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 House Progressives Cover Long Term Care in Latest Medicare-for-All Proposal

Legislation introduced by progressive Democrats in the House goes well beyond other so-called Medicare-for-All proposals that aim to install a single-payer, government-run system in the United States by providing universal coverage for long term care and care for people with disabilities.

The bill also goes well beyond what some Western countries with national health care cover, such as Canada, which does not offer government payment for vision care, dental care, or rehabilitative services as the new proposal seeks to do.

Congressional Progressive Caucus Co-chairs Reps. Mark Pocan (D-Wis.) and Pramila Jayapal (D-Wash.) introduced Jayapal’s Medicare for All Act of 2019, calling it “bold, visionary legislation to transform our health care system and ensure that all Americans, regardless of race, Zip-code, or income level, have access to quality treatment and care.”

No price tag was placed on the plan, and there were no specifics on how to pay for what would amount to an enormous undertaking. One expert who talked to Provider about the legislation, and the broader movement by the more liberal wing of the Democratic Party to go all-in for Medicare-for-All, says the Jayapal bill is more aspirational than a reflection of reality in terms of getting single-payer passed in the near term, if ever.

“Certainly, you have wings of the [Democratic] party that are fully gung-ho on pursuing this, and in some respect issues like this got them elected and excited the base,” says John Feore, associate principal, Avalere Health. “For those folks, they are asking, ‘Why would we shy away from something bold we believe in?’ But, there is a factual, political reality about it ever being signed into law by President Trump or pass the Senate or even the House.”

What the Jayapal proposal envisions is the creation of a single-payer, government-funded health care program within two years that gets rid of the age-65 marker for Medicare eligibility. There would be no beneficiary copays, premiums, or deductibles, and coverage would span the gamut from prescription drugs to vision and dental, to mental health and substance abuse, to maternal care, to long term care and care for those with disabilities.

All of this would cost trillions of dollars, Feore says, given the basics of covering an entire nation of more than 325 million people.

For just the long term care/disabilities piece, he alludes to the difficulties in doing a sliver of what the new legislation calls for with the failure of the Community Living Assistance Services and Supports (CLASS) program, even if not an apples to apples comparison.

The CLASS program was a component of the Affordable Care Act that would have established a national, voluntary insurance program for purchasing community living services and supports. The design sought to expand options for people who sustain functional disabilities and require long-term help.

“Even the HHS [Department of Health and Human Services] with Obama in charge realized it was financially unsustainable and could not implement it, and it was taken out of the legislation by Congress,” Feore says. “It is a very expensive proposition to cover long term care, but if you are going all the way for the most progressive Medicare-for-All proposal, it makes sense clearly.”

What is really happening, he explains, is that the Jayapal bill, and others like the far less expansive Medicare-for-All plan authored by Sen. Bernie Sanders (I-Vt.), is setting a marker for 2020 and where the candidates on the Democratic side will fall on the issue.

“Obviously, nothing is going to happen for a couple of years, and you have to get something of a drastic change that would really require a solidly unified government under one party and most likely with a super-majority in the Senate of 60 votes to get over any filibuster. This is political reality vs. aspirational,” Feore says.

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