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First Published: July 30, 2020.                                                                                                                                                                            JAMA FORUM VIEWS – 6,056

The author of this article,  is Dr. Stuart M. Butler, is a Senior Fellow at the Brookings Institution and former Director of the Center for Innovation at the Heritage Foundation, both prominent and influential policy power houses in DC. With this article, and his support of Medicare-Advantage-For-All, he joins ranks with Steve Forbes, former presidential candidate and head of Forbes Magazine, our healthcare guru, Dr. Oz and George Halvorsen, former CEO of the Kaiser Permanente, one of the first HMO’s and now one of the largest health insurers in the CA, in recognizing the efficacy of this potent solution that we need for meaningful health care reform in the United States. His case is logical and very well reasoned. It just makes sense. Medicare Advantage is the fastest growing most successful insurance program we have in the United States. There is absolutely NO REASON our government can’t extend this program to all Americans. We have the answers. Medicare Advantage has majority support in both political parties, in both houses of Congress and this plan is consistent with what President Donald Trump has been advocating.

Dr. Butler believes that Medicare Advantage For All is the framework for a bipartisan discussion on creating a new framework for the US health system. The program also fits into the Republican Study Commitee’s Health Care plan entitled “A Framework for Personalized, Affordable Care”. Unlike the higher-profile Medicare-for-all approach, a Medicare Advantage–for-all approach would have several advantages, Dr. Butler suggests for instance that:

  • Medicare Advantage has wide popular support as well as broad political support. Medicare Advantage enrollment has been growing rapidly, doubling in the last decade, with the proportion of Medicare beneficiaries in such plans now exceeding 34% and rising. Moreover, Republicans as well as Democrats have supported and expanded Medicare Advantage, and the idea of making Medicare Advantage plans available to younger US residents has begun to intrigue some reformers on the right.
  • The capitation system permits competing Medicare Advantage plans to offer a variety of benefits beyond a required core of basic benefits. Moreover, in contrast to traditional Medicare’s rigid and detailed payments system, it allows plans to explore different payments as a means of achieving greater efficiency and beneficiary satisfaction.
  • In contrast with the design of traditional Medicare, Medicare Advantage plans are generally consistent with the growing managed care pattern in non-elderly coverage, including within the employer-based system. Today, about 90% of Medicaid beneficiaries are enrolled in some form of managed care. Meanwhile, about two-thirds of workers with employment-based plans are enrolled in health maintenance organizations or other network coverage that is similar to most Medicare Advantage plans. Medicare’s income-adjusted premiums are also broadly compatible with the structure of income-based subsidies available for plans in state health insurance exchanges, and many insurers offer Medicare Advantage and health insurance exchange plans that have similar designs. Thus, for a large proportion of households, transitioning from their existing coverage to coverage more like Medicare Advantage plans would not involve a big adjustment.
  • Recent changes in laws and regulations allow Medicare Advantage plans to include more nonclinical services that can influence health, such as non-urgent transportation, nutritional services, and even some simple home modifications to reduce the risk of injuries. This reflects the growing interest in addressing so-called social determinants of health.

President Donald Trump is about to release an Executive Order that will guarantee health insurance coverage for all per-existing health conditions in the united States. This Executive Order will lay the ground work for a legislative component that will support Medicare Advantage For All as part of this important health care framework that will provide healthful and affordable health insurance for all Americans.