SEN. KAMALA HARRIS (D-CALIF.): I support the bill [Medicare-for-all].
HARRIS: So, it doesn’t get rid of all insurance.
TAPPER: OK. It doesn’t get rid of all insurance.
HARRIS: OK. Right.
TAPPER: ... but for all essential health care benefits.
— exchange on CNN’s “State of the Union,” May 12, 2019
This is one of those inside-the-Beltway exchanges that probably leaves many Americans scratching their heads. Harris, a 2020 presidential hopeful, is a co-sponsor of Sen. Bernie Sanders’s plan to create a “single-payer” government-run health-care system. It’s called Medicare-for-all since it will be more all-encompassing than the current government-run program for the elderly.
Harris made these remarks after Tapper asked her if she wanted to clarify comments she had made in a CNN town hall in January. At the time, her remarks “let’s eliminate all of that” were widely interpreted to mean doing away with private insurance. In her recent appearance, she argued that in context she was talking about health-care bureaucracy today. (Rereading the full exchange, she has a point.) She said she did think there was a role for private insurance in the government-run system.
That’s when Tapper interrupted to say that under the bill, there’s virtually no role left for private insurance.
So what’s going on here?
As of 2017, according to the Census Bureau, 67 percent of Americans — 217 million people — received health insurance through a private plan, mostly through their employer. Almost 38 percent get insurance through a government plan, such as Medicare, Medicaid or the military. Another 9 percent have no insurance. (The numbers add up to more than 100 percent because people can be on more than one type of plan in a given year.) The Sanders bill would put the whole country on a government plan.
Sanders himself has been clear that he sees no role left for private insurance. When the Republican National Committee highlighted his comment that he wanted to “get rid of the insurance companies,” Sanders tweeted: “You’re damn right.”
So what is Harris referring to? A few lines in the bill.
Section 107 would make it illegal for any private health insurer to sell coverage that duplicated benefits under the law or for any employer to duplicate the benefits, but adds that nothing on the proposed law would prohibit the sale of health insurance for benefits not covered under the bill.
Okay, but the bill proposes to cover just about everything. Hospital services. Primary and preventive care. Prescription drugs and medical devices. Mental health care. Lab work. Pediatrics. Dentistry. Hearing and vision care. Rehab. Emergency services. Even long-term care.
Currently, people on Medicare can buy Medigap insurance, which covers co-payments and deductibles. But the Sanders bill would eliminate the need for that, too, as Section 202 decrees “no cost-sharing.”
It’s worth noting that the Sanders plan would be more sweeping in its coverage than just about any existing universal health-care system. For instance, Canadians must buy private insurance for prescription drugs, dentists and optometry, while Britain has a parallel private system that about 10 percent of the population participates in.
(There is another part of the Sanders bill, Section 303, that analysts say might allow for a boutique primary care practice catering only to wealthy people. It allows for doctors and hospitals to enter into private contracts with patients, but with real limitations. Providers that don’t participate at all in Medicare could enter into such contracts. Providers that do participate in Medicare would have to agree not to submit a claim for any patient for one year after providing care outside the system for any given patient.)
What’s left out of the Sanders plan? Tapper mentioned cosmetic surgery. So has Rep. Pramila Jayapal (D-Wash.), the primary sponsor of a Medicare-for-all bill in the House.
That’s elective surgery generally not covered by health insurance. But insurance is purchased to defray costs for unexpected health problems. Who buys (or sells) insurance for the unexpected nose job or facelift? You can buy insurance for complications from cosmetic surgery, but that’s not going to be an especially large business.
“You are correct that the benefits package is extremely generous; private insurance would not be needed at all because everything that is medically necessary for any given individual would be covered under Medicare-for-all,” said a Sanders aide. But she added: “Under Medicare-for-all, private insurance could continue to exist to cover anything not covered by Medicare, such as private hospital rooms, institutional long-term care and voluntary care.” (Institutional long-term care, such as nursing homes, under the Sanders bill would continue to be covered under Medicaid, the health program for the poor.)
“As a technical matter, the Medicare-for-all bill would allow private insurers to sell supplemental policies for benefits not covered by the government plan,” said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation. “As a practical matter, the government plan covers such a comprehensive set of benefits that there would be virtually no role for private insurance.”
Medicare-for-all “might strongly disincentivize private health insurance, and I think it’s right to ask about what the role of private health insurers would be in this system — but the bill itself doesn’t categorically ban private health insurers,” said Katie Keith of the Center on Health Insurance Reforms at Georgetown University. She suggested that private insurance companies might continue to have a role as claims administrators.
Ian Sams, a spokesman for Harris, said she spoke accurately about the law. “The bill’s language expressly allows supplemental insurance to cover any care/procedures not explicitly covered under the single-payer plan by law,” he said. “So this would allow at least some level of private insurance to continue operating within the marketplace.”
The Bottom Line
Call us skeptical, but Section 107 looks like a loophole for single-payer supporters to claim that private insurance is not being eliminated, even as the main sponsor says he wants to put health insurance companies out of the business. There is virtually nothing left on the table but a few crumbs. Harris called it “supplemental insurance,” which sounds a lot like Medigap policies, but the reality is likely far different than that.
Given the back-and-forth between Harris and Tapper, we can’t quite award Pinocchios. But her language is slippery. She could more forthrightly admit that the health plan she supports envisions virtually no role for the private insurance now used by nearly 220 million Americans.
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