Through Pete’s Medicare for All Who Want It plan, everyone will be able to opt in to an affordable, comprehensive public alternative. This affordable public plan will incentivize private insurers to compete on price and bring down costs. If private insurers are not able to offer something dramatically better, this public plan will create a natural glide-path to Medicare for All. The choice of a public plan empowers people to make their own decisions regarding the type of health care that makes sense for them by leveling the playing field between patients and the health care system. It gives the American people a choice and trusts them to set the pace at which our country moves in a better direction on health care.

Pete’s coverage and affordability plan includes the following policy proposals:

BECAUSE HEALTH CARE IS A HUMAN RIGHT, GUARANTEE UNIVERSAL COVERAGE THROUGH MEDICARE FOR ALL WHO WANT IT.

The Medicare for All Who Want It public alternative will help America reach universal coverage by providing an affordable insurance option to the currently uninsured. The public alternative will provide the same essential health benefits as those currently available on the marketplaces and ensure that everyone has access to high-quality, comprehensive coverage.

The plan will automatically enroll individuals in affordable coverage if they are eligible for it, while those eligible for subsidized coverage will have a simple enrollment option. A backstop fund will reimburse health care providers for unpaid care to patients who are uninsured. Individuals who fall through the cracks will be retroactively enrolled in the public option.

END SURPRISE BILLING.

Most commonly, unexpected bills arise when a patient receives care at an in-network hospital and, unbeknownst to them, is treated by an out-of-network physician.4 This mismatch is a deliberate business strategy fueled by profit-driven firms in private equity.5 About one in five visits to the emergency room is likely to lead to a surprise bill.

Pete will require that bills related to in-network facilities be billed as in-network. His plan will also place limits on what out-of-network providers, including ambulances and air ambulance services, can charge.

EXPAND PREMIUM SUBSIDIES FOR LOW-INCOME PEOPLE TO MAKE MARKETPLACE COVERAGE DRAMATICALLY MORE AFFORDABLE FOR INDIVIDUALS AND FAMILIES.

Pete will make premium subsidies more generous for low-income people. Today, a family of three making $31,000 a year pays about $1,200 annually for “silver” coverage on the marketplace.6 Under Pete’s plan, they will pay a maximum of roughly $600 a year for higher quality (i.e., gold-level) coverage.

CAP MARKETPLACE PREMIUM PAYMENTS AT 8.5% OF INCOME FOR EVERYONE, WHICH WILL PRIMARILY HELP MIDDLE-INCOME INDIVIDUALS AND FAMILIES.

This plan will also extend the subsidies to more middle-income people by capping premium payments for everyone. That means that the 60-year-old in Iowa making $50,000 and currently paying $12,000 annually in premiums will now pay no more than $4,250 annually for gold coverage. Pete will also lower out-of-pocket costs for consumers by increasing cost-sharing assistance.

CAP OUT-OF-POCKET COSTS FOR SENIORS ON MEDICARE, WITH A LOWER CAP FOR LOW-INCOME SENIORS.

One in four Medicare beneficiaries—15 million people—spend over 20 percent of their income on premiums and medical care.7 Costs run much higher for many, including those with chronic disease and disability. The traditional Medicare program does not have a cap on out-of-pocket spending, putting seniors at risk of having medical or drug costs wipe out their savings. Pete believes that seniors in traditional Medicare deserve the same financial protection. He will improve affordability in Medicare by capping out-of-pocket costs, with lower caps for low-income seniors.

ENSURE THAT NON-PROFIT HOSPITALS TRULY SERVE THEIR COMMUNITY BY STRENGTHENING HOSPITAL COMMUNITY BENEFIT REQUIREMENTS.

Non-profit hospitals do not pay federal taxes under the assumption that they benefit their communities. Many benefit their communities in a number of ways, such as by providing free care to uninsured patients and offering medical training.8 However, some non-profit hospitals are doing little to benefit their community—sometimes even harming their own patients through aggressive billing and predatory collection practices.9 Pete’s plan will strengthen community benefit requirements to ensure that hospitals are investing in the health of their patients and communities.

LIMIT WHAT HEALTH CARE PROVIDERS, INCLUDING HOSPITALS, CAN CHARGE FOR OUT-OF-NETWORK CARE AT TWICE WHAT MEDICARE PAYS FOR THE SAME SERVICE.

Health providers often charge private insurers exorbitant fees. As hospital prices for outpatient care increase at a rate four times faster than physician prices,10 hospital profits have risen to their highest levels in decades.11 As President, Pete will prohibit health care providers from pricing irresponsibly. This will also provide insurers with leverage to demand lower rates for in-network care.12 As noted in our rural health plan, for these providers in underserved areas, Pete’s administration will increase Medicare reimbursement rates and encourage states to increase Medicaid reimbursement rates.

MAKE IT EASIER TO AFFORD AND FIND CARE FOR MENTAL HEALTH AND SUBSTANCE USE DISORDER BY ENFORCING PARITY.

TACKLE HIGH ADMINISTRATIVE COSTS TO FURTHER BRING DOWN THE COSTS OF HEALTH CARE IN AMERICA.

Our health care system is the most costly in the world in part because it spends $496 billion annually on administrative costs—more than any other system globally.13 To lower cost and improve quality, we must make our health care system more efficient. Pete’s plan will do this by harmonizing standards for transactions and holding insurance companies accountable for adopting them. It will simplify billing by creating a central clearinghouse for claims,14 establish an All-Payer Claims Database that supports health care quality initiatives,15 and require integration of electronic records.

EMPOWER THE FEDERAL GOVERNMENT TO BETTER MONITOR AND CHALLENGE MORE HEALTH CARE MERGERS, WHICH OFTEN RAISE THE COST OF CARE WITHOUT IMPROVING OUTCOMES.

Health insurers, hospitals, pharmaceutical companies, and health care provider groups are all growing larger, but bigger has not been better for patients. Greater consolidation among providers and insurers results in higher prices for patients without improving quality. To ensure robust competition in health care markets and protect patients, Pete will increase funding for federal antitrust authorities to empower them to review more mergers and equip them to bring enforcement cases against activity that harms competition and hurts health care workers.