The Guttmacher Institute is evaluating how sexual and reproductive health and rights fit into U.S. health care reform efforts. Previous analyses have described people’s wide array of sexual and reproductive health needs and laid out a set of principles for how to address them within the health care system. This analysis applies those principles to one specific health care reform proposal. Evaluations of additional proposals can be found here.

Proposal name and bill number: Choose Medicare Act (S. 2708, 115th Congress)

Proposal sponsor/author: Sen. Jeff Merkley (D-OR)

Proposal version date: 4/18/2018

Related proposals: H.R. 6117, 115th Congress, Rep. Cedric L. Richmond (D-LA)

Summary of Proposal

Creates new public health plans (known as Medicare Part E plans) that would be available as options for people buying insurance through an employer or on their own through the Affordable Care Act’s (ACA) health insurance marketplaces, with all of the ACA’s subsidies to make coverage more affordable. Does not directly alter other major aspects of the U.S. health care system.

Ensure Comprehensive Insurance Coverage for Everyone

Provide coverage to all without cost or paperwork barriers: Provides new options for U.S. residents purchasing insurance through an employer or the individual marketplace, but does not attempt to guarantee coverage for all U.S. residents. No explicit restrictions related to immigration status; however, “residency” would be defined by the Department of Health and Human Services, providing a hostile administration an opportunity to exclude many immigrants. Requires patients to pay monthly premiums but expands on the ACA’s premium subsidies.

Cover the complete scope of sexual and reproductive health services without barriers: Requires coverage for all current Medicare benefits, the ACA’s 10 essential health benefits (which specifically includes maternity care), and “abortions and all other reproductive services.” Other reproductive health services are not listed. Includes language intended to override restrictions on the use of federal funds for abortion coverage and care (like the Hyde Amendment) and includes a “sense of Congress” that all restrictions on reproductive health coverage should end. Allows cost sharing (e.g., copays) for most services but expands the ACA’s subsidies to help patients afford cost sharing.

Build and Maintain a Robust Provider Network

Ensure that patients may seek care from any qualified provider: Not addressed.

Fully reimburse providers and invest in their education, facilities and technology: Not addressed.

Keep pace with emerging services and methods, such as telehealth: Not addressed.

Guarantee and Enforce Strong Patient Protections

Eliminate legal, cultural and safety-related barriers to care: Not addressed.

Respect patients’ privacy and autonomy and guard against coercion: Not addressed.

Fight discrimination and promote equitable health care access and experiences: Not addressed.

Overall Assessment

Strengths:

  • Creates new health insurance options and makes coverage more affordable for many U.S. residents.
  • Explicitly covers abortion and "all other reproductive health services" as a category and lifts federal restrictions on that coverage.
  • Under a supportive administration, would have strong potential to expand health insurance access to many immigrants and other groups whose coverage choices are currently limited.
  • Under a supportive administration, would have strong potential to expand the scope of sexual and reproductive health services available to all.

Weaknesses:

  • Under a hostile administration, many specific sexual and reproductive health services and the providers who offer them could be excluded from coverage (perhaps with the justification that those services could be covered under separate, privately purchased insurance plans).
  • Under a hostile administration, many immigrants (who could be defined as not being U.S. residents) could be excluded from coverage.
  • Has a relatively narrow scope that does not address many areas of importance, including anything around the provider network or patient protections.