“Build back better” sets up a government option and paves the way for a single payer



While negotiations over the staggering price of the $ 3.4 trillion “Build Back Better” plan continue to cause concern, the health policy agenda presented in the plan is equally alarming.

At first glance, some might argue that the Build Back Better plan takes a more modest approach to healthcare by avoiding the inclusion of a full-fledged, government-run, single-payer proposal. Yet the various health care provisions of the proposal taken collectively expose an agenda to use a public option to pave the way for single payer health care.

Instead of “Medicare for All,” a congressional proposal to ban private insurance and put everyone on a government-run health plan, Build Back Better is taking key steps in that direction. The proposal focuses on strengthening and expanding the Affordable Care Act footprint by removing income limitations on grants, making existing Affordable Care Act grants more generous, and creating a new option. federal similar to Medicaid.

Much of this progressive path to government-run health care hinges on the creation of the new government option of Medicaid. The Build Back Better plan starts small by targeting this new federal program only to people who reside in states that have chosen not to adopt the Obamacare Medicaid extension.

After a transition period, the secretary of the Department of Health and Human Services would contract with two entities to administer the government option (most likely a boon to existing Medicaid managed care plans). Benefit requirements under this new program would largely follow those outlined in Medicaid and there would be no cost-sharing requirement for participants.

Once the federal infrastructure is in place, the next phase would be to gradually open up access to the government option. The legislation already provides for expansion. It includes language to realign federal payments to allow states that have extended Medicaid under Obamacare to enroll these people in the government option.

The bill would also displace people who participate in the exchange but who would otherwise be eligible for Medicaid as part of the Obamacare expansion into the government option.

The bill also creates a pool of potential enrollees for the government option by increasing the number of people eligible for grants in the exchange by lifting this income restriction and relaxing the restrictions to allow those with access to employer’s coverage to enroll in the exchange. .

Under the rules of the new program, the secretary has broad authority to administer and execute the program. This means the secretary can tip the rules in favor of the government option by making the government plan (at least on the surface) appear more generous and affordable than private competitors.

For example, the bill allows the secretary to set lower payment rates than private competitors. While providers may balk at lower payment rates and decline to participate, other government option proposals allow the secretary to require suppliers to participate in the public option. It is therefore not excluded that these harsh tactics can also be applied within the framework of this plan.

Without significant reforms, costs and premiums will continue to rise in the Obamacare exchange. The Obamacare system today gives insurance companies more taxpayer money every time they raise prices – a recipe for the higher costs and fewer, worse choices we’ve seen in the program. Rather than taking this problem head-on and tackling the government policies that underlie it, this new agenda deals with it with a bigger government.

The single-payer “solution” would of course be to open up access to the government-managed option. This would drive out private competitors, leave the government option as the only option and open the door to the single payer.

Of course, this is where the single payer fantasy meets reality. Generous benefits would increase demand, and increased demand would increase costs. Either politicians would have to raise taxes – some estimates predicting the need for an additional 20% payroll tax – or start rationing access to care as is done in countries with single-payer models.

While it may seem like the push for a single payer has faded, the reality is that the Build Back Better plan continues to lead the way towards a single payer on the installment plan.

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