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Medicare for all?

Kaplan, Louise PhD, ARNP, FNP-BC, FAAN, FAANP

doi: 10.1097/01.NPR.0000580796.97474.91
Department: Advocacy in Practice

Louise Kaplan is an associate professor at Washington State University Vancouver, Vancouver, Wash., and family NP at Tumwater Family Practice Clinic, Tumwater, Wash.

The author has disclosed no financial relationships related to this article.

Healthcare is emerging as a pivotal issue in the 2020 presidential race with “Medicare for All” as a rallying point. Several aspects of Medicare for All proposals are important to consider before deciding whether and how the healthcare system would change.

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What is Medicare for All?

Democratic presidential candidate Senator Bernard Sanders of Vermont, a leading proponent of Medicare for All, is the prime sponsor of S. 1129—Medicare for All Act of 2019.1 The bill proposes to establish a national health insurance program for every resident of the US.

Unlike the current traditional Medicare program (Parts A and B), the proposal would ensure coverage for oral health, audiology, and vision services; direct states to offer institutional long-term care services; and there would be no copayments or deductibles.1

Representative Pramila Jayapal, a Democrat from Washington, is the prime sponsor of the House of Representatives bill H.R. 1384—Medicare for All Act of 2019.2

The House bill offers coverage similar to the Senate bill noted above as well as eliminating private insurance that would offer the same service as the Medicare plan would. Notable differences include the House bill being implemented with a shorter time frame; a provision for the Department of Health and Human Services to adopt standards for “mandatory minimum safe RN-to-patient staffing ratios and optimal staffing levels for physicians and other health care practitioners”; healthcare institutions would be subject to global budgeting (a fixed payment) and healthcare providers, such as physicians working in hospitals or similar facilities, could be salaried or paid for services under a new federal pay scale.3

There are an additional 7 plans that would expand healthcare coverage, 6 of which are sponsored by members of Congress with 1 promoted by the Urban Institute. Three of these plans would cover all individuals in the US, 6 would require premiums and purchasing insurance through employment, 3 would require a tax increase, and all 9 would empower the government to regulate healthcare prices.4

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Public opinion

In a January 2019 Kaiser Family Foundation poll, 51% of participants favored a Medicare for All proposal; 74% favored an optional Medicare for All program, 75% favored a Medicaid buy-in program, and 77% favored a Medicare buy-in for individuals ages 50 to 64.5

A CNN poll conducted in late June 2019 found 56% of respondents supported a national health insurance program for all Americans even if it would require higher taxes.6

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What should NPs do about access to healthcare?

The 2020 presidential election serves as an opportunity for NPs to critically analyze access to healthcare under the current system and compare the various proposals. The 2020 elections are also an opportunity for NPs to query all candidates running for federal office about their position on changing Medicare law to allow NPs to certify patients for home health, document the face-to-face home health patient assessment, and order diabetic shoes. An important aspect of advocacy is educating policy makers about barriers to practice and access to care. Speak up, speak out, and make a difference!

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1. United States Senate. S.1129—Medicare for All Act of 2019. 2019.
2. United States House of Representatives. H.R. 1384—Medicare for All Act of 2019. 2019.
3. Ollstein AM, Kenen J. From abortion to immigration, things you didn't know were in Medicare for All. 2019.
4. Kliff S, Scott D. We read 9 Democratic plans for expanding health care. Here's how they work. 2019.
5. Kaiser Family Foundation. Public opinion on single-payer, national health plans, and expanding access to Medicare coverage. 2019.
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