Many healthcare reform terms are used rather loosely and mean different things to different people, especially politicians. To most productively discuss the issues it is important to be as clear and defined as possible. For instance, in our own usage of the term “Medicare-for-All” in these pages, we refer to the Medicare For All Act of 2019 co-authored by Senator Sanders, Senator Warren and 13 other senators.
Universal Coverage
A "healthcare system in which all residents … are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own with either health services or the means to acquire them, with the end goal of improving health outcomes.” from Wikipedia
Single Payer
A “type of universal healthcare financed by taxes that covers the costs of essential healthcare for all residents, with costs covered by a single public system (hence 'single-payer').” from Wikipedia
Medicare
The government-run health insurance program (since 1965) covering ALL American citizens 65 and older, funded by taxpayers via payments taken from paychecks (a portion of that taken for Social Security goes toward Medicare) to cover most services, e.g. hospitalization, but NOT all. People covered by Medicare can also choose to get additional coverage from Medicare-approved private insurers to cover other services such as dental, vision and prescription drugs.
Part A = Hospitalization insurance; Part B = Outpatient insurance; Part D = Prescription drug coverage
Medicare Advantage (“Part C”)
“Medicare Advantage Plans are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Your Medicare services aren’t paid for by Original Medicare. Below are the most common types of Medicare Advantage Plans.” from Medicare.gov
Medicare-for-All
Note that Medicare does not cover “all” and, indeed, was not intended to be “universal coverage” and is not a “single-payer” system as it includes private insurance plan options, e.g. under Medicare Advantage. But, who and what is covered how by Medicare-for-All plans depends on the particular plan. The plan proposed in the Medicare-for-All Act of 2019, co-authored by Senators Sanders and Warren and others, is intended to be a true single-payer, universal coverage plan. Ultimately, for any plan to be passed in Congress and signed by the President, the details would have to be worked out through political negotiations on many levels.
“Understanding the Medicare For All Act of 2019” from Physicians for a National Health Program
“Quick: What’s the Difference Between Medicare-For-All and Single-Payer?” from Kaiser Health News, Nov, 2018
Affordable Care Act (“ObamaCare”)
“The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”). The law has 3 primary goals:
Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the federal poverty level.
Expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. (Not all states have expanded their Medicaid programs.)
Support innovative medical care delivery methods designed to lower the costs of health care generally.
However, coordinated opposition has year-by-year cut away protections of this program and still threaten to eliminate it entirely.
Public Option
A "proposal to create a government-run health insurance agency that would compete with other private health insurance companies within the United States. The public option is not the same as publicly funded health care, but was proposed as an alternative health insurance plan offered by the government. The public option was initially proposed for the Patient Protection and Affordable Care Act, but was removed …” to avoid a filibuster. Wikipedia
Medicaid (MediCal)
A “federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The Health Insurance Association of America describes Medicaid as ‘a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.’ Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017. It is a means-tested program that is jointly funded by the state and federal governments and managed by the states, with each state currently having broad leeway to determine who is eligible for its implementation of the program. States are not required to participate in the program, although all have since 1982. Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities. Poverty alone does not necessarily qualify someone for Medicaid.” Wikipedia
Best Sources:
“The Difference Between a ‘Public Option’ and ‘Medicare for All’? Let’s Define Our Terms” - NYTimes, Sept, 2019
“Medicare for All? A Public Option? Health Care Terms Explained” - NPR
“Glossary of Healthcare Terms” - Ballotpedia
“Navigating the Shifting Terrain of US Health Care Reform—Medicare for All, Single Payer, and the Public Option” - Milbank Quarterly
CONTACT: health@marinlwv.org