On July 29, more than 100 people participated in a Zoom webinar on the topic of “health coverage for all.” The panel discussion featured three policy experts on a wide range of issues, such as the fiscal implications of expanded health insurance coverage, options to achieve full population coverage, as well as the patient and health-care provider perspective.
Panelists rounding out the conversation during “Health Coverage for All: What Does that Mean and What are the Implications?” included Charles Blahous, the J. Fish and Lillian F. Smith Chair and senior research strategist at the Mercatus Center at George Mason University, Dr. Patrick Ho, president of the New Hampshire Psychiatric Society and chief resident in psychiatry at Dartmouth-Hitchcock, and Margarida Jorge, executive director of Health Care for America Now (HCAN).
The moderators were Robert L. Bixby, executive director of The Concord Coalition, and Lucy Hodder, professor of law at UNH Franklin Pierce School of Law and the director of health law and policy programs for the College of Health and Human Services, Institute for Health Policy and Practice. Attendees also submitted a variety of questions to the moderators.
You can watch the entire program by playing the YouTube video embedded below.
Attendees were given opportunities to participate in live polling during the event, and below you will find the three questions asked and the responses. The first participant-poll asked the audience which method of health insurance coverage they preferred.
Each panelist began with prepared, opening remarks.
Blahous, providing insight on the costs associated with a nationwide, “Medicare for All” plan, said “My analysis was a study of one specific approach of the many approaches providing coverage for all, and that was the so-called ‘Medicare for All’ legislation that was introduced by Senator Sanders in 2017.”
Blahous said his analysis is not aimed at making a value judgment on the idea of Medicare for All, rather it speaks to the quantitative effects and tradeoffs involved.
“My study found that there was a lower-bound on cost for a Medicare for All type system … if everything works as we might hope and expect with respect to cost containment, the least such a system would cost is about $32.6 trillion in additional federal costs over the first 10 years,” he said. “That is something larger than we would be able to finance even if we were to double all currently projected federal individual-income and corporate-income taxes.”
Some of the major factors that impact cost projections include the intended consequence of increased use as people move from uninsured to insured, as well as a higher-level of use by those that already have insurance coverage, both of which would increase the total amount of health care services utilized.
“The reason for that is that when insurance covers the first dollar of your health expenses, you tend to utilize more,” Blahous said. “If, on the other hand, you owe a substantial payment out of pocket, you’re more likely to undertake something of a personal cost-benefit analysis as to how much you’re willing to pay.”
Because of such cost increases, most Medicare for All proposals try to save money in other ways, including controlling provider payments, paying less for prescription drugs and saving on administrative costs.
“There probably would be substantial savings in administrative costs, for a number of reasons,” Blahous said. “We have to be a little bit careful though because there is a limit on how much we can save on administrative costs … we have to remember that it’s unlikely we could actually get administrative cost rates quite as low under Medicare for All as they are under current Medicare for the simple reason that Medicare serves a senior population that has much higher per-capita health spending than the general population.”
Ho, providing perspective on key patient and provider needs, said, “Many of those needs fall into, first-and-foremost, the bucket of providing the right patient, the right care at the right time.”
“So, could a new system, instead of investing so heavily in the downstream consequences of chronic disease, emphasize prevention?” He said, “especially in rural places like New Hampshire, where health care resources are not as plentiful, we can avoid costlier care that occurs when patients are unable to afford necessary medications or when they feel that they should ration care and not seek care until their condition worsens.”
He suggested that we could shift to a more regionalized model of health care where primary care is the focal point, and that if everyone had health insurance coverage providers’ jobs would be a bit easier. But he also identified potential barriers and concerns.
“A major concern would be ensuring that a system of insurance coverage would be easier to navigate,” Ho said. “Another concern is maintaining high quality of care; in determining the cost of health care, we have to consider not just the price of care but also utilization and quality.”
“How can we maintain and improve the quality of care we deliver in a different system, and how can we incentivize that?”
Jorge, discussing the Affordable Care Act, key policy considerations and the impact of the pandemic, said “COVID, which is the biggest paradigm that we’re looking at in the health care conversation right now at the national level, is going to really transform the health-care debate in a lot of critical ways.”
“Back in 2008, when HCAN was created and looking at passage of the Affordable Care Act ... we talked about this notion of the public option, and one thing that was central in the debate over health care was ‘what is the role of government,’ " Jorge said. “What is the role of government in the provision of health care and the provision of direct services and employing a workforce, and what is the role of government in regulating cost and profit?”
“The compelling part of that language is really around choice, and that Americans tend to interact with health care often as consumers, not just patients,” she said. “That’s critically important to remember.”
Jorge said the ACA was a big achievement in regulating health coverage, in expanding Medicaid and creating many now-popular provisions, but it is at risk and another legal challenge has reached the U.S. Supreme Court.
She added that because of COVID-19, the debate about health care is changing. “For most of the time that I have worked on health care, the debate has largely been around cost,” Jorge added. “It’s largely not a debate about public health; so COVID has tremendous opportunity to insert and infuse the debate with some larger concepts around public health.”
Some of those concepts include social determinants of health, health disparities and chronic care.
Jorge added that the pandemic has called into question the nation’s current health insurance system, largely centered around employer-provided insurance, because of the millions of people that are currently unemployed.
“Coverage for all has never been a more timely topic than it is right now, when every single day the number of unemployment claims is rising and people are going without coverage, when state and local governments are facing huge budget shortfalls that are going to force cuts in public services, health care workforces, you name it,” she said.
The second participant-poll pertained to how COVID-19 has impacted attendees perspectives on health insurance.
The third and final participant-poll inquired about the fiscal and economic implications of methods to achieve health insurance coverage for all.
A Q&A session followed opening remarks, during which the panelists fielded prepared questions from the moderators and questions submitted by the audience. Watch the webinar via YouTube, linked below, to hear more. The event was also live-streamed on Facebook.
As the webinar concluded, attendees were provided with additional resources. The PowerPoint presentation from the program can also be found on this webpage.
- Glossary of terms
- Public polling data on single-payer health insurance
- Survey data on COVID-19 implications on health insurance
- Blahous study on Medicare for All
“Health Coverage for All: What Does that Mean and What are the Implications?” was co-hosted by Concord, Health Law and Policy Programs, at UNH Law, The Institute for Health Policy and Practice and The Warren B. Rudman Center, in partnership with Granite State Progress and the New Hampshire Medical Society. Support for the event was generously provided by the Peter G. Peterson Foundation and the Endowment for Health.