A new—and markedly different—set of proposals has emerged in the wake of attempts to repeal the Affordable Care Act. Rather than scaling back the role of government, these ideas expand the social safety net to improve health care accessibility and affordability. Many of these proposals are featured in the January 2018 edition of The American Prospect (co-produced with The Century Foundation) and will likely be debated by candidates for the presidency in 2020. Yet, these public and public-private health care proposals differ on key dimensions, such as who runs them, who qualifies for them, and how much enrollees pay. This table compares major public plan and hybrid plan proposals.

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How Proposals for Public and Hybrid Health Care Plans Differ
 

Who Runs the Plan?

 Who Qualifies for the Plan? Can People Choose a Different Plan? What Do Enrollees Pay? What Do Enrollees Get?

How Much Do Providers Get Paid?
Medicare for All (S. 1804) Medicare All people No Taxes (no premiums) Enhanced ACA benefits with low cost sharing Medicare payment rates
Medicare Part E* Medicare All non-elderly people except those Medicaid-eligible Depends: Employers choose for workers; yes for others Federal gov’t-set premiums, decreased for low-income enrollees; employer payments Medicare benefits and reduced cost sharing Medicare payment rates
Medicaid Option* (S. 2001 / H.R. 4129) States All non-elderly people in such States Yes State-set premiums, decreased for low-income enrollees ACA benefits and reduced cost sharing Medicaid payment rates, Medicare rates for primary care
House Public Health Insurance Option (H.R. 3962, 2009) Federal gov’t People buying coverage on their own and small businesses Yes Federal gov’t-set premiums based on costs; decreased for low-income enrollees (current law) ACA benefits and cost sharing reductions (current law) Negotiated rates which fall between Medicare and average private rates
Medicare Rates Applied to Private Plans* Individual market plans; federal gov’t regulates rates People buying coverage on their own Yes (although Medicare rates apply to all plans) Private insurance-set premiums, decreased for low-income enrollees (current law) ACA benefits and cost sharing reductions (current law) Medicare payment rates
Medicare X  (S. 1970 / H.R. 4094) Federal gov’t People buying on their own and small businesses in underserved areas initially Yes Federal gov’t-set premiums based on costs; decreased for low-income enrollees (current law) ACA benefits and cost sharing reductions (current law) Medicare payment rates (with plus up for rural areas)
Midlife Medicare* Medicare People age 50 to 64 without access to employer coverage Yes initially but no once in Midlife Medicare, except in limited cases Federal gov’t-set premiums, decreased for low-income and increased for high-income enrollees Similar to Medicare benefits and cost sharing Medicare payment rates
Medicare for Individuals with Disabilities* Medicare People qualifying for Social Security Disability Insurance Yes Medicare premiums, increased for high-income enrollees (current law) Medicare benefits and cost sharing (current law) Medicare payment rates
Public Reinsurance Program for Private Plans* Employers and insurers; federal gov’t runs reinsurance People with very high costs enrolled in participating plans Yes (although reinsurance applies to all plans) Private insurance-set premiums, decreased for eligible low-income enrollees (current law) ACA benefits and cost sharing reductions as applicable (current law) Medicare payment rates paid through employers and insurers

* Described in an article in the Health Reform 2020 issue of The American Prospect. View the collection online here.

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