Covers all Americans without regard to employment status over a two-year implementation period.
2.5 million more of uninsured will be covered but total uninsured still estimated to number over 10.6 million.
Expands ACA subsidies above 400% of poverty and increases subsidies for those making between 100% and 400% of the poverty level, for two years (2021 and 2022).
Includes financial incentives to states to expand Medicaid.
COBRA coverage for laid off workers from April 1 to September 30.
Establishes public option for uninsured individuals, families, and small businesses, covering primary care services without cost-sharing.
Extends eligibility for the premium tax credit to those at and above 400% of the Federal Poverty Level (FPL), limits individuals to paying 8.5% of their income and reduces the percentage of income an individual below 400% of FPL will contribute toward a plan.
Who is covered
Any resident of the U.S. and family members.
Undocumented immigrants (3.9 million people) ineligible.
Millions still uninsured or underinsured.
Plan available in areas with one or no options on the Federal- or State-based individual exchanges. Over four years, the plan would expand, starting in areas with high-cost plans and those with fewer plans offered, including health professional shortage areas and rural areas, to all rating areas and the Small Business Health Options Program Marketplace.
Undocumented are not eligible.
Millions still uninsured or underinsured.
What is covered
Robust coverage, including dental, hearing aids, vision, home health care, and long-term care.
Negotiates drug prices.
Does not cover dental, hearing aids, vision, or home health, vision.
Coverage is premium-based depending on gold, silver, or platinum level and size of risk pool. Current plans generally exclude dental, hearing aids, vision, and home health care. Added coverage is dependent upon actuarial cost analysis to be determined.
Negotiates drug prices.
Complexity
One simple easily understood Universal plan. Choice of provider and no narrow networks or surprise bills.
Complexity & fragmentation of health care system maintained & expanded. Narrow networks remain.
Adds still another option to an already complex and fragmented system
Cost to you
No premiums, deductibles, or copays.
COBRA and subsidized health insurance exchange policies will have deductibles and copays as required by plan level.
Risk of surprise bills continues.
Covers primary care services without cost-sharing; creates options in the silver and gold tiers with flexibility to add bronze and platinum options. Adequate premiums are required to finance program. Deductibles and copays will continue.
Risk of surprise bills continues.
Financial impact
Administrative savings of $600 billion/year. Prescription drug savings of $200-$300 billion/year and additional savings with global health budgets. Over 10 year period estimated to lower overall health care costs by $2-$5.1 trillion over current system and reduce Health Consumption Expenditures to 15.8 percent of GDP.
Net costs of health care for middle income families fall by between 2.6 and 14.1% of income. Taxes for high income families will rise slightly.
Centers for Medicare & Medicaid Services estimates national health care spending reached $3.81 trillion in 2019 and would increase to $4.01 trillion in 2020 and that by 2028, health care spending would reach $6.19 trillion, accounting for 19.7 % of GDP, up from 17.7 % in 2018. Plan will contribute to overall rise in health care spending.
Authorizes three years of funding for a national reinsurance program at $10 billion per year to help cover the cost of high-cost patients. Plan is premium based depending upon risk pool and other factors to be determined.
No overall reduction in health care spending.
Duration
Benefits run from birth to death.
Enhanced subsidies only last two years. COBRA extension expires September 30, 2021.
Benefits run while premiums are paid
Justice
Heals the health care disparities experienced by people of color.
Continues to exacerbate structural racism and economic inequities.
Continues to exacerbate structural racism and economic inequities.
Other provisions
Ends the disparity of coverage for all Americans, covers long-term services and supports, provides for global budgeting of hospitals and nursing homes, equalizes access to health care, eliminates price gouging for drugs by authorizing price negotiation, and eliminates the profit motive from health insurance coverage.
Provides $20 million for marketplace modernization to help state-based marketplaces update their systems.
Providers who participate in Medicare and/or Medicaid must accept Medicare-X plan patients and must serve plan holders on similar terms and conditions as any other Federal or State health plan holder. Providers may opt out only in exceptional circumstances. The HHS Secretary may enroll additional providers, such as pediatricians and OBGYNs. The plan will reimburse providers at 100% of Medicare fee-for-service (FFS) rates, with flexibility for the secretary to reimburse up to 150% of Medicare rates for hospitals and physicians located in rural areas.
Authorizes $50 million for the Department of Justice Antitrust Division and $100 million for the Federal Trade Commission for each of the following five years to investigate health care markets and anticompetitive practices and take appropriate enforcement action.
