'Medicare for All' not likely to gain traction, former Senate leaders say

July 1, 2019


DALLAS — "Medicare for All" will remain a centerpiece of political debate up to and beyond the 2020 presidential election, but there is little chance Congress will pass such a sweeping overhaul of the health care system anytime soon, two former Senate leaders told the Catholic Health Assembly.

"It is embedded in the political narrative over the next 18 months, but probably for much longer than that," said former Senate Majority Leader Bill Frist of Tennessee. "Why? Because Medicare for All is really asking for better value, better access, less chaos. It's having an impact."

Former Senate majority leaders Tom Daschle, left, a South Dakota Democrat, and Bill Frist, a Tennessee Republican, discuss the nation's fractious health policy debate and identify potential areas for bipartisan cooperation on June 9 at the Catholic Health Assembly.
Photo by Jerry Naunheim Jr./© CHA

Frist, a Republican who now chairs the executive board of the health service private equity firm Cressey & Company, appeared onstage with former Senate Majority Leader Tom Daschle, a South Dakota Democrat and chief executive of the Daschle Group, a strategic advisory firm. During their hour-long "chat" the two men staked out areas of potential political consensus, in stark contrast to the hyper-partisan tenor of Washington politics today.

They speak at least once a month, touching upon the central questions of how best to go about strengthening the individual market for health insurance and how to arrive at consensus on the proper role of government in U.S. health care finance and infrastructure.

Daschle said the Affordable Care Act, which was signed into law in 2010, was the most recent attempt to answer the question about the role of government in health care finance.

As the ACA has been weakened by court decisions, congressional actions and regulatory changes, several prominent Democratic presidential hopefuls — including Vermont Independent Sen. Bernie Sanders — have touted Medicare for All. But Frist and Daschle agree that there is no clear consensus on what is even meant by Medicare for All. Some proponents favor universal coverage while others think a Medicare option should be available to people beginning at age 55.

"Medicare is a great program and both of us have worked hard to make it better," said Frist, a heart and lung transplant surgeon who was Senate majority leader from 2003 to 2007. He succeeded Daschle in that leadership role. He said Medicare coverage has gotten better in the last decade or so. "Still, it only pays for about 60 percent of the overall health care cost for seniors." Medicare excludes coverage for vision, hearing and long-term care.

Medicare has four distinct categories of coverage: hospital coverage, physician coverage, Medicare Advantage and prescription drug coverage. Daschle said Medicare Advantage Plans administered by private insurers have been growing in popularity since they were introduced in the 1990s. About one in three Medicare beneficiaries are enrolled in these plans today.

How Medicare is extended to "all" will bear heavily on the costs of the program, Frist said. If "for all" means 350 million people, Medicare will become a $30 trillion program that will significantly increase Americans' tax bills, he warned. By contrast, the taxpayer share of the Affordable Care Act is about $1 trillion.

"So then the Medicare for All when you start dissecting it starts to lose some support," said Frist, who added that support still remains strong at 62 percent.

But tell people that they will have to give up their private insurance or see a significant jump in their taxes, he said, and the support erodes. Frist stressed that the price of Medicare will grow significantly even if it is not expanded beyond those already eligible. The Congressional Budget Office forecasts that Medicare will grow to about 6 percent of the gross domestic product within 10 years, he said, compared to 3.2 percent today if no changes are made.

"I think it's fair to say there is little likelihood that Medicare for All is going to pass any time in the future," Daschle said.

"There's strong support for an employer-based system. There's strong support for Medicare. What we haven't really been able to figure out is how do we fix the individual marketplace adequately," he said.

He added there is significant bipartisan support for requirements that insurers provide coverage for people with preexisting conditions. That requirement was established by the ACA but is being challenged by a group of Republican attorneys general and governors in Texas v. United States, a case that is before the Fifth Circuit Court of Appeals. The circuit court could affirm through the appeals process the lower court decision to repeal the ACA's mandate that requires individuals to have credible health insurance coverage. If that happens, the rest of the ACA could be struck down. Frist said a repeal of the individual mandate will spark a rise in uncompensated care at U.S. hospitals.

Daschle said it is possible that Congress could reach bipartisan consensus on a reinsurance program to shore up insurance coverage for people with preexisting conditions.

The ACA passed without a single Republican vote. Frist and Daschle agreed that the partisan nature of its passage plays a major role in the ongoing rancor over the law. "It's an absolute truism, the only permanent legislation is bipartisan legislation," Daschle said.


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