Insurers’ Utilization Management Tools Vary Widely on Anti-Nausea Drugs for Cancer
Chart of the Day: LDI Researchers Report Major Coverage Differences Across ACA and Medicaid Plans, Affecting Access to Drugs That Treat Chemo-Related Nausea
In Their Own Words
A Bold Plan to Fix Medicaid
Democrats Must Go Beyond Reversing Trump-Era Cuts With a New Strategy to Streamline Coverage, Reduce Waste, and Expand Access to Medicaid
Print:
While the devastating consequences of Trump’s “One Big Beautiful Bill” are clear–like lost Medicaid coverage for an estimated 12 million Americans–rolling this bad bill back is not enough for Democrats.
Medicaid is flawed and broken, and must be improved so we can bring quality health care to all Americans. How? I’ve identified seven core design elements Democrats can propose to fundamentally fix Medicaid, not just repair the damage done by Trump:
- Create one national exchange combining Medicaid, CHIP, and ACA exchanges where all uninsured Americans can purchase coverage based on income, with automatic enrollment.
- Require five-year plan commitments instead of annual enrollment to reduce churn, lower administrative costs, and incentivize prevention.
- Limit choices to no more than six plans per region, with at least two being state or local insurers, to enhance decision-making and limit market concentration.
- Standardize benefits nationwide with low deductibles and out-of-pocket expenses capped at 2% of income, ensuring sick people don’t skip care due to costs.
- Increase provider payments to Medicare levels while recalibrating to incentivize prevention and value-based care through primary care bonuses and bundled payments.
- Create a single claims clearinghouse for all insurers and providers to reduce administrative waste and improve coordination.
- Establish a separate long-term care program for nursing homes and assisted living, allowing families to avoid impoverishment and be reimbursed for care they provide.
I elaborate on all of these in my new piece in The Bulwark.
As Americans fear what Trump’s bill means for them, Democrats must offer a plan that’s better, cheaper, and more compassionate. Now is the time for bold reform that guarantees simple, standardized coverage that puts health over profit and protects families from bankruptcy.
Ezekiel J. Emanuel, MD, PhD is a Senior Fellow at the Leonard Davis Institute of Health Economics, Vice Provost for Global Initiatives and the Diane v.S. Levy and Robert M. Levy University Professor at the University of Pennsylvania.
Author
Ezekiel J. Emanuel, MD, PhD
Diane v.S. Levy and Robert M. Levy University Professor, Perelman School of Medicine, Wharton School.
More on Health Care Access & Coverage
Why You May Have Fewer Health Insurance Choices Than Your Neighbor
Insurers Avoid Counties With Small Populations and Poor Health but a New LDI Study Finds Limited Evidence of Anticompetitive Behavior
Acupuncture Could Fix America’s Chronic Pain Crisis–So Why Can’t Patients Get It?
A Proven, Low-Risk Treatment Is Backed by Major Studies and Patient Demand, Yet Medicare and Insurers Still Make It Hard To Use
Integrated Care Plans Didn’t Boost Medicaid Enrollment for the Poorest Seniors
Chart of the Day: Medicare-Medicaid Plans—Created to Streamline Care for Dually Eligible Individuals—Failed to Increase Medicaid Participation in High-Poverty Communities
Less Postacute Care for Medicare Advantage Beneficiaries Does Not Mean Worse Health
Research Brief: Shorter Stays in Skilled Nursing Facilities and Less Home Health Didn’t Lead to Worse Outcomes, Pointing to Opportunities for Traditional Medicare
The Unseen Fallout of Abortion Bans
How Threatened Reproductive Rights Pushed More Pennsylvanians Toward Sterilization