February 19, 2021
Senate Democrats reintroduced the Medicare-X Choice Act, which creates a public option close to what President Biden campaigned on and restarts the debate on government-run health care plans. The measure, which would shift costs to employer plans, could be included in the next budget reconciliation process, thus avoiding a Senate filibuster.
The public option plan follows the Medicare framework but will be available to younger populations. The measure includes:
Potential problems for employers: Because the bill would utilize Medicare reimbursement rates for the public option, health care providers would shift costs to employer plans. Employer plans not having access to Medicare-negotiated drug prices would also shift costs. Further, fixing the "family glitch" without a safe harbor for employer plans could expose employers to ACA penalties because employers will not know if an employee's contribution for family coverage exceeds their household income, which is data they don't have or want to ask employees for.
The public option plan would first be available in parts of the country, mostly rural, where there are limited insurers on the individual market or where premiums are higher. By 2025, the public option would be available everywhere in the U.S.
The plan also includes a requirement for providers who participate in Medicare and/or Medicaid to also accept Medicare-X patients. Providers would be reimbursed at 100% of the Medicare fee-for-service rates and, in rural areas, up to 150% of Medicare rates.