{"bills":[{"photos":{"featured":"https://assets.causes.com/bill/photo/s981-116/featured_medicare-x-choice-act-of-2019-1565448349.jpg","featured_large":"https://assets.causes.com/bill/photo/s981-116/featured_large_medicare-x-choice-act-of-2019-1565448349.jpg","shareable":"https://n.causes.com/share-images/bills/s981-116.png"},"introduced_on":"2019-04-02","title_override":"Should Medicare Be Expanded to Establish a Public Option for Individual & Small Business Health Insurance?","summary_override":"

This bill — the Medicare-X Choice Act of 2019 — would build on the Medicare framework to establish a public option on the individual and small business health insurance exchanges. The Medicare-X plan would cover essential health benefits, including pediatrics and maternity care, to align with other plans on the exchanges established by the Affordable Care Act (aka Obamacare). It would also make Advance Premium Tax Credits and Cost-Sharing Reduction (CSR) payments available to enrollees.

Medicare-X would be phased in as follows:

Beginning in 2021, this bill would make Medicare-X available in areas with one or fewer options on the ACA Exchange. The Medicare-X plan would also be available in rating areas with a provider shortage or lack of plan competition, such as Health Professional Shortage Areas (HSPAs) and rural areas.
By 2024, the plan would be available in all rating areas.
Finally, in 2025, it would be available on the Small Business Health Options Program Exchange.

The Health and Human Services (HHS) Secretary would have the authority to contract with outside entities to process claims or administer additional components of the plan. This would include contracting with entities that currently administer certain functions for Medicare. This bill would also direct the HHS Secretary to gather data from State Insurance Commissioners to set adequate premiums.

Some key specifics of this bill are outlined below.

SUBSIDIES FOR PREMIUMS

This bill would eliminate the subsidy cliff by extending premium tax credit eligibility to those at and above 400% Federal Poverty Line (FPL). Individuals at 400% FPL would pay 9% of their income toward the “benchmark plan,” increasing to 13% of their income at 600% FPL and above.

For those below 400% FPL, this bill would reduce the percentage of income they’re expected to contribute to the benchmark plan by 0.5%.

REINSURANCE

This bill would authorize three years of funding for a national reinsurance program at $10 billion per year.

PROVIDER NETWORK REIMBURSEMENT RATES

This bill would require that providers participating in Medicare and/or Medicaid also accept Medicare-X patients. It would direct the HHS Secretary to enroll additional providers, such as pediatricians and OB/GYNs, to provide their specialized services. Providers would be reimbursed at Medicare rates, with flexibility for the HHS Secretary to reimburse up to 125% of Medicare rates for hospitals and physicians in rural areas.

PRESCRIPTION DRUGS

This bill would authorize the HHS Secretary to negotiate drug prices under Medicare Part D and allow the public plan to participate in those arrangements. The HHS Secretary would be encouraged to use value-based payment arrangements for prescription drugs.

DELIVERY SYSTEM REFORM FOR AN ENHANCED HEALTH PLAN

The bill would direct the HHS Secretary to use outcomes-based alternative payment models that are aimed at care coordination for patients with chronic conditions. It would also encourage providers to use innovative technology, such as telehealth and remote patient monitoring, and integrate social services like food, housing, and transportation.

This bill would also authorize the HHS Secretary to establish a grant program to fund broader experimentation with accountable communities for health in order to integrate social needs in health care delivery services.

FUNDING

This bill would set premiums to cover the plan’s full actuarial cost, including administrative costs.

TRADITIONAL MEDICARE

This bill wouldn’t have any effect on benefits offered through Medicare Fee-for-Service (FFS), Medicare Advantage or the Medicare trust fund.

","official_title":"A bill to establish a public health plan.","short_title":"Medicare-X Choice Act of 2019","popular_title":null,"short_summary":"","summarized":true,"cost":null,"cost_commentary":"A CBO cost estimate is unavailable.","impact":"Americans seeking health insurance; Americans seeking a public health care option; Medicare; Part D drug pricing; hospitals; health providers; Medicare and/or Medicaid providers; and the HHS Secretary.","argument_for":"Using the existing Medicare framework to create a public option for health insurance coverage will help create more competition in the health insurance marketplace and give people in rural and undercovered areas another option for medical coverage.","argument_against":"This plan would be tremendously costly to hospitals and healthcare providers, which makes it a nonstarter. It could also be a step along the road to single-payer healthcare that would eliminate employer-sponsored plans, which many Americans are happily on now.","bill_type":"s","published":true,"type":"FederalBill","id":"s981-116","bill_id":"s981-116","formal_id":"S. 981","chamber":"senate","congress":116,"last_action_at":"2019-04-02T00:00:00.000Z","active":false,"enacted":false,"enacted_at":null,"vetoed":false,"last_vote_at":null,"debated_on":null,"congress_url":"https://www.congress.gov/bill/116th-congress/senate-bill/981","plain_text_url":null,"shareable_image_url":"https://n.causes.com/share-images/bills/s981-116.png","congress_full_text_url":"https://www.congress.gov/bill/116th-congress/senate-bill/981/text","is_current_congress":true,"last_version_on":null,"related_bill_ids":null,"progress":"Introduced","house_passage_result":false,"senate_passage_result":false,"position_count":331,"committees":[{"name":"Committee on Finance","chamber":"senate","committee_id":"SSFI","subcommittee":false}],"links":{"rollCalls":"/api/roll_calls?bill_id=s981-116","details":"/api/bills/s981-116/details","sharingMessage":"/api/sharing_messages/s981-116","positionsFor":"/api/bills/s981-116/positions/for","positionsAgainst":"/api/bills/s981-116/positions/against"},"upcoming":false,"cosponsors_count":11,"slug":"s981-116-medicare-x-choice-act-of-2019","latest_chamber_votes_id":null,"official_url":null,"target_video":true,"following":false,"vote_count":1540,"yea_vote_count":1193,"nay_vote_count":345,"passed_house":false,"passed_senate":false,"vote_id":null,"my_position_id":null,"topic_ids":["health"],"issue_ids":["insurance","health"],"sponsor_id":560}],"votes":[],"issues":[{"id":"insurance","name":"Insurance","slug":"insurance","description":"Vote on the latest federal legislation regarding Insurance. Make your voice heard about the issues you care about. \r\n","page_title":"Insurance Legislation - Vote on Bills, Stay informed, Hold Your Reps Accountable","icons":{"black":"https://assets.causes.com/issue/icon/insurance/black_insurance-1429042051.svg","grey":"https://assets.causes.com/issue/icon/insurance/grey_insurance-1429042051.svg","white":"https://assets.causes.com/issue/icon/insurance/white_insurance-1429042051.svg"},"cover_image_url":null,"is_following":false},{"id":"health","name":"Health","slug":"health","description":"Federal legislation around Health, encompassing: the Affordable Care Act, Medicare, Research into diseases (Cancer, HIV/Aids, Ebola), Drug safety, Hospital care and prescription drugs.","page_title":"Health Related US Federal legislation, including Medicare, ACA, and research - Vote on Bills, Stay informed, Hold Your Reps Accountable","icons":{"black":"https://assets.causes.com/issue/icon/health/black_health-1429042037.svg","grey":"https://assets.causes.com/issue/icon/health/grey_health-1429042037.svg","white":"https://assets.causes.com/issue/icon/health/white_health-1429042037.svg"},"cover_image_url":null,"is_following":false}],"users":[{"name":"MarianToon","vote_count":208,"photos":{"large":"https://assets.causes.com/user/avatar/9odNv0jb/large_9odnv0jb-1584407673.jpg","small":"https://assets.causes.com/user/avatar/9odNv0jb/small_9odnv0jb-1584407673.jpg","tiny":"https://assets.causes.com/user/avatar/9odNv0jb/tiny_9odnv0jb-1584407673.jpg"},"links":{"following":"/api/users/9odNv0jb/following","followers":"/api/users/9odNv0jb/followers"},"about_me":"Retired , Mother , Gramma, sibling, progressive, loves my home, t v hound, Artist","twitter_id":null,"facebook_id":null,"youtube_id":null,"google_plus_id":null,"website":null,"slug":"mariantoon","issue_count":29,"is_following":null,"influence_score":1080,"influence_level":30,"follower_count":47,"following_count":101,"position_count":234,"id":"9odNv0jb","partner_id":null},{"name":"jimK","vote_count":523,"photos":{"large":"https://assets.causes.com/user/avatar/9odrQBnb/large_9odrqbnb-1557000969.jpg","small":"https://assets.causes.com/user/avatar/9odrQBnb/small_9odrqbnb-1557000969.jpg","tiny":"https://assets.causes.com/user/avatar/9odrQBnb/tiny_9odrqbnb-1557000969.jpg"},"links":{"following":"/api/users/9odrQBnb/following","followers":"/api/users/9odrQBnb/followers"},"about_me":"Retired, Politically Independent. Won’t listen to slogans, chanted mantras or generally any kind of marketing spin or “rebranding” crap. I firmly believe that everyone else is entitled to their erroneous opinions. Citizen vigilance and due diligence is price we must pay to live in a thriving, functional democracy.\nI fear that our citizens are too easily swayed by politician’s pablum about “babies”, “jobs” and now, in particular, perceived “enemies”. I fear that a citizenry focused on the “here-and-now” is easily tricked by short term benefits that have negative long-term consequences. I fear that our legislators are more concerned about buffing their constituents than looking out for the long-term welfare of our country- and are way too eager to provide those short-term benefits to the “here-and-now” crowd.\nI fear that honor is generally being sacrificed/replaced by expediency. I hear politicians eloquently argue for one side of an issue and later, when it’s to their benefit, just as eloquently argue for the opposite side. OK, so they are good at arguing- but what is that they actually believe? What is it that they actually stand for? An honorable person has values that persist even when it is not convenient or expedient. An honorable person has a moral compass that stops them from doing something wrong even if it is not illegal. A foul is a foul- even if the referee doesn’t catch you.\nI fear that each of our federal governmental branches have devised or discovered shortcuts which tend to protect them from the checks and balances our founders intended.","twitter_id":null,"facebook_id":null,"youtube_id":null,"google_plus_id":null,"website":null,"slug":"jimk","issue_count":4,"is_following":null,"influence_score":42330,"influence_level":40,"follower_count":1438,"following_count":76,"position_count":516,"id":"9odrQBnb","partner_id":null},{"name":"Robert ","vote_count":423,"photos":{"large":"https://assets.causes.com/user/avatar/49VrwED9/large_49vrwed9-1492274632.jpg","small":"https://assets.causes.com/user/avatar/49VrwED9/small_49vrwed9-1492274632.jpg","tiny":"https://assets.causes.com/user/avatar/49VrwED9/tiny_49vrwed9-1492274632.jpg","facebook":"https://graph.facebook.com/1630669563636248/picture"},"links":{"following":"/api/users/49VrwED9/following","followers":"/api/users/49VrwED9/followers"},"about_me":"Human being. Retired HR manager. Proud father and grandfather. Corporal Marine Corps, Peace Corps volunteer. Hoosier. IU & Notre Dame. Seagan. INFP Livin’ the dream.","twitter_id":null,"facebook_id":null,"youtube_id":null,"google_plus_id":null,"website":null,"slug":null,"issue_count":46,"is_following":null,"influence_score":8120,"influence_level":40,"follower_count":267,"following_count":482,"position_count":297,"id":"49VrwED9","partner_id":null},{"name":"Joanne ","vote_count":360,"photos":{"large":"https://assets.causes.com/user/avatar/zm8wROXZ/large_zm8wroxz-1583291005.jpg","small":"https://assets.causes.com/user/avatar/zm8wROXZ/small_zm8wroxz-1583291005.jpg","tiny":"https://assets.causes.com/user/avatar/zm8wROXZ/tiny_zm8wroxz-1583291005.jpg"},"links":{"following":"/api/users/zm8wROXZ/following","followers":"/api/users/zm8wROXZ/followers"},"about_me":null,"twitter_id":null,"facebook_id":null,"youtube_id":null,"google_plus_id":null,"website":null,"slug":null,"issue_count":0,"is_following":null,"influence_score":2610,"influence_level":30,"follower_count":101,"following_count":13,"position_count":270,"id":"zm8wROXZ","partner_id":"efa417af-11b4-4a08-9b10-fff245626400"},{"name":"Marizzapan","vote_count":908,"photos":{"large":"https://assets.causes.com/user/avatar/3W1n1kVZ/large_3w1n1kvz-1532040759.jpg","small":"https://assets.causes.com/user/avatar/3W1n1kVZ/small_3w1n1kvz-1532040759.jpg","tiny":"https://assets.causes.com/user/avatar/3W1n1kVZ/tiny_3w1n1kvz-1532040759.jpg"},"links":{"following":"/api/users/3W1n1kVZ/following","followers":"/api/users/3W1n1kVZ/followers"},"about_me":"I wanna live in a world where Zimmerman offered Trayvon a ride home to get him out of the rain that night. ~G. Brewer","twitter_id":null,"facebook_id":null,"youtube_id":null,"google_plus_id":null,"website":null,"slug":"marizzapan","issue_count":114,"is_following":null,"influence_score":2490,"influence_level":30,"follower_count":96,"following_count":68,"position_count":46,"id":"3W1n1kVZ","partner_id":null},{"name":"Jeffrey ","vote_count":191,"photos":{"large":"https://assets.causes.com/user/avatar/default-with-flags.png","small":"https://assets.causes.com/user/avatar/default-with-flags.png","tiny":"https://assets.causes.com/user/avatar/default-with-flags.png"},"links":{"following":"/api/users/jW2owzXZ/following","followers":"/api/users/jW2owzXZ/followers"},"about_me":null,"twitter_id":null,"facebook_id":null,"youtube_id":null,"google_plus_id":null,"website":null,"slug":null,"issue_count":16,"is_following":null,"influence_score":710,"influence_level":30,"follower_count":25,"following_count":66,"position_count":128,"id":"jW2owzXZ","partner_id":null},{"name":"Sean","vote_count":664,"photos":{"large":"https://graph.facebook.com/1566223833389954/picture?width=150&height=150","small":"https://graph.facebook.com/1566223833389954/picture?width=75&height=75","tiny":"https://graph.facebook.com/1566223833389954/picture?width=20&height=20","facebook":"https://graph.facebook.com/1566223833389954/picture"},"links":{"following":"/api/users/jW2oYBeZ/following","followers":"/api/users/jW2oYBeZ/followers"},"about_me":null,"twitter_id":null,"facebook_id":null,"youtube_id":null,"google_plus_id":null,"website":null,"slug":null,"issue_count":3,"is_following":null,"influence_score":330,"influence_level":20,"follower_count":7,"following_count":5,"position_count":6,"id":"jW2oYBeZ","partner_id":null},{"name":"Lisa","vote_count":92,"photos":{"large":"https://assets.causes.com/user/avatar/default-with-flags.png","small":"https://assets.causes.com/user/avatar/default-with-flags.png","tiny":"https://assets.causes.com/user/avatar/default-with-flags.png"},"links":{"following":"/api/users/mrvyP3yz/following","followers":"/api/users/mrvyP3yz/followers"},"about_me":null,"twitter_id":null,"facebook_id":null,"youtube_id":null,"google_plus_id":null,"website":null,"slug":null,"issue_count":17,"is_following":null,"influence_score":30,"influence_level":10,"follower_count":0,"following_count":5,"position_count":16,"id":"mrvyP3yz","partner_id":null}],"bill_position":{"flagged":false,"id":"e053bb95-53f8-48dd-9cd3-8ce2439db108","argument_for":"Please support S 981 Using Medicare framework to create a public option for health insurance coverage. Thanks to Michael Bennet ! This is life saving !","argument_against":null,"show_argument_for":true,"show_argument_against":false,"upvote_count":8,"upvotes_for_count":8,"upvotes_against_count":null,"has_upvoted":false,"endorsement_count":8,"links":{"self":"https://www.causes.com/positions/e053bb95-53f8-48dd-9cd3-8ce2439db108"},"body":"Please support S 981 Using Medicare framework to create a public option for health insurance coverage. Thanks to Michael Bennet ! This is life saving !","stance":"yea","created_at":"2019-08-15T22:22:16.924Z","shareable_image_url":"https://n.causes.com/share-images/positions/e053bb95-53f8-48dd-9cd3-8ce2439db108.png","note_color":null,"note_text":null,"bill_id":"s981-116","user_id":"9odNv0jb","endorser_ids":["9odrQBnb","49VrwED9","zm8wROXZ","3W1n1kVZ","9odNv0jb","jW2owzXZ","jW2oYBeZ","mrvyP3yz"]}}

Like Causes?

MarianToon

Should Medicare Be Expanded to Establish a Public Option for Individual & Small Business Health Insurance?