Fri, May 1, 2020

Dr. Adam Gaffney, PNHP President 
Reply-To: “Dr. Adam Gaffney, PNHP President”
To: Betsy Zucker, HCAO

Dear colleague,
The COVID-19 pandemic and economic meltdown have exposed the fault lines in our fractured health care system. Each week, millions more Americans lose their jobs — and their health coverage — with no end in sight. We need Medicare for All to provide full health protection to Americans, in good and bad times. During this current crisis, however, the nation also needs immediate, emergency measures to protect our patients’ health, until Medicare for All can be achieved, as called for in PNHP’s recent “8 Needed Steps in the Fight Against COVID-19.” 

You have likely heard of several proposals to provide health coverage to the growing ranks of the uninsured. PNHP welcomes The Medicare Crisis Program, introduced in Congress today by Reps. Pramila Jayapal (D-Wash.) and Joseph Kennedy (D-Mass.). This program would provide Medicare Parts A&B coverage to any U.S. resident who is eligible for unemployment insurance, and their households. While “Medicare Crisis” doesn’t require premiums for enrollment, it does require deductibles and coinsurance for all services besides those for COVID-19 testing and treat-ment. The bill has a number of other provisions, for instance it requires coverage of all COVID-19 related treatment costs, described in greater depth below.
PNHP also welcomes the more comprehensive Health Care Emergency Guarantee Act, announced earlier this month by Sen. Bernie Sanders (I-Vt.) and Rep. Jayapal. This proposal would provide coverage for all medically necessary care — including prescription drug coverage — to anyone who is currently uninsured, and would cover all out-of-pocket costs for those with public or private insurance.
These two proposals differ in several ways. The Health Care Emergency Guarantee Act would go further in protecting Americans from health care costs by covering cost-sharing regardless of our patients’ diagnosis,
which is especially critical at these moments of increased need. Both, however, build on the strength of Medicare to provide emergency coverage to millions of uninsured Americans for the duration of this crisis.

In contrast, Reps. Bobby Scott (D-Va.) and Debbie Dingell (D-Mich.) earlier this month introduced the Worker Health Coverage Protection Act, which would allow laid-off workers to stay on their workplace health plans by subsidizing the full costs of COBRA premiums — typically more than $20,000 per year for a family plan.

It would also subsidize the employee share of premiums for furloughed (temporarily laid-off) workers. While this plan would allow some workers to maintain their insurance after job loss, it fails to offer the protections Americans need, while providing an indefensible bailout to the private insurance industry. It privileges those who were already covered under employer-sponsored insurance plans and completely ignores the millions of newly unemployed restaurant, hospitality, retail, and other workers who did not have job-based coverage before the pandemic. This plan also fails to address workplace plans’ narrow networks and high deductibles that keep patients — especially those with reduced incomes — from seeking timely care.

PNHP has developed a comparison chart detailing the main components of each bill. You can download a printable version of the chart on our website, or read through the list below.

The Medicare Crisis Program (Jayapal – Kennedy)
Coverage model: Enrolls the uninsured eligible for unemployment insurance in Medicare Parts A&B (doctor and hospital coverage). Expands state Medicaid programs.
Cost-sharing: No premiums, and no cost-sharing for COVID-19 testing or treatment. Enrollees pay deductibles and coinsurance up to 5% of income for non-COVID care, and may purchase Part D drug coverage and “Medigap” plans to cover non-COVID costs.
Eligibility & enrollment: Any resident of the U.S. who is uninsured and eligible for unemployment, along with members of their household.
Duration: Coverage would begin from enrollee’s initial unemployment claim and last until the unemployment rate is within 2% of 2019 levels.
Other provisions: Funds purchase and distribution of necessary medical and personal protective equipment; increases federal matching rate for Medicaid and increases income threshold to 300% of poverty level during crisis; prohibits cost-sharing within Medicaid and CHIP for COVID-19 vaccine and treatment; requires all insurers to cover COVID-19 testing and treatment without cost-sharing or prior authorization.

Health Care Emergency Guarantee Act (Sanders- Jayapal)
Coverage model: Enrolls uninsured in an improved Medicare that covers all medically necessary care and drugs; covers cost-sharing for the insured. Cost-sharing: No cost sharing for the uninsured. For those with insurance, Medicare to cover out-of- pocket costs for the duration of pandemic. Eligibility & enrollment: Available to any resident of the U.S. When patients receive care, providers will bill Medicare directly for the full cost of treating the uninsured, or the cost-sharing portion for those with insurance.
Duration: Effective immediately, lasting until an FDA-approved COVID-19 vaccine is widely available.
Other provisions: Bans surprise billing and collection of medical debt; allows Medicare to purchase pharmaceuticals at VA prices; prohibits private insurers from increasing copays and deductibles or decreasing coverage for the duration of crisis.

Worker Health Coverage Protection Act (Scott – Dingell)
Coverage model: Subsidizes 100% of COBRA premiums for laid-off workers with employer health plans.
Cost-sharing: Preserves private workplace plans, including their limited provider networks, and requires copays and deductibles, which for family coverage can be more than $4,000. Eligibility & enrollment: Eligible to laid-off or furloughed workers with existing employer-sponsored health plans. Does not include small businesses with fewer than 20 workers; provides no coverage for the millions of previously uninsured.
Duration: From March 1 until 6 months after the end of pandemic. Provides up to 15 months of premium subsidies per worker.

Our patients can’t wait. Please take a moment and call your Congressional representative at (202) 224-3121 and request that they support the Medicare Crisis Program and the Health Care Emergency Guarantee Act during this crisis.
Of course, only single-payer reform will secure health care for all Americans in the years ahead (and recent polling shows it is more popular than ever). As you’re reaching out to your member of Congress, tell them to co-sponsor H.R. 1384, the Medicare for All Act of 2019. If they are already a co-sponsor, thank them and ask them to fight even harder for reform.

Adam Gaffney, M.D., M.P.H.

Physicians for a National Health Program
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