Thread by @charles_gaba

📣 Since @NikkiHaley decided to remind everyone that @NeeraTanden's organization, @AmProg, produced a universal healthcare plan called "Medicare Extra for All", let's take a look at the plan (which was actually spearheaded by @TopherSpiro, I believe). 1/
acasignups.net/18/04/11/updat…

Note: I wrote up my analysis of Medicare Extra for All (#MEFA) back in February 2018, and in May 2019 I wrote an analysis of the House bill largely based on it, #MedicareForAmerica, sponsored by @RosaDelauro & @RepSchakowsky. 2/

Full disclosure: From June 2019 - last month, I was contracted w/@AmProg to do part-time healthcare analysis. However, my analyses of both #MEFA & #MedicareForAmerica were done prior to this, and this thread is being written after my contract expired) 3/

The basic idea of both #MEFA & #Med4America is based on the fact that nearly half the U.S. population has healthcare coverage via their employer...while the other half have a patchwork of Medicare, Medicaid, ACA plans, miscellaneous plans, junk plans or no coverage at all. 4/

The political Catch-22 of this is that the very inefficiencies & inequities of the current situation are also the same things which make it so difficult to overhaul. There are problems in every category, but there's also pushback from those in most of these categories. 5/

During the Dem primary, the two main issues in the healthcare battle between Bernie & Biden (plus other candidates in each "wing") were over a) funding/taxes and b) making it mandatory vs. optional. 6/

Those were the two which sucked up 99% of the oxygen, although back in 2017, I listed a half-dozen major issues which ANY major overhaul of the US healthcare system has to tackle (whether M4All, MEFA, ACA 2.0, etc). 7/
cracked.com/blog/a-zero-b.…

So, ANY overhaul is going to cause anger/ fear/ concern among a large chunk of the population...and not all of those are along ideological lines.

Like any major piece of legislation impacting 330 million people, you have to walk a tightrope. 8/

The way I described #MEFA was that it tackles most of these issues in a way which a) pisses off the fewest number of people, while b) scaling up gradually enough to cause minimal disruption, but c) quickly enough to achieve universal coverage within 2 Presidential terms. 9/

I'm gonna switch over to my #Med4America writeup instead going forward since it's more in-depth, but the framework is mostly the same. 10/
acasignups.net/20/04/10/reall…

So, again, here (roughly) is the current coverage status of the entire U.S.:
~45% have employer coverage.
~17% have Medicare
~23% have Medicaid
~4% ACA individual market plans
~2% have junk plans (#ShortAssPlans, "sharing ministry" plans, etc.)
~9% have no coverage at all. 11/

For the first two years, #Med4America would basically act like a temporary version of #BidenCare: It would amount to #ACA 2.0 + a robust Public Option for the individual market only.

This would provide time to get the ducks in a row for the next phase. 12/

This *alone* should cut the uninsured rate in half while dramatically improving coverage for *everyone* on the #ACA individual market, which I'd guess would go from ~13 million to ~30 million, give or take. 13/

Starting in yr. 3, the uninsured, plus newborn children & those turning 65 would be auto-enrolled in #Med4Am. The current #ACA individual market would also shift to Med4Am.

Current Medicare enrollees would gain the extra coverage but wouldn't pay any more than they do now. 14/

Also starting in yr. 3, EMPLOYER PLANS would have to be GOLD-LEVEL+. No more "skinny plans"...all private plans would have to be solid. Small biz could also switch their employees to Med4Am if they wish...or sm. biz employees could individually. 15/

At this point we'd have achieved universal coverage...but still broken into a (less complex) patchwork. Perhaps 30% of the population would be enrolled in #Med4Am. 16/

With the dust having settled, the system having adjusted & Medicaid/CHIP programs having had 4 years to prepare, Year 5 would be the biggest shift: Medicaid/CHIP enrollees would be absorbed into the system. FEHBP, IHS & TriCare enrollees could *voluntarily* move to it. 17/

By Year 6, you'd have 100% universal coverage, w/perhaps ~60% of the population being enrolled in #Med4Am & the other ~40% still having Gold-level+ private employer coverage. The "Psychedelic Donut" would be dramatically simpler vs. today. 18/

Finally, in Year 7, *large* employers would have the *option* of shifting their employees over to #Med4Am, *or* their *individual employees* would have the option of doing so if the employer chose not to. The employers would pay a flat 8% payroll tax if they made the move. 19/

By Year 8 on, around 2/3 of the population would have Med4Am coverage, the other 1/3 would have employer plans.

After that, it would really depend how various employers and/or individual employees felt. Some companies might make the move & pay the flat 8%...others might not. 20/

As @TopherSpiro noted, the @AmProg version of this plan (#MEFA) had a 10-year cost analysis which projected that it would add between $2.8 - $4.5 trillion to current federal spending, or around $300 billion LESS than we're currently projected to spend. 21/
acasignups.net/20/12/02/caps-…

Of course, neither #MEFA *nor* #Med4America are gonna happen in the near future. Even if Dems flip both Georgia Senate seats in the January runoffs, a 50+VP Senate majority & a 5-6 seat House majority means even #BidenCare (which is still a massive upgrade) would be tough. 22/

As I noted the other day, my personal guess would be:

IF Dems flip both GA seats:
--ACA is saved from SCOTUS
--ACA 2.0
--either Medicare 60+ *or* a weak PO

IF Dems *don't* flip both GA seats:
--ACA's fate depends on SCOTUS
--*IF* ACA survives SCOTUS, *maybe* a weak ACA 1.5

(by "weak ACA 1.5", I mean it's *possible* that Biden could cut some deal with Mitch McConnell to shore up the ACA as it stands today, but he'd have to give McConnell something else in return which I guarantee no one on the left side of the aisle would like.)

#FlipBothGASeats!

Speaking of which...

secure.actblue.com/donate/garunof…

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