Letters: No, Medicare Advantage for All isn't the answer

Regarding the recent op-ed by Dr. Sachin Jain, CEO of Scan Health Plan, CMS spends about the same on enrollees in Medicare Advantage plans and traditional Medicare enrollees. There’s no evidence that MA plans save the government money, and the enhanced coordination and quality these plans offer is also available from many physician-led accountable care organizations.

The main result of replacing President Joe Biden’s proposed public option with Medicare Advantage for All would be an immense windfall for health insurers, especially Humana and UnitedHealthcare. Sooner or later, this country will have Medicare for All, and giving away the store to profit-making entities will simply delay the transition to single-payer healthcare.

Ken Terry
Sheffield, Mass.

I read the recent op-ed “The missing piece in our fight against COVID-19: primary care,” by Drs. David Blumenthal and Farzad Mostashari. The authors rely on and reference a report on shoring up the supply and availability of primary-care clinicians produced by a Commonwealth Fund Task Force on Payment and Delivery System Reform. I find this reference symptomatic of why we have not solved the healthcare crisis in our country. You see, the overwhelming majority of this task force’s members are not currently practicing primary-care physicians.

As a board member of a very successful large pediatric group, I find when we need a practical solution to a problem impacting our physicians and their patients, our best approach is to ask our practicing physicians. We have not come up with practical solutions to our healthcare crisis because we have relied primarily on academicians, bureaucrats and payers (who are well represented on the Commonwealth Fund task force) and not healthcare providers.

Nathan Kaufman
Managing director
Kaufman Strategic Advisors
San Diego

The article “Biden to reopen ACA marketplace, revisit work requirements” was helpful in understanding the ongoing threats to Medicaid coverage through work requirement waivers. The Trump administration tried to kill the program through “death by a thousand cuts.”

Hopefully, the Biden administration will turn this situation around by expanding enrollment opportunities and eliminating work requirements, which were not part of the ACA law.

Medicaid expansion should have been a no-brainer for every state more than a decade ago when the ACA was signed into law. It’s past time for the 12 states that haven’t expanded the program to stop playing politics with the health of their citizens and approve simple expansion. Congress can help speed the process.

As part of the original ACA legislation, the feds were going to pay 100% of expansion costs for three years. After that, the state was to pay 10% of the cost, a great deal for any matching grant. Plus, the original ACA legislation stated that if a state did not expand Medicaid, it would lose all Medicaid funds. That poison pill was intended to ensure that all states fully participated. And it would have worked.

However, in a split decision, the Supreme Court struck down that clause. Thus, some of the poorest states opted out and many of their neediest citizens lost coverage.

If the House and Senate (now controlled by Democrats) care to do so, they can work to abolish the 10% state matching requirement for Medicaid expansion. Maybe that could entice some of the holdouts to finally opt in, giving their neediest residents access to coverage. States that have already expanded could use their matching funds (which would no longer go to Washington) for other pressing needs, like COVID vaccinations.

This legislation would benefit both red and blue states. All it takes is the political will.

Jack Bernard
Peachtree City, Ga.