PUBLISHED ARTICLES
Medicare Direct was first unveiled via a three-part series on the Health Affairs blog. We link to those articles here as well as other work we have published that contributes to the Medicare for All and public option debates.
A Single Public Plan Option Versus A Multiplan Approach: A Colorado Case Study
Colorado and Washington State are in the process of implementing public option programs. Other states continue to explore similar actions as well as a variety of Medicaid buy-in proposals. A core consideration states implementing these programs face is whether to allow multiple public option plans (potentially offered by multiple carriers) to any given consumer or just a single public option plan. In both forerunner states and presumably those to follow, policy makers are charged with striking a delicate balance between maximizing affordability and maintaining market stability, including in their exchanges, where such plans are likely to be offered.
Medicare Direct, A Blueprint For Public Option Waivers, Part 3: Waiver Design, Legal Authority, And Conclusion
Through a combination of existing waiver authority under sections 1332 and 3021 of the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) may approve state-initiated waivers to introduce these plans in their health insurance exchange markets. In previous posts, I detailed the administration, financing, benefits, provider network, and reimbursement levels for the Medicare Direct program. In this post, I explain the legal and policy foundation of the waivers necessary to execute it.
Medicare Direct, A Blueprint For Public Option Waivers, Part 2: Benefit Design, Provider Networks, And Reimbursement
In my first post of this series, I outlined the rationale, administration, and financing terms for a state-initiated, Medicare-based public option waiver program that I call Medicare Direct. In this post, I will address the core design components identified above. In the final post, I will present the key elements and legal basis for the combination of waivers that would allow states to proceed with the program without the need for congressional action.
Medicare Direct, A Blueprint For Public Option Waivers, Part 1: Introduction, Administration, And Financing
In the absence of federal legislative action, states have an opportunity to advance the concept’s core principles—lower-cost, higher-quality coverage delivered via a trustworthy, public-interested platform—using a unique combination of waiver authorities permitted under current law. I suggest such a program be titled Medicare Direct.
Medicare For All Can Begin In 2021: Here’s How
While Democratic presidential candidates and the newspaper headlines hash out the ideological nuances of a Medicare-based single payer coverage scheme, work is underway to consider how coverage can be expanded to those in need within a realistic timeframe at minimal cost or disruption to the existing system.
Public Option 1.0: Washington State Takes An Important Step Forward
On Sunday, the Washington State legislature passed a bill to create standardized health plans in the state’s Exchange and establish new public option-ish plans that contract directly with its Health Care Authority, which operates the state’s Medicaid program. The hallmark of these new plans, and the foundation of their claim to the title “public,” is they are required to cap provider reimbursements at Medicare-based levels.
Creating Medicare Advantage Premium Support For All, Part 5: Which Proposal Is Actually Medicare?
Instead, I continue to believe that a regime that truly leverages the existing Medicare program in a way that minimizes disruption and maximizes market forces will produce the cheapest, highest quality, most sustainable, and – to use a loaded term – American result.
Creating Medicare Advantage Premium Support For All, Part 4: Financing
In this post, I will illustrate how current spending by the federal government, states, and employers could be repurposed to fund universal Medicare coverage that emphasizes competition among private, Medicare Advantage plans and the traditional fee-for-service option, deployed via a premium support benefit model.
Creating Medicare Advantage Premium Support For All, Part 3: Provider Considerations
In this post, I will examine what a Medicare Advantage (MA)-based universal coverage regime would mean for providers, who will continue to be the heart of our system and whose decisions affect the cost and quality of our care more than anyone else’s.
Creating Medicare Advantage Premium Support for All, Part 2: Benefit Design
Not coincidentally, before the quixotic rise and fall of the Graham-Cassidy bill, we saw a boomlet in the debate over a Medicare-for-all approach to universal coverage. So I would like to continue our inquiry into what the concept really means and try to answer the question: Is a bipartisan solution possible?
The Bipartisan ‘Single Payer’ Solution: Medicare Advantage Premium Support For All
My goal with this post is to demonstrate that a “unified” (punchline: It wouldn’t truly be single payer…), market-driven, federally regulated, privately delivered system need not possess any of these objectionable attributes. In fact, the parameters of such a system are all but staring us right in the face. I call it: Medicare Advantage Premium Support for All (MAPSA).