Evaluating Sanders’s Medicare for All Act of 2019, Part 5

Part 1 reviewed Title 1, which states that basically everyone will be covered and can receive care from pretty much any provider. Part 2 reviewed Title 2, which states that insurance benefits will be comprehensive without any regular out-of-pocket expenditures. Part 3 reviewed Titles 3 and 4, which lay down some provider standards and also some expectations regarding data reporting. Part 4 reviewed Titles 5 and 6, which establish some quality standards and a national health budget, plus it gives an updated process for how provider fee schedules will be made.

We’ve gotten through the main architectural parts of this bill, but let’s see if the rest offers any additional insight into how M4A would be structured so we can evaluate it properly.

Title 7

This creates a universal Medicare trust fund, which is where the taxes used to fund M4A will be placed. It reappropriates all the funds that used to go to Medicare, Medicaid, the Federal employees health benefit program, the TRICARE program, and a variety of smaller programs that M4A will make obsolete.

It also dedicates a short paragraph to ensuring that any prior restrictions on spending federal funds on “reproductive health services” do not apply to any money in this trust fund.

This is just administrative stuff that is important but not so germane to our purposes.

Title 8

There is no new exciting information in here, it is just clarifying statements that there cannot be health plans administered by employers that duplicate any of the M4A benefits, plus a number of clerical statements to amend some existing laws so that they conform to the changes proposed in this bill.

Title 9

I don’t think I mentioned it in Title 2, but states will receive grants to pay for “institutional long-term care services” (nursing facilities, inpatient psychiatric care, intermediate care facilities). That’s basically the one category of healthcare expenditures that will be delegated to the states. I’m not sure I understand why this decision was made.

This title also clarifies that if states are already providing benefits over and above what M4A will provide, it doesn’t automatically take those away; states can continue to provide those extra benefits.

The rest of Title 9 is just a list of other “conforming amendments.”


Ok, we’re getting close to finishing. Title 10 is a big one–it discusses details of the transition to M4A, so that should be interesting. And the last title–Title 11–is a number of miscellaneous crossing of T’s and dotting of I’s. So this means that, after next week, we will have looked at the entire bill! And after that I will proceed with giving a more complete assessment of what changes would be needed for this bill to get M4A right.

Continue to Part 6.

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