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Single-payer proposals crop up at state, federal level


In the latest AACU Legislative Update, Ross E. Weber examines so-called “public options” being weighed in several states and the nation’s capital. Learn more.

Based on a partnership with Urology Times, articles from theAmerican Association of Clinical Urologists (AACU) provide updates on legislative processes and issues affecting urologists. We welcome your comments and suggestions. Contact the AACU government affairs office at 847-517-1050 or info@aacuweb.org for more information. 

Sen. Bernie Sanders' campaign for the Democratic Party's nomination for president reminds many Americans that single-payer health care proposals often pop up in his home state of Vermont. Proponents of universal health care wield great influence not only in Montpelier, however. Lawmakers in state capitals across the country, as well as Washington, are weighing various so-called "public options."

Read: Competition-stifling facility regulations scrutinized nationwide

State-level single-payer legislation has been introduced in 26 states at one time or another. Of the 16 campaigns launched in 2015-2016, a few proposals remain active in New York, Massachusetts, Pennsylvania, California, Minnesota, Oregon, and elsewhere.

Vermont introduced and passed legislation that instructs the state to develop a complete single-payer implementation plan and put it into effect after receiving necessary federal waivers. Lawmakers in Maine and Rhode Island approved bills requiring similar studies earlier this year. Only Rhode Island's inquiry will move forward, however, since Maine Gov. Paul LePage (R) vetoed the legislature's action (ME L.D. 384; RI H. 5387/S. 619).

Other proposals still being considered across the country include Illinois' Universal Health Care Act, which prohibits investor-ownership of health delivery facilities and frees beneficiaries from deductibles, copayments, coinsurance, and other cost sharing (IL S.B. 2177).

The New York Health Act is a "one-house bill” that, having been approved by the Assembly, "will not be taken up by the NYS Senate," according to the Medical Society of the State of New York (A. 5062).

Having achieved nearly universal insurance coverage in Massachusetts, single-payer advocates secured the introduction and consideration of two bills in the Bay State that establish Medicare for all (MA H. 1026/S. 579). Another pair of bills go even further by establishing a public health insurance option and requiring that only Medicaid managed care organizations administer that public option (MA H.1033/S.604).

Also read: Increased use of telehealth prompts heightened legislative activity

Activists in Colorado, meanwhile, are pursuing a statewide single-payer ballot initiative to bypass the legislative process. Proponents of ColoradoCare secured more than enough signatures for the question of a "State Health Care System" to be placed on the 2016 ballot. Initiative 20 calls for Colorado residents to continue to choose their medical providers, but their bills will be paid by the state via a 10% payroll tax generating an estimated $25 billion per year.

Colorado State Association of Health Underwriters President Byron McCurdy was quoted in The Denver Post as saying, "A single-payer system would destroy our industry. I don't think there's any question about it." Gov. John Hickenlooper (D) likewise expressed skepticism, telling an influential group of business leaders that the plan's costs would be huge and may very well damage the state's business climate.

At the national level, the Expanded & Improved Medicare For All Act (H.R. 676) was introduced by Rep. John Conyers (D-MI). The legislation proposes to create a publicly financed, privately delivered health care system that uses the already existing Medicare program by expanding it to all U.S. residents.

Meanwhile, Rep. Jim McDermott, MD (D-WA), introduced the American Health Security Act (H.R. 1200, formerly S. 1782). Under this bill, every state would be required to set up and administer a single-payer health program. Private health insurance sold by for-profit companies could only exist to provide supplemental coverage.

Recommended: Urologists take action on worrisome definitions of 'quality'

However many delegates Sen. Sanders earns in the presidential primaries, and however many single-payer bills are introduced across the country, it's clear to most observers that there is little political will to implement the "public option" at the state and/or federal level. Incremental steps may be taken in that direction, however, particularly in more progressive jurisdictions.

The Affordable Care Act was written with little regard for physicians. Since Americans trust physicians the most when it comes to proposing health care reform, doctors must step up and make their voices heard. Organizations including the American Association of Clinical Urologists exist to marshal resources and facilitate individuals' interactions with government bodies. Your continued support ensures that the urologic community's interests are considered in committee rooms and back rooms alike.

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