NBGH: Large employers have serious reservations about 'Medicare for All'

Health insurance form payer plan enroll
The National Business Group on Health polled large employers on "Medicare for All." (Valeriya/Getty)

Employers have plenty of concerns about plans to expand Medicare coverage, a new survey shows. 

For the first time, the National Business Group on Health (NBGH) polled large employers about Medicare expansion plans, including a single-payer “Medicare-for-All” system, as part of its annual report examining their healthcare strategies.

Among the top issues: the possibility that costs could rise and quality could decrease.


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For example, 47% said they believe Medicare for All would lead to increased healthcare costs for employees, and 56% said it would lead to lower care quality. 

In addition, 57% said moving toward a single-payer system built on Medicare could lead to higher healthcare costs overall, and 69% said they believe it would limit innovation in care delivery. 

RELATED: Large employers embraced advanced primary care in 2020—NBGH survey 

The main reason employers are skeptical? Though Medicare for All is a hot political topic, especially among 2020 Democratic presidential contenders, many plans are bare-bones, which leaves a lot of uncertainty, NBGH CEO Brian Marcotte said at a press briefing Tuesday. 

“There are a lot of questions around ‘Medicare for All,’ and it’s not so much an issue of employers dismissing it outright,” Marcotte said. “There are too many unanswered issues on the table.” 

Employers are concerned about the impact of increased taxes—81% of those surveyed said they believe Medicare for All would lead to higher taxes—and how payment rates could play out, as the private insurance market subsidizes care in the government sectors, Marcotte said. 

Marcotte added that some employers are also concerned that a Medicare-for-All system could eschew value-based care in favor of a return to fee-for-service, as it’s unclear what role—if any—managed care services would have in such a model. 

RELATED: As ‘Medicare for All’ debate gains steam, many Americans are on the fence, survey shows 

Feelings on lowering the enrollment age for Medicare were more mixed, the survey shows. Close to half (45%) of employers said they don’t believe Medicare eligibility should be expanded below age 65. 

By comparison, 23% said they support allowing people aged 60 to 64 enroll in Medicare, and an additional 23% said the same for people aged 50 to 64. 

Marcotte said the key concern with expanding Medicare access to a younger cohort is adverse selection, with healthier employees choosing the government plan while sicker workers stick with employer-sponsored benefits. 

“There’s a risk there,” he said. 

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