December 21, 2022

December Congressional Recess Toolkit 

Key Talking Points 

  • The most effective way to expand access to affordable, high-quality health coverage and care is to build on what’s working in health care – not to create an unaffordable, new government-controlled health insurance system such as the public option, Medicare for All, or opening up seniors’ Medicare to younger Americans.  
    • Enhancements to our current health care system have helped a record number of Americans gain access to coverage when they needed it most. 
      • Building on our current health care system through enhanced subsidies led to record-high Marketplace enrollment, with “nearly 3.4 million people nationwide have selected an Affordable Care Act (ACA) Marketplace health plan since the start of the 2023 Marketplace Open Enrollment Period (OEP) on November 1.” (Department of Health and Human Services, 11/22/22) 
        • During the 2023 OEP, there are 655,000 people who are new to the exchanges that picked a plan already, making up 19% of the total plan sign-ups so far. CMS said that 2.7 million people who already have 2022 coverage renewed or selected a new plan for 2023.  (Fierce Healthcare, 11/23/22) 
        • There is notable growth on during the 2023 OEP, which has seen 493,216 new enrollees compared to 354,137 for the same time period last year. (Fierce Healthcare, 11/23/22) 
  • Building on our current health care system has led to the rate of Americans without health insurance dropping to a near historic low. 
    • A recent survey conducted by the Department of Health and Human Services (HHS) found that “the uninsured rate declined throughout 2021 and early 2022 – reaching a historic low of 8.0% by the first quarter of 2022. This reflects 5.2 million people gaining coverage since 2020.” (Department of Health and Human Services, 08/02/22). 
  • Building on and improving what’s working in health care is the future of health care reform that lawmakers should continue to focus on.  
    • The 2022 Senate candidates were overwhelmingly focused on building on what’s working in our current system. Of the fourteen Senate Democrats who ran for re-election in 2022, only one supported Medicare for All. 
    • Because government-controlled health insurance systems are unaffordable and have negative, unintended consequences, there has been no movement by the Biden administration to include creating one in its agenda. 
    • Results from early primary races showed that “progressives can tout a few key wins,” in the 2022 primary elections, while candidates who support building on what’s working in health care are winning. To win key elections, “Democrats need moderate support to win outside the bluest parts of the country.” For candidates, this means that supporting creating unaffordable, one-size-fits-all government health insurance systems like Medicare for All, is not a winning strategy. (Axios, 07/31/22) 

Public Option 

  • The public option could come with unaffordable, new costs for working Americans.  
    • The public option could harm the existing health care insurance system and cause premium increases for currently insured Americans, force a reduction in coverage options, and reduce access to care for seniors and low-income families. (Congressional Budget Office, 4/07/21)  
    • The public option could have significant impacts on America’s future fiscal condition and either increase the federal debt or require higher taxes on American families. (Lanhee J. Chen, Ph.D., Tom Church, and Daniel L. Heil, 2/3/21)  
    • In fact, the public option could be even more expensive for working families than originally projected.    
      • A public option could add $700 billion to the federal deficit in its first 10 years and would become the third most expensive government program behind Medicare and Social Security, both of which are already at risk for the seniors that rely on them. (Lanhee J. Chen, Ph.D., Tom Church and Daniel L. Heil, 1/24/20)   
      • Research found that, under the public option, the average American family could eventually see their payroll taxes increase by more than $2,500 a year and 10-year deficits could increase by $800 billion due to the public health crisis. (Lanhee J. Chen, Ph.D., Tom Church and Daniel L. Heil, 10/20/20)  
      • Over 30 years, a public option could lead to a new 4.8 percent payroll tax or marginal tax rate increases for most American families to finance the new program. (Lanhee J. Chen, Ph.D., Tom Church and Daniel L. Heil, 1/24/20)  
  • Creating the public option could harm patients’ access to the affordable, high-quality health care they need and deserve – especially among vulnerable, rural and minority communities.  
    • The public option could put a $774 billion financial strain on hospitals over a 10-year period, potentially forcing hospitals to reduce staff and eliminate services as they operate on a negative profit margin due to lower reimbursement rates. (KNG Health Consulting, 3/12/19)  
    • The closure of hospitals could decrease access to care in rural communities. A public option could put one in four rural hospitals at an increased risk of financial distress and in many of these communities, these hospitals are the only source of health care. (FTI Consulting, 7/14/21)  
    • Reductions in private payment rates may make it more difficult for rural hospitals to hire additional physicians or other health care professionals in areas already facing shortages of such workers. (Urban Institute, 3/21)  
    • The public option could force health care providers to shorten appointment times, make staffing changes, or eliminate services in order to remain financially viable. This would diminish access to essential health care services for patients. (FTI Consulting, 7/14/21)  
    • The negative impact of the public option on hospitals could also harm communities where racial and ethnic minority patients are overrepresented and often rely on hospitals for their health care. Many of the hospitals already at risk for closure serve predominantly minority communities who could be left without a health care provider, especially in southwestern United States. (FTI Consulting, 7/14/21)  
    • The hospitals most at risk under the public option admitted more children and non-Hispanic Asian or Pacific Islander patients as a share of total admissions than hospitals with lower ratios of private to total charges. (Urban Institute, 3/21)  
    • Relative to specialized Medicaid managed care plans that prioritize care coordination and address social determinants of health, the public option may not provide the coverage necessary to meet the unique health care needs of at-risk, low-income populations. (FTI Consulting, 7/14/21)  
  • Creating the public option could cause “significant disruptions” and “result in only a modest decrease in the number of uninsured persons compared to how many people would gain coverage through leveraging the public/private framework that exists under current law.” (KNG Health Consulting, 3/12/19)  
    • Overall, the public option could drastically alter the current health care market. It could drive anestimated 60 million people (40 percent of the market) out of employer-sponsored insurance which could potentially eliminate the entire private exchange market. (FTI Consulting, 5/21)  
    • A public option could force up to two million Americans off their current coverage and leave eight million Americans without a private coverage option. (FTI Consulting, 11/19/19)  
  • Creating a national public option could exacerbate the country’s widespread health care workforce shortages, contradicting policymakers’ goals to expand access to care. (FTI Consulting, 7/21/22) 
    • There are currently 2,640 physicians per million people in urban areas compared to 1,170 in rural areas. A public option would reduce that further, widening the disparity. Low reimbursements could also cut into the margins rural hospitals depend on to pay health care workers. (FTI Consulting, 7/21/22) 
    • The public option could cut into financial resources providers reserve for wages and, as a result, registered nurse (RN) graduations may fall by two percent, or 88,000 nurses, by 2050 under a public option. (FTI Consulting, 7/21/22) 
    • Under a public option, the specialist workforce may shrink by nearly 3,400 physicians by 2050 resulting in a total shortage of 46,304 specialists. (FTI Consulting, 7/21/22) 
    • A national public option could elevate the physician shortage to 78,701 providers and contributing to a projected shortage of nearly 33,000 primary care providers (PCP) by 2050. (FTI Consulting, 7/21/22) 

Government-Controlled Health Insurance Systems’ Poor Track Records  

  • California’s latest proposal for single-payer health care in 2022 failed due to the proposal’s high cost of $222 billion per year. (Los Angeles Times, 1/12/22) 
  • California’s previous single-payer proposal in 2017, which was estimated to cost $400 billion a year, could not pass in the state. (Cal Matters, 8/16/21) 
  • Vermont lawmakers attempted to pass single-payer health care in 2011 but abandoned this plan due to high costs. (Health Affairs, 12/19/18) 
  • In Washington, the state public option remains unaffordable and unpopular.  
    • Public option premiums were on average higher than the lowest silver plan premium available in 2021. (NPR, 2/21/2022) 
    • Only 1% of people buying plans on the exchange chose public option plans in 2021. (NPR, 2/21/2022) 
  • The Department of Health and Human Services approved Colorado’s Section 1332 State Innovation Wavier amendment request to enact a new state government-controlled health insurance system known as the Colorado Option. The approval of Colorado’s rate-setting waiver will ultimately shift costs onto providers, increase costs for patients, and reduce coverage options. 
    • Recent actuarial analysis demonstrates how the Colorado Option will limit Coloradans’ access to affordable, high-quality health coverage and care, including those in vulnerable or underserved communities. (Novarest, 2/1/22) 

Medicare for All 

  • Research demonstrates Medicare for All could mean higher taxes and health care costs for hardworking Americans and threaten existing coverage options.  
    • A single-payer system could come with unprecedented costs, including a $24,000 yearly tax increase on the average family. (Urban Institute, 10/10/18) 
    • A single-payer system could also triple payroll taxes and double other taxes. (Committee for a Responsible Federal Budget, 10/28/19) 
    • Other research shows that taxes on high earners and corporations alone could not finance Medicare for All.  This could mean higher payroll taxes for hardworking American families. However, a payroll tax to finance Medicare for All would reduce GDP by 7.3 percent in 2030. (Committee for a Responsible Federal Budget, 3/17/20) 
  • Research also shows that Medicare for All could lead to longer wait times, reduced access to care, and provider shortages. Benefits may not address the unique needs of many Americans.  And reimbursement cuts could exacerbate our national nurse and physician shortage, reducing access and harming patient outcomes.   
    • One study found that shifting the entire U.S. population to Medicare could result in an estimated 16% cut to spending on patient care provided by physicians. (FTI Consulting, 1/20/20) 
    • When fully implemented, Medicare for All could result in a nationwide loss of 44,693 physicians by 2050.  (FTI Consulting, 1/10/20) 
    • Medicare for All’s reimbursement cuts could result in 90% of hospitals across the country running consistent deficits, increasing the risk of hospital closures nationwide and negatively impacting the health care workforce.  (FTI Consulting,1/10/20) 
    • If Medicare for All became law, 1.8 million health care jobs nationwide could no longer be needed, upending thousands of middle-class workers whose jobs largely rely on health insurance companies, including insurance brokers, medical billing workers and other administrative employees. (University of Massachusetts Political Economy Research Institute (PERI), 11/30/18) 
  • Overall, Medicare for All could threaten current coverage for 250 million Americans by eliminating employer-provided coverage, the highly popular Medicare Advantage program, Medicaid Managed Care, and Exchanges. (Pollitz, Karen, et al. “The Henry J. Kaiser Family Foundation, 7/29/19) 

Medicare at 60 

  • Opening up seniors’ Medicare to younger Americans through proposals like “Medicare at 60” could come with higher costs, worse quality of care, and an unaffordable price tag.   
    • Lowering the Medicare eligibility age to 60 could add $42.6 billion to the federal deficit in 2023 and increase 10-year deficits by as much as $452 billion (excluding interest costs). (Tom Church and Daniel L. Heil, 4/27/22)   
    • Hospitals and physicians could face steep cuts as millions are shifted from private insurance payment rates to lower Medicare rates. If Medicare at 60 were enacted for 2023, aggregate payments for hospitals and doctors would fall by $15.1 billion under the projected current-law rates. (Tom Church and Daniel L. Heil, 4/27/22)   
    • Over one-third of ACA marketplace enrollees could see their combined premium and out-of-pocket payments rise under the proposal, while gaining few additional benefits. (Tom Church and Daniel L. Heil, 4/27/22)   
    • To finance Medicare at 60, Congress could pursue various tax increases. This includes raising the additional Medicare tax rate by 285 percent or raising the standard Hospital Insurance (HI) tax rate by up to 12 percent in 2022. (Lanhee J. Chen, Ph.D., Tom Church and Daniel L. Heil, 6/23/21)   
    • Enrolling in Medicare could result in high costs for 60-64-year-olds that could otherwise be avoided in the current health care system. (Lanhee J. Chen, Ph.D., Tom Church and Daniel L. Heil, 6/23/21)   
      • Nearly 70 percent of this group currently receive subsidies and could end up paying more after transitioning to Medicare, particularly those with incomes above 135 percent of the poverty line.  
      • New Medicare plans could have higher cost-sharing requirements and add increased costs to families that are split between Medicare and Marketplace plans.  
    • “Medicare at 60” could negatively affect hospitals and medical providers that are already financially strained by reducing the reimbursement rates they receive. These potentially unsustainable cuts could mean lower quality and less access to care for the current Medicare-eligible population. (Lanhee J. Chen, Ph.D., Tom Church and Daniel L. Heil, 6/23/21)    
    • Already, Medicare is the second-largest single line item in the federal budget; it will soon surpass Social Security and grow more quickly than every other component. Under “Medicare at 60,” gross Medicare expenditures could rise by $82.9 billion in 2022 and total Medicare spending could rise by $995 billion over 10 years. (Lanhee J. Chen, Ph.D., Tom Church and Daniel L. Heil, 6/23/21)   
    • Absent alternative financing mechanisms, the Hospital Insurance (HI) Trust Fund would be depleted in 2024, two years sooner than currently projected.  (Lanhee J. Chen, Ph.D., Tom Church and Daniel L. Heil, 6/23/21)   

Build on what’s working in health care  

  • Improvements to current law are already helping to lower costs for Americans and increase access to health care.   
    • 3.2 million Americans selected a plan for $10 or less per month after the additional subsidies provided by the American Rescue Plan. (Department of Health & Human Services, 01/27/22) 
      • Expanded Premium Tax Credits have reduced monthly premiums for new enrollees by an average of 25 percent. Americans have been able to sign up for health insurance plans that have lower out-of-pocket maximums with the mean deductible for new consumers falling by nearly 90 percent. (Centers for Medicare & Medicaid Services, 5/6/21)  
  • Since the ACA’s introduction, adult uninsured rates and racial and ethnic coverage inequities declined in nearly every state, particularly in states that built on what’s working by expanding Medicaid eligibility. (The Commonwealth Fund, 6/9/21)  
    • Nearly 35.8 million Americans have enrolled in Affordable Care Act (ACA) Market plans as of early 2022. (Healthcare Dive, 05/02/22) 
    • A record 14.5 million people signed up for coverage through the ACA exchanges for 2022. (Healthcare Dive, 05/02/22) 
  • The American Rescue Plan lowered health care costs for most Marketplace consumers and increased enrollment to these records levels: Americans saw their average monthly premium fall by 23%, compared to the 2021 enrollment period that ended before the American Rescue Plan passed.   (Department of Health & Human Services, 01/27/22) 
    • The current health care system has lowered adult uninsured rates and reduced racial and ethnic coverage inequities in almost every state over the past decade. (The Commonwealth Fund, 6/9/21)  
  • Recent polling shows that a growing majority of voters prefer building on and improving what’s working in health care, earning more support than any other health care proposal. A growing majority of voters would rather build on our current system than create the public option. The majority of voters are also against policymakers in Washington making sweeping changes to our health care system. (Voter Vitals, 12/14/22) 
    • Support for fixing what we have today (67% support, +6% since June) has INCREASED and still earns more support than any government-run proposal.  
    • A GROWING majority of voters (67%, +4% since June) would still rather build on our current system than create the public option (33%, -4% since June).  
    • A GROWING majority of voters (76%, +6% since June) – even Democrats (67%, +3% since June) – are UNWILLING to pay more for health care to create a new government health insurance system.  
    • The vast majority of voters remain CONCERNED about the access, cost, and long-term fiscal impacts of creating the public option or opening up Medicare to younger Americans. 


Sample Social Media 

NEW Voter Vitals: 67 percent of voters would still rather build on our current system than create the public option. Read more:   

DYK: A national public option could lower the physician-to-patient ratio by 10 physicians per 1,000 people by 2050, threatening access to high-quality care. Learn more from experts at @FTIConsulting:

Building on  what’s working in health care – where private coverage, Medicare, and Medicaid work together – is the future of health care. Read our latest blog to learn more:  

With our current health care system, we’ve achieved historic coverage gains. Building on and improving what’s working in health care is the path forward in health care. 

Implementing a public option could result in higher costs for more Americans and lead to increased health care workforce shortages, threatening access to high-quality care. Read the latest study from experts at @FTIConsulting to learn more: 

NEW POLL: The vast majority of voters remain CONCERNED about the access, cost, and long-term fiscal impacts of creating the public option or opening up Medicare to younger Americans.   

Better access to affordable, high-quality health care coverage doesn’t require starting from scratch. Let’s build on and improve what we have today instead of starting over with unaffordable proposals. Learn more: 

From our latest #VoterVitals: Support for fixing what we have today has INCREASED and still earns more support than any government-run health care proposal. Read more:   

Medicare at 60 could result in lower quality care and less access to care for the millions of seniors who rely on the program, due to Medicare’s lower reimbursement rate. Read the report to learn more:  

Opening up Medicare to younger Americans could result in lower quality care, and less access to coverage for seniors who rely on Medicare. Get the facts on the real consequences of Medicare at 60: 

Our latest #VoterVitals polling shows that 76 percent of voters are UNWILLING to pay more for health care to create a new government-controlled health insurance system. Read more:   

Proposals like Medicare at 60 could lead to an unavoidable trade-off between higher costs to taxpayers and revenue cuts to physicians and hospitals. Read the latest research to learn more: 

Experts at @FTIConsulting find that under a public option, access to care could be threatened due to health care workforce shortages. Learn more: 



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