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On the Issues: Winning Expanded Access to Healthcare

by Barb Bloomfield and Rose Johnson

The idea of “Medicare for All” has gotten a lot of attention lately, but what does this mean? There are several approaches in the Senate and House of Representatives that would expand coverage to everyone in the U.S. For all these proposals, the basic ideas are that:

  1. All people should have health insurance

  2. It should be affordable for all levels of income

  3. It should guarantee essential health benefits

  4. Government should be involved in regulating costs and guaranteeing coverage

On the other hand proposals differ in the range of government involvement – from full funding and management of insurance to regulation of public and private providers to ensuring quality availability and affordability – and the speed at which we would move to the new system.

Medicare for All, as proposed by Senator Bernie Sanders in 2017, is a national health insurance program that would cover everyone in the US. It would eventually replace all private health insurance, and all other government health insurance programs. It would pay for every medically necessary service – routine doctor visits, specialist visits, surgery, mental health care, prescription drugs, dental care and vision care, services such as physical therapy, and equipment such as

prosthetics. It would replace all other insurance, with some exceptions, such as cosmetic surgery.

Other proposals would develop a national health insurance program but would allow an opt out for those who prefer coverage from their employer (Medicare for America), or would allow those between ages 50 and 64 to buy into Medicare (Medicare at 50). In addition, Medicare-X and Public Option proposals would offer Medicare or another nationwide plan as an option on the Obamacare marketplace. It has also been proposed to let Americans buy into Medicaid rather than Medicare.

While so many proposals may be confusing, a key thing to remember is that many Democrats are working on ideas to expand access to healthcare. Republicans, on the other hand, after trying and failing to repeal Obamacare, have not come up with any other plan.

So what about action on the state level? As Americans have more and more voiced their concerns about healthcare, we’ve seen action either in legislatures or ballot initiatives in several states. In Virginia, after Democrats came close to taking the state Assembly in 2017, legislators found the will to expand Medicare. But legislators in Nebraska, Idaho, and Utah have blocked implementation of successful ballot initiatives that sought to expand care, and others, such as Arkansas and Kentucky, have limited benefits in those states. A U.S. News ranking of states shows that the states with the best access to healthcare are “blue” or “purple”.

In Pennsylvania, Democrats have offered bills to protect the essential benefits provided by Obamacare (SB51, 2019-20), to protect Pennsylvanians with pre-existing conditions (SB50 and HB 1013, 2019-20) and to provide for single-payer healthcare (SB1014, 2017-18) among other efforts, but Republicans have kept these initiatives locked up in committee, not letting them come up for a vote. Perhaps the way to improve healthcare in Pennsylvania is to turn the state more blue!

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