Secret weapon: the "new" Medicare as a route to health security

Medicare Advantage for Most

Policy Points Fixing the ACA requires real cost containment in addition to better subsidies. Private Medicare (Medicare Advantage) plans are uniquely empowered to control costs and deliver good care. Medicare Advantage plans should serve as the public option on the ACA Marketplace. Medicare Advantage plans can also be deployed to voluntarily raise minimum employer-sponsored benefits and contain their costs.

Navigating the Shifting Terrain of US Health Care Reform-Medicare for All, Single Payer, and the Public Option

Policy Points "Medicare for All" is an increasingly common term in US health care reform debates, yet widespread confusion exists over its meaning. The various meanings of Medicare for All and other related terms reflect divergent political and philosophical assumptions about the preferred direction of health care reform, as well as the hybrid structure of the current Medicare program.

Boutique to Booming: Medicare Managed Care and the Private Path to Policy Change

In 2014, Medicare Advantage (MA) enrollment surpassed 30 percent of eligible beneficiaries. Twenty-five years earlier, enrollment hovered at just 3 percent. The expansion of private Medicare plans presents a puzzling instance of policy change within Medicare-a program long held to be a quintessential case of policy stasis. This article investigates the policy features that made Medicare susceptible to this dramatic policy shift, as well as the processes by which the initial policy change remade the politics of Medicare and solidified the MA program. The first enrollment surge occurred in the absence of a proximate legislative or administrative change. Instead, increased spending and expanded benefits were the result of the interaction of new market dynamics with an existing legislative framework-demonstrating an expansionary form of policy drift. The 1982 Tax Equity and Fiscal Responsibility Act created a policy space that gave the new and lightly controlled managed care industry considerable operational discretion. As the interests of the government's private partners changed in response to new market dynamics, a change occurred in the output and performance of the Medicare managed care program. As enrollment and spending increased, Medicare's politics were remade by the political empowerment of the managed care industry and the creation of a new subconstituency of beneficiaries.

Voucherizing Medicare

This article explores the evolving language of Medicare reform and recent conflicts over "voucherizing" Medicare. The Medicare reform debate is, in part, a contest over how to frame policy alternatives in order to enhance (or diminish) their political viability. "Voucherizing" has emerged as a powerful rhetorical weapon in that fight. Yet the accompanying debate is often misleading about both the current state of Medicare and the necessity of altering its programmatic structure to ensure future stability.

Right-wing conspiracy? Socialist plot? The origins of the Patient Protection and Affordable Care Act

On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). Did the ACA signify a government takeover of the health care system, a first step on the road to socialism, as conservative critics charged? Or was it, rather, a sellout to the right wing, as liberal single-payer advocates proclaimed? The ACA's key provisions, the employer mandate and the individual mandate, were Republican policy ideas, and its fundamental principles were nearly identical to the Health Equity and Access Reform Today Act of 1993 (HEART), a bill promoted by Republican senators to deflect support for President Bill Clinton's Health Security plan. Yet the ACA was also a policy legacy of the Clinton administration in important ways that rarely are acknowledged, notably Medicaid expansion and insurance company regulation. Although the ACA departed from the liberal vision of a single-payer plan and adhered closely to the objectives of those who believed that the health care system should encourage the free market, it included provisions that will make coverage more affordable, reliable, and accessible.

Between liberal aspirations and market forces: Obamacare's precarious balancing act

The 2010 Affordable Care Act (ACA) represents a milestone in U.S. health care policy. The ACA moves the American health care system away, in important respects, from market-driven health care, including imposing new regulations on health insurers. Yet the ACA also relies, in other respects, on market forces to achieve its aims, including its embrace of health plan competition and high-deductible insurance. This article explores how the ACA balances liberal aspirations and market principles, and the implications for health reform implementation and the future of U.S. health care.