October Member Toolkit

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 2022 “overall enrollment [increasing] by a whopping 21 percent (i.e., by 2.5 million people) from the 2021 open enrollment period.” (Health Affairs, 03/28/22) 
  • Building on our current 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 are overwhelmingly focused on building on what’s working in our current system. Of the fourteen Senate Democrats running for re-election in 2022, only one supports 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 show 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, 4/21)  
  • 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 an estimated 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)  

• Implementing 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 unpopular and unaffordable.  
  • 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 cost 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 lowering costs remains the top health care priority for voters of all parties – especially in a time of high inflation. The vast majority of voters – including Democrats – prefer for lawmakers to build on our current health care system rather than create the public option or open up Medicare to younger Americans. Most are unwilling to pay any more in taxes or health care costs to create a new government-controlled health insurance system. (Voter Vitals, 6/15/22)  
  • Lowering COSTS (62 percent) remains the top health care priority for Democratic, swing, and Republican voters.  
  • 63 percent of voters prefer BUILDING ON our current system rather than creating the public option, and 69 percent prefer building on our current system instead of opening up Medicare.  
  • Voters still prefer to build on what’s WORKING by providing subsidies for those in states that did not expand Medicaid to purchase coverage in the existing marketplace (58 percent) over creating a new government-run insurance plan (42 percent).  
  • 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. 

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Sample Social Media 

74 percent of insured voters remain SATISFIED with their current health care coverage, according to our latest #VoterVitals. More about what voters’ health care priorities: https://bit.ly/3ScrQIF 

The country’s health care workforce could face extreme shortages and limited resources if a national public option were to created. Learn more from experts at @FTIConsulting: https://bit.ly/3Q84VMR  

The path forward in health care doesn’t involve starting from scratch. Building on what’s working in our current system is the future of health care. Read more: https://bit.ly/3Lq0FXL  

Over the past 12 years, our current health care system has helped America reach record-high coverage gains. Building on and improving what’s working in health care, where private coverage, Medicare, and Medicaid work together, is the future of health care. https://bit.ly/3Lq0FXL 

Not only could public option proposals result in higher costs for more Americans, but it could lead to increased health care workforce shortages, exacerbating our national nurse and physician shortage. Read the latest study from experts at @FTIConsulting to learn more: https://bit.ly/3Q84VMR 

Polling shows that American voters would rather build on what’s working in health care  instead of starting over with unaffordable proposals like the public option. More from #VoterVitals: https://bit.ly/3ScrQIF 

A record number of Americans have gained access to affordable, high-quality health care coverage through programs that build on our existing system. Let’s continue these improvements instead of starting over with unaffordable proposals. Learn more: https://bit.ly/3bnsYZh 

Our current health care system has already delivered access to affordable, high-quality health coverage to millions of Americans. Let’s continue building on that system and expand access to more people: https://bit.ly/3bnsYZh 

Research shows that under Medicare at 60, Medicare’s lower reimbursement could lead to potentially unsustainable cuts, resulting in lower quality and less access to care for themillions of seniors who rely on the program. Learn more: https://bit.ly/3Q84VMR  

Medicare at 60 could result in unsustainable cuts, lower quality care, and less access to coverage for seniors who rely on Medicare. More: https://bit.ly/3Q84VMR 

Voters still would rather build on what’s working in our health care system than open up Medicare to younger Americans, according to #VoterVitals: https://bit.ly/3ScrQIF 

The U.S. could face an unavoidable trade-off between higher costs to taxpayers and revenue cuts to physicians and hospitals if we implement Medicare at 60. Learn more: https://bit.ly/3Q84VMR 

Experts at @FTIConsulting find that under a public option, the U.S. could see a 2% decrease in graduates from nursing programs, resulting in 88,000 fewer nurses by 2050. More: https://bit.ly/3Q84VMR