Washington, D.C. –– Today, U.S. Senators Michael Bennet (D-Colo.) and Tim Kaine (D-Va.) announced the reintroduction of their legislation, the Medicare-X Choice Act, which would create a public option by expanding on the Affordable Care Act (ACA) and Medicare. The Medicare Exchange (Medicare-X) plan would offer families, individuals, and small businesses affordable health insurance, decrease the number of uninsured Americans, control the cost of health care, and increase competition in the health insurance market.
Bennet and Kaine’s bill would help achieve universal health care by making coverage more affordable and accessible.
“Our health care system repeatedly falls short of giving working Americans the care they need, especially in rural communities,” said Bennet. “Medicare-X is the best way to cover everyone regardless of where they live, reduce health costs, and improve the quality of available health insurance. We have a responsibility to create the best health care system possible and achieve universal coverage in our country. We can do that through Medicare-X.”
“Everywhere I go in Virginia, I hear about how essential access to quality and affordable care is to the health and well-being of our communities. While landmark legislation like the Affordable Care Act helped us make major strides in helping Virginians get covered, there’s still work to do,” said Kaine. “This legislation will help more Virginians, including those living in rural communities, get the care they need at a price they can afford.”
The ACA expanded health insurance coverage to an additional 20 million Americans, established critical protections for patients with pre-existing conditions, and standardized essential health benefits for all qualified health plans. However, many Americans still face high health care costs and limited options for affordable health insurance.
The bill would work within the Medicare framework to establish a Medicare Exchange public option plan in every county in America for individuals and small businesses, providing an additional, affordable option in all communities. It would also build on the ACA and permanently expand premium and cost-sharing support to make all exchange options even more affordable.
Under Medicare-X, the public option would initially be available on the individual exchange in areas where there is a shortage of insurers or higher health care costs due to less competition—including rural communities in Colorado and Virginia. By 2029, the Medicare Exchange plan would expand to every ZIP code in the country and be added as another option on the Small Business Health Options Program Marketplace.
Medicare-X would expand Medicare’s network of doctors and providers and guarantee the essential health benefits established in the ACA, such as maternity care and mental health services. Medicare Exchange plans would expand benefits and provide all primary care services without cost-sharing requirements for plan holders.
Additionally, it would ensure access to affordable prescription drugs by empowering the Secretary of Health and Human Services to negotiate drug prices for Medicare Exchange plans.
Finally, Medicare-X would create $10.9 billion in savings for households due to lower premiums and overall health care costs, $43.1 billion in savings in small-group markets due to lower overall health spending, and $20.3 billion in savings for the federal government due to lower premium tax credits as a result of lower provider payment rates and prescription drug price negotiation.
The legislation includes several policies to make coverage affordable for more Americans:
- To better support rural hospitals and providers and increase access to health care for Americans living in rural communities, the proposal would allow for payment adjustments of up to 150% of Medicare fee-for-service rates.
- On top of the essential health benefits required for qualified health plans under the ACA, Medicare Exchange plans would expand on those benefits and provide primary care services with no cost-sharing for plan holders.
- The bill makes permanent increased tax premium subsidies for Americans living below 400% of the Federal Poverty Level (FPL). This proposal permanently expands eligibility for the ACA’s premium tax credit to families above 400% of the FPL.
- This proposal codifies the fix to a glitch in the ACA that prevented family members of people who are insured through the health care exchange from receiving a tax credit.
- This legislation would direct the Centers for Medicare and Medicaid Services to study the effect of covering services such as long-term services and support; home- and community-based services; assistive and enabling technologies; and vision, hearing, and dental services. The study would examine the effects on benefits and the costs to beneficiaries. It would also review the implications in the health market and provide recommendations to Congress on potential inclusion of these benefits under Medicare plans.
- This plan would help drive down costs across the entire health care industry by providing additional resources to the Department of Justice and the Federal Trade Commission to take appropriate antitrust enforcement actions and address the root causes of consolidation in the health care market.
The bill text is available HERE. A summary is available HERE.
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