All major Democratic candidates agree that the ultimate goal of any health care reform proposal should be universal health care coverage, but disagree about the best way to get there. Some believe the best option is to add a public option, thereby capitalizing on the coverage and affordability gains achieved by the Affordable Care Act, while others believe that exchanging our current fragmented system of insurance for a new single-payer system is the appropriate pathway to lower costs and increased consumer protections. The remainder of the field have staked out ground along the continuum. The general opportunities and trade-offs inherent in these various proposals have taken center stage, discussed extensively both in policy circles and at kitchen tables across the country.
65 million low-income Americans might be affected
As these debates wage, an essential question has often been absent from the conversation: What do these proposals mean for the 65 million low-income individuals in this country – essentially one in five – that receive their insurance through Medicaid?
The answer is a perhaps unsatisfying: “It depends.” Undoubtedly, regardless of the proposal being promoted, we should strive to ensure that all individuals have access to quality health care services. But to the extent universal health care proposals intend to replace Medicaid, drafters need to understand what elements are critical for the populations Medicaid serves, and ensure that those features are both included, and protected in any new legislative proposals.
Medicaid provides benefits to low-income individuals and families not covered by insurance
Low-income and underserved individuals and families have unique needs, and Medicaid includes specific benefits, rights, and protections targeted to meet those needs. For example, Medicaid guarantees transportation to medical appointments (usually in the form of bus fare or van rides). This benefit is practically unheard of in employer-sponsored insurance, but in Medicaid it is mandatory. For most people, a two-dollar bus fare is not a barrier to health care; but for those without two dollars, it is–and can result in delay or postponement of necessary services.
Other essential features unique to Medicaid include strict affordability protections, robust due process rights, and the coverage of comprehensive benefits, including the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children and home and community based services (HCBS)—just to name a few.
Universal health care proposals that replace or significantly reform Medicaid must explicitly guarantee the benefits and protections that currently exist for low-income individuals in Medicaid. It is vital that the needs of these populations be part of the ongoing conversations in order to ensure that new health reform coverage proposals do not harm Medicaid enrollees.
NHelp developed a set of Universal Health Care Guideposts and Principles
To that end, the National Health Law Program has developed a set of Universal Health Care Guideposts and Principles. These guideposts and principles will form the basis for our analysis and evaluation of all universal health care proposals moving forward, as they set forth what we believe are the minimum guarantees that all policies should include to protect the rights of low-income individuals. We encourage health care advocates to use these, or similar, guideposts and principles to evaluate proposals at the federal and state level. For more information, please contact Héctor Hernández-Delgado or Jennifer Lav.
NHeLP will soon be hosting a webinar on Universal Health Care Guideposts, Principles, and Proposals is forthcoming.