Single payer systems (also referred to as Medicare-for-all) are national health insurance models whereby public agencies organize and oversee funding. Such systems also permit for additional private coverage if desired.
Many states are employing Section 1332 waivers to work toward single-payer systems; however, it remains unlikely that the federal government will adopt such a system anytime soon.
1. Taxes
The Affordable Care Act imposed multiple taxes that have led to higher costs for many Americans, such as a medical device tax and an individual mandate that required people to purchase insurance or face fines; it also levied taxes on specific insurers and placed restrictions on healthcare-related tax deductions.
Some states have passed single-payer bills using a 1332 waiver, similar to what can be found under the Affordable Care Act (ACA), that would offer universal health coverage through public options as well as controlling spending via expansive rate setting and simplified administration.
2. Subsidies
Lower-income Americans can receive subsidies from the government to assist with paying their premiums, with subsidies paid directly to insurance providers and then claimed on taxes.
Subsidies vary annually based on your income and cost of benchmark plans in your area, typically 400% of poverty level or below to qualify.
Obamacare provides low co-pays or deductibles for preventive screenings in an effort to promote wellness and avoid costly treatments in the future.
3. Mandate
In 2019, this fee was eliminated. The individual mandate required Americans to acquire insurance or face a tax penalty. This tax penalty has now been repealed.
The Affordable Care Act (ACA) permits young adults up until 26 to remain on their parents’ health insurance plan until then, helping increase enrollment. Furthermore, federal subsidies cover costs of private plans sold on ACA exchanges.
4. Exchanges
Health insurance exchanges (or marketplaces) provide individuals in each state a way to purchase Affordable Care Act-compliant health plans through organizations known as exchanges. Plans sold on an exchange must abide by certain regulations regarding cost-sharing reductions and premium subsidies.
Plans that don’t qualify for an exchange may still be sold “off-exchange”, though DC Health Link only permits ACA-compliant policies to be bought through that route. Unfortunately, such plans don’t enjoy the same cost-sharing and premium subsidy support that are available when bought from within an exchange marketplace.
5. Pre-existing conditions
Pre-ACA, health insurance companies could exclude or charge more for those with preexisting conditions. Now that Obamacare has taken effect, all Americans must be offered coverage regardless of medical history – no one should be denied due to health status alone.
Opponents of the new health-care law now have an opportunity to demonstrate that their alternative is just as capable of protecting sick individuals. An emerging solution on a state level involves robust, well-funded high-risk pools.
6. Coverage year round
Single payer systems would replace private health insurance with government funds, eliminating copays, deductibles and out of pocket costs entirely to create one tier of plans with equal benefits and networks.
People can sign up for Marketplace health insurance coverage year-round during a special enrollment period (SEP), while those eligible for Medicaid or Children’s Health Insurance Program can also make applications at any point throughout the year.
The Affordable Care Act brings America closer to universal healthcare through cost assistance, the individual mandate and Medicaid expansion. Furthermore, states can take advantage of 1332 waivers to tailor solutions unique to them.
7. Tax penalties
The Affordable Care Act (Obamacare) required everyone to have health insurance or pay a penalty. In addition, this legislation provided premium tax credits and cost-sharing reductions to individuals earning less than 400% of poverty level.
ACA included an employer mandate requiring firms to either provide insurance coverage or face a penalty; however, this has since been repealed under the Tax Cuts and Jobs Act; nonetheless some states such as New Jersey, Vermont, Massachusetts and California have implemented their own penalties for failure to provide coverage or pay penalties.
8. Accessibility
In 2010, President Obama signed into law the Patient Protection and Affordable Care Act, commonly known as Obamacare. It sought to transform our nation’s health care system.
The Affordable Care Act has protected millions of Americans from insurers that discriminated against them or increased costs by restricting care or benefits, and helped make prescription medicines more cost-effective.
Single payer systems come in many different forms; most countries that provide universal healthcare use a hybrid approach that combines public and private methods. “Medicare for all” refers to a specific type of single payer that operates like Medicare does.
