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September 12, 2017 02:36 PM UTC

Medi-Something for All!

  • by: Colorado Pols
Cary Kennedy.

Senator Bernie Sanders (I-VT) plans to introduce “Medicare for All” legislation in the U.S. Senate on Wednesday, and several big names (Sen. Kamala Harris, Sen. Cory Booker) have already said that they will support the proposal. Senator Brian Schatz (D-HI), meanwhile, is working out the kinks on a “Medicaid for All” measure.

Here in Colorado, Democratic gubernatorial candidate Cary Kennedy made a bold move on Tuesday by announcing her plans to push for a “Medicaid for All” program in our state. As the Denver Post reports:

Cary Kennedy announced Tuesday that she supports allowing anyone to buy into the state’s government-run Medicaid system — a policy stance that puts a line in the sand in the crowded 2018 Democratic primary on the issue of health care.

“My health care plan makes this promise: We can do better,” she said at a campaign event in Denver.

Kennedy said her proposal would not cost the state any money — instead, anyone who buys into the system will cover the cost of their care through premiums. The actual cost remains undetermined, but Kennedy said the cost of premiums could be 20 percent less than the rates available on the individual insurance market.

But the former state treasurer’s plan represents a significant extension of Medicaid and will open her to criticism from Republicans who want to curtail the program expanded under the Affordable Care Act and mired in ever-increasing costs to state and federal taxpayers.

Nevada’s legislature recently passed a “Medicaid for All” bill that was vetoed in June by Gov. Brian Sandoval.

What’s the difference between “Medicare for All” and “Medicaid for All”? We’ll hash this out in a separate post, but in general, “Medicare for All” is more of a federally-focused program while “Medicaid for All” is more of a state-centered plan (though neither idea can really be boxed in quite so easily).

From a purely political standpoint, Kennedy’s declaration today will likely speed up a Democratic shift toward being more openly favorable to a “public option-type” healthcare proposal. Republicans will no doubt respond gleefully to this news, though their rhetoric will have to be somewhat muted given their complete and utter failure at doing anything on healthcare with their majorities in Congress and control of the White House.


16 thoughts on “Medi-Something for All!

  1. Moldy's going to have a conniption.  Saying we need to take benefits away from people because free market invisible hand fisting.

    Besides, people dying due to lack of healthcare is not a bad thing.  And we make fun of his honesty which just makes us look bad.

    1. I can see the GOP campaign slogan on healthcare now: "If you can't get health insurance on your own, please have the decency to suffer and die in silence!  That goes for your kids too."

      Might be a bit long for a bumper sticker, but I'm sure they can tighten it up some.

  2. The biggest practical difference between Medicare and Medicaid is that the programs (assuming a “for all” version”) reimburse providers at different rates. (The other big difference is that Medicare is a categorical program available to almost everyone over age 65 and certain other people, while Medicaid is means tested and available only to people who have low incomes and few assets, although the means test is greatly relaxed under Obamacare.)

    Medicare reimburses providers at rates slightly below those of private health insurance and has only minimal authority to set reimbursement rates with providers.

    Medicaid reimburses providers at rates far below those of private health insurance and, as a result, new Medicaid patients are not accepted by many providers. Basically, Medicaid involves significant partial charity care by providers and is subsidized by Medicare and privately paying patients whose prices are increased to cover losses incurred from caring for Medicaid patients. 

    Medicaid for all is, obviously, for any given group of people, cheaper than Medicare for all, which is what makes it attractive. But, Medicaid for all might not be economically viable because there wouldn’t be anyone left in other revenue streams to subsidize Medicaid patients, without major increases in Medicaid reimbursement rates.

    Yet another difference between the programs is that Medicaid has a component that covers long term care (i.e. nursing home care) for middle class people, while Medicare does not.

    1. But Cary Kennedy is proposing a "Buy in to Medicaid" program, which would not cost taxpayers more, since people would be privately paying into the program at Medicaid rates.

      In principle, I like this proposal. I'd have to see more how it's fleshed out. I like it because it will provide an incentive to keep private insurance premiums lower, since there will be no profit motive for this plan. Many working poor people will opt for this plan. I would. 

      It will be interesting to see if the same folks that trashed Coloradocare pile on to trash this one:

      "Oh no! It will prohibit insurance paying for abortions!" (State employee insurance can't pay for abortions, since Colorado is one of the states that won't use state funds for abortions). Medicaid in Colorado can't use funds for abortions unless mother's life is in danger, or rape or incest. People who want abortions will have to pay for it separately – an "abortion rider" on the insurance policy. Sucks, but so does bearing children one can't support.

      "Oh no! We can't possibly do anything at a state level. It must wait for the Federal Medicare for All, or else nothing nohow!"

      "Oh no! This undermines union negotiations on insurance benefits ( It won't – it would actually strengthen them) , so unions can't support it.

      Prepare for misinformation galore, and all kinds of equivocatin' and position skatin amongst all the other Dem candidates. Wonder what Jared Polis will do.


      1. How is buying into Medicaid any fundamentally different than, for example, Ted Cruz's let-them-buy-whatever-(inadequate)-health-insurance-coverage-they-want plan?

        And, really I'm just asking here, because I don't know what Medicaid does, or doesn't, cover . . .

        . . . but, preventative care?  Birth control?  Health screenings?

        It just seems to me that, a bandaid by any other name is still just a bandaid . . . 

        1. Under the original ACA plan, Medicaid subsidies on the state health exchanges subsidize plans which have to cover those things you name: birth control, preventative care, including health screenings. I also think that, under Trump, there has been a gradual whittling away of these regulations. But we're in pretty decent shape here, having accepted the Medicaid subsidies and having some progressive legislators. (Thanks, Dr. Aguilar)

          So in Colorado, Medicaid is called Health First Colorado, and what it covers is pretty comprehensive.  The co-payments are very reasonable, too. Probably on the order of , "You have to pay something, or you show you don't value it. "

          In general, Medicaid doesn't pay for prescription drugs. However, it seems that Health First Colorado does. Including contraception. Although not abortion , except in the conditions I named in my earlier post.

      2. I like it because it will provide an incentive to keep private insurance premiums lower, since there will be no profit motive for this plan.

        I don't want to scare you, Mama, but I too kind of like the option to buy in to Medicaid as well. And for the same.

    2. Letting people buy in to Medicaid brings their premium dollars with them, but it doesn't address the crappy reimbursement.  Even in Denver metro, try finding a GI, Neurologist, or Endocrinologist who takes Medicaid. CU and Denver Health have to, but their clinics can't see everyone, and they're not conveniently located for all who need them.  

      Now try the same experiment in Mesa or Weld counties, never mind the less populated hinterlands. Insurance doesn't mean access if providers aren't willing to accept the pay on offer.

      Doctors were trained in the current system with capitalist medical school tuition rates, and 30-year loans which aren't tax deductible. It's problematic making someone else's work product in to a right. Making licensure contingent upon accepting Medicaid pay will drive doctors out of the field.

      1. I agree that Medicaid reimbursement rates would have to increase for this to be  practical.  Schatz' bill in Congress would be a good start. Forgiveness of medical loans for working in high-poverty practice areas would be another.

        "It's problematic making someone else's work product into a right." True, but Kennedy's proposed plan is an option, not a right.

        I saw nothing in either piece of proposed legislation to 'make [Doctor] licensure contingent upon accepting Medicaid pay". Does that happen?

  3.  I hope they go for Medicare. Medicaid, with its lower payments, would just spawn more "concierge" practices where people can pay cash to get "Cadillac" care. Even in countries with fully socialized medicine, this happens. And the part where Medicare doesn't cover nursing homes is idiotic. It's FOR people who are quite likely to need to be in one.

    As long as they’re doing Medicare-For-All, they need to fix that part.

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