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Ari Ne'eman @aneeman
, 19 tweets, 5 min read Read on Twitter
In honor of #Medicaid's birthday, I'm going to do a quick thread on why I believe #MedicaidForAll makes a great deal more sense than #MedicareForAll. #Medicaid53
First, most #MedicareForAll proponents describe a health care program that looks a lot closer to Medicaid than it does to Medicare, in terms of benefits & cost-sharing.
This Vox piece from @singlepayertom and @_Middleman says #MedicareForAll should mean zero cost-sharing. Medicare doesn't work that way - Medicaid does.…
Medicare comes with significant premiums and cost-sharing. The only Medicare enrollees who do get zero cost-sharing are those that are also enrolled guessed it...Medicaid!
Advocates for #MedicareForAll stress the importance of a publicly operated program. Again, Medicare doesn't actually work that way. One-third of Medicare beneficiaries are in privately operated "Medicare Advantage" plans.
Within the remaining 2/3rds, private health plans are still used to manage the Medicare Part D prescription drug benefit. Everyone on Medicare interacts with an insurance company if they need prescription drugs.
Medicaid has also witnessed a significant shift to Managed Care - health plans managing Medicaid benefits under government contract. Most Medicaid beneficiaries have some portion of their benefits in managed care today.
But a minority are receiving fully publicly managed services. There are arguments in both directions as to if managed care is good or bad, but if you want a fully public system, Medicaid is closer to that than Medicare.
More importantly, Medicaid has a more comprehensive benefits package than Medicare - including coverage of long term services and supports and a strong preference for community-based services that doesn't exist in Medicare.
Existing Medicare beneficiaries who need long term care services - or help with cost-sharing or other key benefits - usually rely on qualifying for Medicaid too.
There are also some important political arguments for making Medicaid the backbone of a future health care reform too.
First, since Medicaid is state-operated and has an open-ended federal match, it's possible to pursue incremental state by state experiments to prove viability - as we're already seeing with proposals in Gubernatorial races.
Second, Medicaid Buy-In proposals (a la Sprinklecare) mean that Medicaid can be the foundation for state public options that allow middle-income people to "buy-in" to Medicaid, possibly setting the stage for further expansion of the public system later.
Third, Medicaid already has lower provider reimbursement rates than Medicare, so expanding the number of people covered on Medicaid would realize greater cost-savings.
There are risks that this might reduce access - but this would likely be mitigated by the greater market power that Medicaid as a primary payer would have.
Most importantly, there are dozens of major unanswered policy questions that exist about how #MedicareForAll would become viable. Most of the answers rely on making Medicare more like Medicaid.
It is only the relative popularity of Medicare - relative to Medicaid, a program that is still viewed as "for the poor" - that has made #MedicareForAll the slogan for advocates.
But at a policy level, Medicaid offers a superior foundation for future health policy efforts. We should lean in to supporting Medicaid - in part because it continues to be under attack from the GOP.
By making the case for expanding Medicaid as the future of American health care, we can protect it now and lay the groundwork for good health policy later. #Medicaid53
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