What ‘Medicare for All’ Could Mean for Your Facility Much would depend on the plan the federal government adopts BY STEVE SELDE

Over the last two years, Democrats on the cam- paign trail have used “Medicare for All” as a slogan and to describe a

variety of policy proposals. In the 116th

Congress, almost a dozen bills

have been introduced that fall under the “Medicare for All” umbrella. Although these proposals do not have bipartisan support, the Demo- cratic majority in the House of Rep- resentatives has spent the last year holding preliminary hearings to learn more about the topic. If signed into law, the proposals would have varying impacts on ASCs. Legislation under the Medicare

for All banner generally falls into two categories. On one end of the continuum, these bills would pro- hibit private insurance entirely and leave federally funded and regulated care as the only option. On the other end, some plans would allow pri- vate insurance to continue, with new coverage options offered through the existing Patient Protection and Affordable Care Act (ACA) health- care exchanges and options for indi- viduals 50 and over to buy into the Medicare program.

Under the single national pro- gram popularized by Senator Ber- nie Sanders (D-VT), federal cover- age would be the only option. ASCs, other healthcare facilities and pro- viders would experience the great- est changes under this plan, which would replace the Medicare program and fee schedule, cover everyone and eliminate the current private payer mix that has long served the market- place. Patients would no longer be responsible for premiums, deduct- ibles or other cost-sharing obliga-

tions. Regulatory issues, like the use of the Consumer Price Index for All Urban Consumers to update reim- bursement to ASCs, would have a greater impact, and implementation of such a broad law by the Centers for Medicare & Medicaid Services (CMS) likely would introduce addi- tional discrepancies that do not rec- ognize the important role that ASCs play. Additionally, increased federal spending required to fund such pro- posals is high, with some estimates as high as $32 trillion over the first 10 years. If tax increases are used to fund those proposals, federal individ- ual and corporate income taxes could easily more than double. These costs would need to be offset by lower provider and facility reimbursements and likely new and higher taxes on healthcare professionals and those outside the medical sector. The option-based proposals dif- fer in many respects but have a few common elements among them. The majority maintain the current pre-


Visit ASCA’s website every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA’s Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs. GovtAffairsUpdate

mium, deductible and cost-sharing structure of private health plans or the Medicare program, if applicable. Additionally, the ACA’s premiums subsidies would be kept or enhanced. To define scope of coverage, public option plans would use the ACA’s 10 essential health benefits and Medi- care buy-in plans would rely on the benefits offered under Medicare Parts A and B.

Medicare payment rates are pro- posed to be used in both the public option plans and the Medicare buy- in plans. Overall, the increased fed- eral expenditures are intended to be offset through premiums and cost- sharing, but it remains to be seen how much additional funding would be needed to offset federal subsidies or maintain Medicare


ment rates. Likely, this would entail additional or higher taxes. Similar to the single national program, regula- tory issues would have a heightened impact on ASCs as they would serve more patients under the option- based proposals.

Hearings held this year in the House are a preliminary step toward enacting a Medicare for All plan. Among Democrats, there is not una- nimity on which direction to go, and it took negotiations to even hold hearings on the topic. Moving for- ward, it is likely that specific provi- sions in any formal legislation styled under the Medicare for All umbrella will evolve while the overall propos- als will maintain some of the core elements described above.

Steve Selde is ASCA’s assistant director of government and legislative affairs. Write him at


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