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Factory Worker (Ohio)
Age: 50 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 7/20
Statement of Opinion:
- Our union gives us health coverage, but my deductibles are still high.
- This policy eliminating cost-sharing sounds beneficial to me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 9 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 9 | 5 |
Entrepreneur (Oregon)
Age: 30 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- I rely on the ACA marketplace which is manageable, but not perfect.
- If Medicare for All gives me better coverage without extra cost, it would help my business goals.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Retired Nurse (Pennsylvania)
Age: 75 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- I probably won't be affected too much since I have Medicare already.
- Covering more of my medication expenses would help, though.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Unemployed (Alabama)
Age: 45 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 20.0 years
Commonness: 6/20
Statement of Opinion:
- I've been without insurance since losing my job, and it's stressful.
- This policy could get me back on track and provide health security.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 3 |
| Year 2 | 6 | 3 |
| Year 3 | 7 | 3 |
| Year 5 | 8 | 3 |
| Year 10 | 8 | 3 |
| Year 20 | 8 | 3 |
Cost Estimates
Year 1: $3000000000000 (Low: $2800000000000, High: $3200000000000)
Year 2: $3100000000000 (Low: $2900000000000, High: $3300000000000)
Year 3: $3200000000000 (Low: $3000000000000, High: $3400000000000)
Year 5: $3300000000000 (Low: $3100000000000, High: $3500000000000)
Year 10: $3500000000000 (Low: $3300000000000, High: $3700000000000)
Year 100: $4000000000000 (Low: $3800000000000, High: $4200000000000)
Key Considerations
- The disruption of current private insurance systems could face significant pushback.
- Efficient negotiations with drug companies are crucial to achieving project savings.
- The potential administrative overhaul must be managed carefully to avoid cost overruns.
- The healthcare workforce needs to adjust smoothly to the new system demands to ensure service levels don’t fall.
- Impact on state versus federal spending responsibilities will have nuanced implications.
- Full fiscal effect will gradually materialize as system integration progresses.