Thread by @charles_gaba

It is. It basically splits the difference between Biden/Buttigieg's plans and Bernie/Warren's plan. Similar to Harris' plan, but phased in more quickly because it deals with the "union contract" issue differently.

https://twitter.com/magi_jay/status/1185935407151828992

FWIW, here's my deep dive into #Med4America (warning: it gets wonky...on the other hand, it also includes colorful psychedelic donuts!):

acasignups.net/19/05/16/reall…

OK, here's the visuals to give a sense of how it'd be phased in:

Here's the current healthcare coverage situation for the entire U.S. population...the "Psychedelic Donut®" as I've dubbed it:

For the first 2 years, #Med4America would act as a combined #ACA2.0 + Public Option (think Biden/Buttigieg), in order to give time for the rest of the industry & HHS to get their ducks in a row. This alone should cut the uninsured rate in half right off the bat.

In year 3, #Med4America would result in universal coverage--anyone not already covered by their employer or by an existing public program would be enrolled. Existing Medicare would have its coverage expanded greatly, but current enrollees could keep paying their current premiums.

In years 3, auto-enrollment would also start for newborn children and those turning 65 (that is, they'd enroll into the more comprehensive version of Medicare). Employers could still offer private coverage, but only if it was comprehensive & gold-level or higher (no junk plans).

In addition, starting in year 3, small business employers OR employees would have the OPTION of making the switch...including regulations preventing employers from forcing only their sickest employees to do so. At this point around 1/3 of the population would be enrolled.

By year 5, CMS, state health depts. & the rest of the industry would have had 5 years to prepare for #Med4Am to take over Medicaid, CHIP & dual-eligible enrollees. This, combined w/some *voluntary* small group, FEHBP, IHS & Tricare transferees would mean ~2/3 would be enrolled.

By year 7, around 70% of the country should be enrolled in the new program (either traditional or Medicare Advantage, which would have to be AT LEAST as comprehensive as the publicly managed version). Large employers/employees would have the option to make the move at this point.

Remember, however, that coverage provided by both large *and* small group employers would have to be HIGH QUALITY...dental, vision, optical, LTSS, etc...at gold level or higher. Alternately, they could move employees to Med4Am & pay a flat 8% payroll tax instead.

What if the employer refused to make the switch but an employee wanted to? No problem: The employer would have to allow them to do so and continue to pay their portion of the employee's premiums. And again, there are provisions to prevent "pushing" specific employees to do so.

In terms of out of pocket (OOP) costs: NO deductibles for anyone, and NO premiums/OOP for 28% of the population. Over that it's a sliding scale like the ACA, but MUCH more robust: No one would pay more than 8% of their income in premiums, w/$5K max OOP at the high end.

So a family of 4 earning up to $50K wouldn't pay anything. Same family earning $100K would pay no more than 6% of their income (4% + up to $2K) no matter what. The absolute MOST a family of 4 would pay TOTAL would be 11.2% of their income, and that's only if they earn ~$150K.

For anyone concerned about network adequacy (ie, what if there aren't enough doctors/nurses/etc. due to it not reimbursing enough), it also includes a robust student debt forgiveness program.

Basically, it's a very well thought-out plan from @rosadelauro & @RepSchakowsky which crosses as many t's and dots as many i's as possible. It achieves universal, comprehensive, portable, affordable coverage as quickly as possible while pissing off as few people as possible.