Comparison of National Health Care Reform Proposals Overview

Simplified Comparison of National Health Care Reform Proposals

Type of proposal

Does it cover everyone

Is it simpler

Is it less expensive

Single payer universal health care



Yes, substantially less

Multi-payer universal health care



No, costs go up substantially

ACA with a Public Option



No, costs go up substantially

Single Payer Universal Coverage Proposals

Name of proposal

Universal or public option

Does it reduce complexity?

Does it reduce the cost of all payers combined?


Foundation recommendation?

Medicare for All S1804,


Universal single payer

Covers 100%:

These plans ensure that everyone has health care, and eliminates or limits out-of- pocket expenses, which fully addresses the issue of under- insurance. They add dental, vision, and hearing benefits.

These plans are referred to as forms of Improved Medicare for All.


One (single) payer after 4 years, will drop private insurance and the army of clerks that providers must have to deal with a multiplicity of plans.

Because all providers are enrolled, consumers have full choice of provider while eliminating the complexity of restricted provider networks.

Provider payments will cover cost of medical care, eliminating the need for cost shifting.

All consumers will have full coverage and not be required to make confusing choices about which policy to buy.


The drop in administrative costs due to a single payer and the reduction in complexity are substantial, accounting for over 20% of health care expenses.

Drug prices will be lower, with negotiations accounting for as much as 4% of all expenses.

Due to the market power of a single payer, excessive for-profit hospital prices will be reduced, accounting for 3% of expenses.

Over the long-term, better treatment coordination and continuity, along with preventive care, will lower costs.

Phase in over a 4-year period.

In the 1st year, S1872 adds dental, hearing, vision, with kids 0-18 eligible. Medicare Parts A, B and D, deductibles and co-pays, are eliminated (except for certain non- generic drugs).

Long-term care for seniors and people with disabilities will continue as currently covered under Medicaid.

2nd Year: age reduced to 55 3rd Year: age reduced to 35. 4th Year: everyone in and no

employer plans.

Full Support

  • These plans will lower the cost of all payers combined, by eliminating the administrative costs that the multiple private plans produce, reducing waste, and containing excessive profits.

  • Both markedly reduce complexity by eliminating the bureaucracy associated with the multiplicity of private health insurance plans.

  • Both substantially improve access to comprehensive health care for all Americans and provide universal coverage for comprehensive, quality health care.



Covers all health services, including Medicaid, and improves coverage.

Coverage will match the Sanders Bill S1872 and be implemented immediately. Medicaid will be folded into the new Medicare.

Multi-payer Universal Coverage Proposals

Medicare Extra

Universal multi- payer

Retains employer-based coverage but available to all. Auto enrollment for newborns and uninsured. Replaces Medicaid, eliminates Medicaid’s 2-year waiting period and asset test.


Many people still must make complex choices of insurance and deal with the limitations of a restricted provider network.

Voluntary opt-in for employers and employees, but with premiums, co- pays, and deductibles based on income.

Leaves private insurers and multiple payers in the system, and increases administrative complexity by adding one more system.


Has cost controls that include reducing the payments to insurance companies for Medicare Advantage, reducing administrative costs on the payer side for those who join Medicare, with Medicare negotiating the price of medications.

These cost controls only partially reduce costs. Covering the uninsured costs more than savings. Major cost reductions require removing administrative complexity, which adding one more system makes worse. In addition, it does not have the market power of a single payer system, which is needed to control for-profit hospital profiteering and pharmaceutical prices.

Leaves private insurers in the system and is funded by premiums, excise taxes, the repeal of tax breaks for wealthy, increases taxes on high earners.

Has the advantage of giving people the choice of keeping employer- sponsored insurance if they are satisfied, but makes combined health care expenses much greater, which is a disadvantage.

If incentives are strong enough for almost everyone to join Medicare Extra, then, after some years of increased expenses, combined expenses will drop to the level of a single-payer system.


We support this plan because it provides universal health care and it may provide a transitional step to a universal health care system that does lower costs and reduces complexity.

The support is limited because it: represents a patchwork solution that preserves many of the inefficiencies of the current system. In the short run, this plan markedly increases overall costs and complexity.

Affordable Care Act with Public Option Proposals

Medicare E,

Murphy and Merkley

Public Option

Provides insurance for most, but leaves under- insured:

These public options move the winners and losers around. Some people pay less for insurance, and taxpayers pay more.

The net effect is that the combined expenses through taxes, premiums, or out-of- pocket, are even more than they are now.

Public options only address the number of insured, but do not address the problem of under- insurance, which is now more

common than uninsurance.


Private health insurance would continue and there would be multiple payers, requiring many claims adjusters.

Premiums, co-pays, and deductibles would finance this plan.


The public option plans have small savings because the administrative expenses on the payer side would be lower for those who join the public option.

Some of the proposals have a limited ability to deal with pharmaceutical prices.

The increase in costs from covering more people would be much greater than the savings.

This Plan would continue the current system, and provide some improvement, but at greater cost and complexity.

Voluntary for employers and employees.


On the positive side, each of these public option plans offers piecemeal improvements, which provide more coverage and lower costs for some. We would not oppose a proposal that helps some.

However, there are several negatives.

  • The impact is small in relation to multiple and severe problems in the health care system.

  • One of the purposes of these incremental approaches is to avoid discussion of universal health care and keep it off the table.

  • Although promoted as politically feasible and an immediate improvement, these proposals are opposed with full intensity by opponents of universal health care.

  • Passage and implementation usually take four or more years, time that would be better spent advocating for the real solution, universal health care.

Medicare X, Kaine and Bennet

This is a very limited public option plan.

The plan is voluntary and only for individuals.

Medicaid Buy-In, Schatz et al

Only a modest number of the 5.8 million covered by Medicaid expansion states could join.

“Healthy America,” Urban Institute Plan


Public plan replaces non-group insurance market (the ACA exchanges and individual private insurance), CHIPS, and acute care for non-elderly.

Employers could continue with private health insurance for group coverage.

Insurance companies could offer Medicare Advantage type plans in the insurance exchange, but private plans that don’t offer coverage similar to ACA requirements are prohibited.


All of the additional adjustments to the current system would make health care even more complicated.


Some of the cost for health care would transfer from individuals to the government, reducing the burden on individuals.

It makes a minor reduction in pharmaceutical prices with Medicaid rebates, but does not have measures to effectively contain pharmaceutical prices.

Voluntary enrollment by individuals and employers.

Tax deduction for employers maintained. Auto enrollment for SNAP & TANF.

Non-elderly disabled can retain Medicaid or enroll in Healthy America (which will have same coverage as Medicaid).

Undocumented not eligible for subsidies. States would be required to maintain current Medicaid levels of funding.

Premiums based on income with poor paying little or nothing.

Plan benefits tied to premium payments for higher income, such that lower premium “standard” plan would have $1,500 deductible and out-of- pocket limit of $6,850 for a single adult in 2018.

Other plans would cost more, as with the ACA.

Tricare, Indian Health Services, VA and Federal employee insurance stay the same.

Urban Institute estimates that

10.4 million legal residents would remain uninsured along with 8 million undocumented.

Uninsured would lose a graduated portion of the standard tax deduction based on income, and would have to pay all their own medical bills.

This results in lower penalties than the ACA for those who are uninsured.