Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma took another swipe at calls for a “Medicare for All” healthcare system this week, saying expanding those benefits to every American would “dilute” the program.
Verma’s comments, made at a session of The Atlantic Festival, echo a speech before the Commonwealth Club in July, where she said calls to expand Medicare are built on a “fundamental lack of understanding about the uniqueness of Medicare to the very specific population it serves.”
At the festival, Verma said instead that the Centers for Medicare & Medicaid Services must focus on the steps it’s taking to “strengthen” the program and ensure its long-term sustainability.
“Putting more people in the program is not going to solve the problem, and actually threatens the focus and security of the program for seniors,” Verma said.
When FierceHealthcare requested more details on how expanded enrollment would hurt seniors, CMS declined to provide specific data. But Verma did say in a statement that a single-payer health system built on Medicare would shift the focus of a program aimed at seniors to a larger population.
It was also unclear if Verma was also dismissing Democratic plans for a Medicare buy-in, which would expand enrollment voluntarily to people between the ages of 55 and 64.
Plans for either expanding Medicare enrollment through voluntary buy-ins or fully transforming Medicare into a single-payer system are still in their nascent stages, but with backers like Sens. Cory Booker, Kamala Harris and Elizabeth Warren—all in the 2020 presidential conversation—calls for growing government healthcare are going mainstream.
A recent survey from the Bipartisan Policy Center found that 37% of adults want the government to play a greater role in regulating the price of healthcare goods, and nearly half (43%) of Democrats feel that ensuring greater access to health insurance is a key priority.
Jack Hoadley, Ph.D., a health policy analyst at Georgetown University and an expert on the Medicare program, told FierceHealthcare that it’s unlikely that expanding Medicare would get in the way of key strategies to improve the program, such as moving away from fee-for-service reimbursement to more value-based care.
“I don’t think any of that is helped or harmed in any way by discussion about expanding Medicare to other populations,” Hoadley said.
Hoadley said that any expansion of the program, regardless of size, would require thoughtful design and planning, and all those decisions would ultimately impact the way Medicare implements alternative payment models and other changes. But, he said, these steps to improve the efficiency of the program should not preclude talk of potentially growing its enrollment.
Department of Health and Human Services Secretary Alex Azar has also drawn a clear line in the sand on Medicare for All. In a speech last week, hosted by the Nashville Healthcare Council, Azar said that expanding the program to all Americans would eliminate their ability to make health choices for themselves.
In addition, Azar said, paying everyone at Medicare rates—which are about 40% less than private insurance rates—could lead some physicians to reject insurance entirely and “move to accepting cash” for care. Azar warned that buy-ins would cut down on private insurance enrollment, which could “consolidate” access to the best doctors to just that population.
“It’s simple math: Higher payments from commercial insurers help doctors take on seniors whose Medicare plans pay less,” Azar said. “It’s far from an ideal set-up, but a single government system would completely unravel it, without a theory for how seniors’ access would be protected.”
JoAnn Volk, a research professor at the Georgetown Center on Health Insurance Reforms who focuses in on Medicare expansion policies, told FierceHealthcare that much of this conversation is the requisite partisan posturing—clearly, a single-payer health system would not gel with the Trump administration’s vision.
Volk said that a public option, for example, would be a solution for any “bare counties” under the Affordable Care Act, in which no insurer currently operates in the exchanges. The administration is especially focused on expanding choice, and she said that some of its steps—such as expanding short-term and association health plans—are likely fragmenting the insurance market instead of strengthening it.
“They need to promote their vision of what is market stabilizing,” she said.