Health Law Daily Sanders’ Medicare-for-all, Graham-Cassidy’s block grant legislation introduced in Senate
Thursday, September 14, 2017

Sanders’ Medicare-for-all, Graham-Cassidy’s block grant legislation introduced in Senate

By Kelly J. Rooney, J.D., M.P.H.

Two health care proposals were introduced on September 13, 2017, one from a group of Democratic Senators led by Bernie Sanders (I-VT) calling for a single-payer health care system and another from Republican Senators calling for the replacement of the Affordable Care Act (ACA) (P.L. 111-148) with a block grant system. The proposals are just two of many offered before the 115th Congress regarding health reform and illustrate the disparity between the Republican majority and the Democratic minority on this issue.

Medicare-for-all proposal. Along with Sanders, Sens. Tammy Baldwin (D-WI), Richard Blumenthal (D-CT), Cory Booker (D-NJ), Al Franken (D-MN), Kirsten Gillibrand (D-NY), Kamala Harris (D-CA), Martin Heinrich (D-NM), Mazie Hirono (D-HI), Patrick Leahy (D-VT), Edward Markey (D-MA), Jeff Merkley (D-OR), Brian Schatz (D-HI), Jeanne Shaheen (D-NH), Tom Udall (D-NM), Elizabeth Warren (D-MA), and Sheldon Whitehouse (D-RI) introduced a federally administered Medicare-for-all national health insurance program to "guarantee health care to every American," including specific comprehensive benefits. The Medicare-for-all bill (S. 1804) introduced by Sanders is the senate version of H.R. 676 "Expanded & Improved Medicare for All Act" introduced in January 2017 (and in every Congress since 2003) by John Conyers (D-MI) with 117 sponsors. Sanders’ program would provide freedom of choice so recipients could choose their own doctors, hospitals, and providers, without concern of finding a provider that is in-network or about what the out-of-pocket costs would be. It would also separate health insurance from employment, leaving employers free to run businesses without having to provide insurance to employees and employees free not to stay at "jobs they dislike simply because of the health benefits." The executive summary notes that the current health care spending is unsustainable and this proposal would be "far simpler, more efficient and more cost-effective."

The program would be implemented over a four-year period:

  • In Year 1, traditional Medicare would be improved by including coverage of dental, vision, and hearing aids for seniors and the disabled, reducing eligibility age to 55 years, and eliminating deductibles for Medicare Parts A, B, and D. That year, eligibility would also be extended to children ages 0-18, and a Medicare transition plan would be established to provide affordable coverage for everyone else and ensure no one loses coverage.
  • In Year 2, the Medicare eligibility age would be reduced to 45 years.
  • In Year 3, the Medicare eligibility age would be reduced to 35 years.
  • In Year 4, entitlement to comprehensive health care services would be extended to every resident of the U.S. who would be provided with a Universal Medicare card.

Medicare-for-all could be funded by several options, according to a document released by Sanders, ranging from imposing a 7.5 percent income-based premium paid by employers, creating a 4 percent income-based premium paid by households, making personal income tax and the estate tax more progressive, or imposing a one-time tax on currently held offshore profits.

Graham-Cassidy-Heller-Johnson proposal. Also introduced on September 13, 2017, the legislation sponsored by Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), Ron Johnson (R-WI), and former U.S. Senator Rick Santorum (R-PA) would repeal the ACA and replace it with a block grant program run through the Children’s Health Insurance Program (CHIP). Offered as an amendmentto the American Health Care Act (AHCA) (H.R. 1628), the proposal aims to "[remove] the decisions from Washington and [give] states significant latitude over how the dollars are used to best take care of the unique health care needs of the patients in each state." It would also more equally divide funding across the states by 2026 because under the current program four states get 37 percent of ACA dollars, according to the proposal’s Frequently Asked Questions document.

Under the proposal, instead of funneling government money into ACA initiatives like Medicaid expansion, tax credits, cost-sharing reduction subsidies, and the basic health plan, states would receiving grant dollars on an annual basis. Those funds would be used to help people purchase health benefit coverage through premium support, enter into arrangements with insurer to encourage market participation, pay providers, help with out-of-pocket costs, create high risk or reinsurance pools, or use as much as 20 percent of the grant to help the traditional Medicaid population.

Among the major points of the proposal are the following: (1) repealing the individual and employer mandates; (2) repealing the medical device tax; (3) strengthening the ability of state to waive ACA regulations; (4) returning power to states and patients by equitably distributing block grants across states; and (5) protecting patients with pre-existing medical conditions.

For a description of the AHCA, see Republicans present health reform that is neither repeal nor replacement, March 7, 2017.

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