Months after all the talk about Democrats signing on to Medicare for All proposals, or attempts to move us in that direction, Senator Elizabeth Warren has proposed a plan to further regulate private insurers as a way to strengthen Obamacare. It is important to keep in mind that she remains a co-sponsor of the single payer bill introduced by Sen. Bernie Sanders, but here’s what she recently said about the politics of that:
…as Warren made clear in a January speech before the consumer group Families USA, she understands that enacting a single-payer plan would be difficult ― and that, as a result, private insurance probably won’t disappear overnight. And so she also wants to focus on what can be done right away to subject the industry to the type of stringent consumer protections she has already successfully championed in the financial sector.
“So long as private health insurance exists, we should require these companies to provide coverage that is at least as good and priced as reasonably as the coverage offered by our public health care programs,” Warren said in January.
Here are some of the specifics Warren has included in her bill:
- Cap premiums to 8.5 percent of income and increase federal subsidies
- All private insurance plans would be required to spend 85 percent of their premium dollars on paying out insurance claims (ACA currently requires 80 percent for insurers in the individual market and 85 percent for those in the group market)
- Prohibit insurers from making changes to covered providers during the course of treatment
- Tighten rules requiring coverage of “essential” health benefits
- Reinstate the federal government’s cost-sharing reduction payments to insurers
- Require insurance companies that bid on Medicare Advantage and Medicaid contracts to offer plans on the ACA marketplaces to increase competition
While those are all laudable goals, the fact that Warren has chosen to go in this direction tells us a couple of things. As noted from her speech to Families USA, she has accepted the fact that single payer is not likely to happen anytime soon and meanwhile, there are problems with Obamacare that require attention. Given that the list of new regulations Warren is proposing would never be acceptable to congressional Republicans and Donald Trump, this is clearly what she would hope to accomplish when/if Democrats win majorities and the presidency. That speaks volumes about where Warren assumes her party stands on healthcare.
Secondly, unlike the kinds of options that would move closer to single payer, such as an expansion of Medicare or Medicaid, Warren isn’t proposing anything that takes us in that direction. That is what I find most puzzling about this proposal. It might have something to do with the fact that, as Andrew Sprung noticed after hearing the speech referenced above, the villain Warren sees as the problem with healthcare in this country is the insurers. That explains why she is focused on additional regulations to rein them in.
In order to move in the direction of single payer, it is clear that one of the biggest challenges will be to control the costs of healthcare in this country and that means dealing with providers. Opening up Medicare or Medicaid to additional populations means that they will be paid less than they currently get from private insurers. In the end, it is much more difficult politically to paint doctors and hospitals as villains.
In her own way, Warren has exposed the issue that proponents of Medicare for All will have to grapple with: private insurance companies aren’t the only problem in our current healthcare system. The other two factors will be much more difficult politically. In addition to the need to control costs, over half of the population is currently covered by an employer-based plan and the vast majority of them like their coverage. By avoiding those two challenges, Warren places herself among the “pragmatic incrementalists” instead of the “philosophical transformationists,” as described by Ezra Klein—at least when it comes to healthcare.