TO: Senate Majority Leader Chuck Schumer (D-NY)

FROM: Morgan McBride, Public Policy Student

DATE: March 3rd, 2023
RE: Reforming Medicare for All

EXECUTIVE SUMMARY
The Commonwealth Fund’s 2015 brief depicted how the United States, before the
Affordable Care Act, had a weaker and inefficient healthcare system when compared to other
high-income countries.8 Valuable data from the Organization for Economic Cooperation and
Development illustrates that the United States has the highest number of preventable
hospitalizations and the highest rate of avoidable deaths compared to peer nations like Germany
and Australia.9 Furthermore, the average U.S. resident paid 1,122 dollars out-of-pocket for their
health care, including expenses like prescriptions, copayments for medical appointments, and
insurance deductibles.10 This 2015 study, amongst others, accentuates the drastically exorbitant
costs throughout the American healthcare system and how it still fails to adequately protect its
citizens’ health.
In 2010, approximately sixteen percent of U.S. citizens, nearly fifteen million people, had
no type of health insurance. Copious individuals and families find healthcare costs a significant
burden on their livelihoods. As a comprehensive health care plan, the Affordable Care Act aims
to increase health insurance’s affordability, expand the Medicaid program, and support
innovative medical care opportunities.1 The ACA sparked a potential wave of invaluable
healthcare reform benefitting the everyday individual. The Affordable Care Act builds a health
care system that further protects American citizens from inequalities within the medical and
insurance systems while ensuring that affordable preventative care becomes feasible for
everyone. This memo pushes for the advancement of the ACA and related policies toward
increased implementation on a federal level. Continuous support of the ACA and similar health
policies form a positive trajectory for the country toward national stability and improved health
prospects for its citizens.

BACKGROUND
House Representative Charles B. Rangel introduced the ACA bill through the House’s
Ways and Means Committee in September 2009. Beginning in 2010, the ACA protected patients
who typically remained uninsured because of their preexisting medical conditions or limited
finances.2 The 111th Congress developed bill H.R. 3590, the Affordable Care Act, which is
legislation designed to improve the American health care system immediately. The law expanded
Medicaid eligibility, developed new health insurance practices, and prohibited specific coverage
denials by insurance companies.3 For example, a core component of the bill requires health
insurance plans to fully cover specified preventive items, recommended immunizations, and the
recommended preventive care screenings requested for women, and children.4 The Affordable
Care Act comprehensively develops more robust programs to fill some present gaps in the health
care system.
The bill also focused on pursuing significant reforms to the health insurance market. With
the primary focus of increased accessibility, the ACA launched the Health Insurance
Marketplace, so eligible people can now search for and purchase health insurance policies.5 The
Affordable Care Act forbids any lifetime monetary cap on health insurance coverage while also
diminishing the use of annual monetary caps6. The law also gives consumers premium tax credits
that reduce the cost of insurance for households with incomes ranging from 100% and 400% of
the federal poverty level.7 These policy additions aim to increase the consumer’s protection from
the bureaucracies amongst American insurance companies. Established under the ACA, the
Prevention and Public Health Fund administers grants to states for prevention programs. Disease
screenings, vaccinations, tobacco use, and nutritional concerns are some of the fund’s program
areas. The bill also mandated that insurance plans financially cover preventive care plans for
children and specific subsects of their adult patients. Consumer protection from powerful
industries remains essential throughout government policy initiatives, and healthcare protection
can transform the nation’s future outlook.
In 2016, former President Donald Trump fervently strived to dismantle the Affordable
Care Act, leading to the Tax Cuts and Jobs Act of 2017, which reduced the scope of the ACA’s
outreach program. The percentage of Americans covered by the Affordable Care Act decreased
by approximately twenty-three percent by 2018. However, President Biden’s administration
created the American Rescue Plan Act and the Inflation Reduction Act, which both work to
restore the Affordable Care Act’s original strengths and values.

POLICY RECOMMENDATIONS AND REACTIONS

A - Uniting Behind a Succinct Policy

After enduring nearly a decade of turbulent polarizing disputes surrounding the
Affordable Care Act, the Democrats now have a solid window of opportunity to push forward
strong healthcare policies. The last two election cycles saw numerous proposed plans developed
by Democratic members of Congress. The core aims of such programs focused on Americans
enrolling in public health plans.11 With some proposals ousting private insurance and others
seeking an increased role for employers in insurance coverage, the broad spectrum of ideas
muddles the public discourse surrounding healthcare reform. For instance, the Medicare-for-all
bill propositions, one developed by House representative Pramila Jayapal and another by Senator
Bernie Sanders, provide all citizens with coverage and guarantee a required tax increase.12
Meanwhile, the Medicare buy-in bill proposals have people still receiving insurance through
their workplace, yet the government still regulates the health care prices.13
The prevalence of nearly ten reform recommendations produced by the Democratic
Congress fails to give the party a clear path forward. During a period of polarizing political
activity, the party must present a united front, which means a singular, unified government-run
health care program. The debate surrounding universal coverage sparks a variety of
research-based opinions. The Urban Institute’s center-left Healthy America plan aims to cut the
number of uninsured Americans without majorly disrupting the large employer market. Their
reasoning stemmed from the understanding that many individuals feel continent with their
employer plans.
Through congressional meetings and further research, we must construct a singular
healthcare reform plan, likely comprised of various attributes of existing propositions, for the
Democratic party to move through the House and Senate. Due to the current composition of
Congress, the bill will likely pass through with slim margins for error, and full-Democratic
support would be required. Standing behind a clear proposal, with strong backing from the party,
presents an opportunity for a crucial period of healthcare reform to persist within a contentious
political period.

B - Battling Contentious Responses

Based on the history of healthcare reform efforts in American politics, the proposed bill
could encounter intense backlash from the opposing party alongside the medical and insurance
industries. The Republican party values the consumer’s choice to purchase lower-cost and
lower-value insurance plans with fewer protections.14 Their primary focuses center around the
employer and individual commercial health insurance markets, which ends in a system of more
options but fewer guarantees. So, opposition to the Democratic Party’s reform plan could spur
from its strong nature of government regulation. I presume that valuable concessions must be
made to account for the opposition’s dissatisfaction with increasing government involvement in
healthcare.
Arguments also state that the Affordable Care Act and similar policies could hurt small
businesses that must provide insurance and raise health care costs. The fiduciary responsibility of
insurance varies depending on how the proposed bill structures coverage plans. The program
could either be employer-sponsored or government-sponsored. Each pathway will likely create
strife among either business owners or citizens against tax increases. Although I cannot
concretely propose a solution to the potential conflict, I recommend implementing an
incremental strategy to dampen the situation’s intensity. An incremental strategy can assuage
such concerns while maintaining an earnest momentum toward comprehensive reform of a
complicated system.

MESSAGING AND PUBLIC RELATIONS STRATEGY

Healthcare reform has grown into a contentious topic often utilized as a political talking
point. With the polarized political forum of 2023 at large, any Democratic bill proposal will need
a strong messaging strategy behind it. Embarking on new messaging tactics could pique the
interest of the new politicians, organizations, and the general public in support of the bill. An
important facet of such a strategy revolves around reframing the message to highlight the
following points: the program’s potential benefits for the working and middle-class holistically
and the improvements for the United States as a force on the global stage. Bipartisan politics
presently creates a divide between members of the working and middle class. The current
rhetoric surrounding healthcare tends to glorify the positions and desires of industry leaders and
other politicians. So, developing a multi-faceted approach to demystifying the actual benefits and
consequences of such a plan could help the general public better understand the realities behind
the proposed reform bill.
Additionally, The United States fails to compete with other high-income countries
amongst numerous issues related to the healthcare system. Despite the US being the highest
spender in the healthcare market, Americans often experience worse health outcomes than their
international peers. A Kaiser Family Foundation poll discovered that the high costs of adequate
health care lead people to skip doses of prescribed medicine and avoid seeking care for known
ailments.15 Besides the United States, nearly all rich countries have implemented an
“international standard” health insurance program, which generally includes universal coverage
and systemwide cost control. Amongst those who value America’s ability to adequately compete
with other similarly positioned nations, illustrating our disparity in value within the realm of
healthcare could function as an incentive to move the bill forward.

CONCLUSION
Although a reform bill in the current political climate has an uphill battle to endure,
refocusing the party’s initiatives into a singular proposal could significantly shift the opportunity
for success. Challenging the existing healthcare narratives that are often promoted by industry
leaders can help create a stronger push toward change. With further research and development,
the Democratic party can unite as a strong, driving force towards restructuring the nation’s health
care system, which could ultimately save millions of lives throughout the next decade.
 Footnotes

1. “Affordable Care Act (ACA) - Glossary.” Glossary | HealthCare.gov. Accessed March 3,

2023. https://www.healthcare.gov/glossary/affordable-care-act/.
2. “Understanding the Affordable Care Act.” American Medical Association. Accessed
March 3, 2023.
https://www.ama-assn.org/delivering-care/patient-support-advocacy/understanding-afford
able-care-act.
3. Kenton, Will. “Affordable Care Act (ACA): What It Is, Key Features, and Updates.”
Investopedia. Investopedia, February 4, 2023.
https://www.investopedia.com/terms/a/affordable-care-act.asp.
4. “H.R.3590 - 111th Congress (2009-2010): Patient Protection and Affordable Care Act.”
Congress.gov. Accessed March 3, 2023.
https://www.congress.gov/bill/111th-congress/house-bill/3590.
5. Kenton, Will. “Affordable Care Act (ACA): What It Is, Key Features, and Updates.”
Investopedia. Investopedia, February 4, 2023.
https://www.investopedia.com/terms/a/affordable-care-act.asp.
6. Kenton, Will. “Affordable Care Act (ACA): What It Is, Key Features, and Updates.”
Investopedia. Investopedia, February 4, 2023.
https://www.investopedia.com/terms/a/affordable-care-act.asp.
7. Assistant Secretary for Public Affairs (ASPA). “About the ACA.” HHS.gov, March 15,
2022. https://www.hhs.gov/healthcare/about-the-aca/index.html.
8. Tikkanen, Roosa, and Melinda Abrams. “U.S. Health Care from a Global Perspective,
2019: Higher Spending, Worse Outcomes?” U.S. Health Care from a Global Perspective,
2019 | Commonwealth Fund, January 30, 2020.
https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-gl
obal-perspective-2019.
9. Tikkanen, Roosa, and Melinda Abrams. “U.S. Health Care from a Global Perspective,
2019: Higher Spending, Worse Outcomes?” U.S. Health Care from a Global Perspective,
2019 | Commonwealth Fund, January 30, 2020.
https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-gl
obal-perspective-2019.
10. Tikkanen, Roosa, and Melinda Abrams. “U.S. Health Care from a Global Perspective,
2019: Higher Spending, Worse Outcomes?” U.S. Health Care from a Global Perspective,
2019 | Commonwealth Fund, January 30, 2020.
https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-gl
obal-perspective-2019.
11. Kliff, Sarah, and Dylan Scott. “We Read 9 Democratic Plans for Expanding Health Care.
Here's How They Work.” Vox. Vox, December 13, 2018.
 https://www.vox.com/2018/12/13/18103087/medicare-for-all-explained-single-payer-heal
th-care-sanders-jayapal.
12. Kliff, Sarah, and Dylan Scott. “We Read 9 Democratic Plans for Expanding Health Care.
Here's How They Work.” Vox. Vox, December 13, 2018.
https://www.vox.com/2018/12/13/18103087/medicare-for-all-explained-single-payer-heal
th-care-sanders-jayapal.
13. Kliff, Sarah, and Dylan Scott. “We Read 9 Democratic Plans for Expanding Health Care.
Here's How They Work.” Vox. Vox, December 13, 2018.
https://www.vox.com/2018/12/13/18103087/medicare-for-all-explained-single-payer-heal
th-care-sanders-jayapal.
14. McDonough, John E. “Republicans Have Stopped Trying to Kill Obamacare. Here's
What They're Planning Instead.” POLITICO, April 26, 2022.
https://www.politico.com/news/magazine/2022/04/26/gop-obamacare-aca-health-care-00
027585.
15. Kearney, Audrey, and Alex Montero. “Americans' Challenges with Health Care Costs.”
KFF, July 14, 2022.
https://www.kff.org/health-costs/issue-brief/americans-challenges-with-health-care-costs/
.