Opponents of Medicare expansion should focus on pitfalls of proposals

At a September gathering of health insurance industry executives, CMS administrator Seema Verma blasted various Democratic coverage proposals as “socialized medicine.” But healthcare industry advisers say such messaging won’t stop those proposals, and it doesn’t begin to address the very real factors that make such proposals impractical.

Many healthcare insurers and providers have expressed concerns that adverse consequences would follow implementation of Democratic coverage expansion proposals, which range from expanding Medicare eligibility to adopting a single-payer system. Although these groups might be seen as being more aligned with the Trump administration’s position in opposing such proposals, they also have very specific reasons for that opposition, which are not well reflected in the administration’s messaging.

Verma continued with the administration’s “socialized medicine” focus in September at a  gathering of America’s Health Insurance Plans, offering the following criticism of the Medicare- expansion proposals: “This will just increase taxes, thwart innovation, lead to rationing and decrease access to care — like it has in every other country that has tried socialized medicine.”

That line of criticism is unlikely to dissuade voters from supporting various Medicare- expansion or single-payer proposals, according to industry advisers.

“One of the things that we have seen is that the argument that this will lead to ‘socialized medicine’ does not resonate,” said Phillip Morris, a partner at Locust Street Group, which conducts polling for the healthcare industry. “We hear consistently that ‘Just because Europe can do it, doesn’t mean that we can’t.’” And for that reason, he suggested, warnings about socialized medicine are actually distracting voters from the very real challenges that are likely to emerge from the Medicare-expansion or single-payer scenarios.

Similarly, the consultancy’s voter polling has found arguments warning voters that such programs will cause them to lose their current private health plan are less effective than they were before enactment of the Affordable Care Act (ACA) because those who are privately insured have become used to their employers switching plans or having to switch when they change jobs.

The challenge

A Kaiser Family Foundation (KFF) public tracking poll conducted throughout 2019 has found little change in view of a national “Medicare-for-All” plan. Findings from the September KFF poll include that about half (53%) of respondents favored such a plan. Other findings include:

• 77% of Democrats favor such a plan.
• 79% of Republicans oppose it.
• 53% of independents favor it.
• 45% of independents oppose it.

The same poll found 69% of the public favored a public option, which was defined as a government-administered health plan that would compete with private health insurance plans and be available to all Americans.

Messaging that does make an difference

But voters’ concerns were raised when they were presented with likely consequences of such proposals, including the high costs, Morris said, noting that it can be eye-opening to most voters when they are presented with the idea, “I’m going to have to pay more for this.”

“The financial consequences this would have are more concerning than any other impact,” Morris said, speaking of the projected price tags of the proposals.

Despite multi-trillion-dollar estimates for several of the Medicare-expansion proposals, an August poll by the consultancy found 64% of voters would be unwilling to pay any more in taxes for universal coverage.

Other concerns to which voters have responded include the possibility that their access to timely and high-quality healthcare services could suffer under expansion proposals, Morris said. “We do hear that voters perceive forcing everyone into a system like Medicare that is perceived as at-risk would mean lower quality of care for everybody,” Morris said. And many healthcare providers and insurers share this concern.

Converting voters

Lauren Crawford Shaver, executive director of the Partnership for America’s Health Care Future, a coalition of physician, hospital, insurance and drug company advocates, said its polling indicates building the current system garners greater voter support. So presenting the option of bolstering existing healthcare options could sway voters who initially have a favorable, if not fully informed, view of Medicare-expansion or single-payer proposals. “There’s still a race to define Medicare for All,” Crawford Shaver said.

For instance, she noted that many support Medicare-expansion proposals because they want to boost insurance coverage rates or reduce the cost of healthcare. But many are unaware that insurance coverage rates could increase from 90% to 98% through implementation of coverage already authorized by the ACA, she said.

Further, several Medicare for All bills would repeal major cost-control provisions of the ACA. “You’re looking to put a whole bunch of people on the Medicare system at current Medicare reimbursement rates, and you’re not actually looking to contain the costs,” Crawford Shaver said.

And this concern is reflected in some KFF polling results, including the finding that 55% of Democrats and Democratic-leaning independents say they would prefer to vote for a presidential candidate who wants to build on the existing ACA in order to expand coverage and lower costs, compared to 40% who want to replace the ACA with a national Medicare for All plan.

Vulnerabilities of so-called public option plans that would offer a Medicare-like plan for purchase include the complexities of implementing such a proposal. When those complexities are explained, support for such proposals decreases, Crawford Shaver said.

Many who cite European universal healthcare programs as a model don’t realize many enrolled in those programs are required to pay up to $400 out-of-pocket before they receive healthcare services, she said. “The idea that Medicare for All is free for everyone is a misnomer.”

To educate the public on these points, her group has held public events and launched advertising campaigns across the country. And a key component of those efforts is to illustrate the various facts of the proposals that the public may not realize, rather than name-calling the proposals.

“We try to drive this conversation based on facts, more than anything else, because healthcare is serious and we cannot bring this down to a political game,” Crawford Shaver said.