screen-shot-2019-02-24-at-5-13-58-pm-273x300-7656328Sen. Kirsten Gillibrand has apparently doubled the price tag of her Medicare buy-in proposal, from 4 percent of income to 8 percent – but the math still does not add up.

In a profile of her presidential campaign in The Nation magazine, Gillibrand pitched an optional buy-in as a transitional step toward a single-payer health system.

I’d let people choose [Medicare] for a certain amount of time—maybe a four-year buy-in at 4 percent of income, and your employer then matches it at 4 percent. That’s 8 percent of income in America. That is enough; it will pay for itself.

In previous interviews and speeches, and in a campaign video, Gillibrand had said her buy-in would cost 4 percent of income without mentioning that it would have to be matched by employers.

Even at 8 percent, however, it’s not clear how her plan would work.

For a Medicare buy-in to truly “pay for itself,” its average per-enrollee charges would have to equal its average per-enrollee costs.

Applied to the typical U.S. household – which has an average of 2.5 members and median income of $58,000 – an 8 percent tax would raise about $1,900 per person.

That’s less than a third of the average premium for employer-sponsored insurance, which is $6,400 nationwide and $7,300 in New York. It’s also substantially less than the $3,300 that Medicaid – with its low fees and limited provider networks – spends on the average non-disabled adult.

Thus the buy-in plan would stand to lose thousands on every low- and median-income family who signs up. Meanwhile, most higher-income people would probably keep the employer-sponsored insurance they already have, especially if it costs less than 4 percent of their wages.

If enrollment were mandatory for Americans of any income –- as under a Medicare for All plan that Gillibrand sees as the ultimate goal – 8 percent income tax would still raise only a fraction of the necessary revenue.

The Urban Institute has estimated that such a plan would require an additional $2.5 trillion per year in federal revenue – which equates to 25 percent of the nation’s total adjusted gross income as of 2016. Sanders himself estimates a cost of about $1.4 trillion per year, which equates to 14 percent of adjusted gross income.

The challenge of raising that much money through income taxes is illustrated in the accompanying chart. The blue and gray bars show the adjusted gross income and tax payments of different income groups in 2016, and the red bar shows the projected cost of single payer. Each box equates to $250 billion.

financing-medicare-for-all-9089869
Source: IRS data. *Cost of the Sanders Medicare for All bill estimated by the Urban Institute. (Click to enlarge)

 

Financing Medicare for All through income taxes would entail collecting 10 blue boxes’ worth of revenue from the bars at left.

As seen in the chart, the wealthiest group (with incomes in excess of $11 million a year) could contribute at most a fraction of one box. Doubling tax collections on the wealthiest 10 percent would generate about four boxes, leaving six more to be extracted from middle- and lower-income Americans.

How Gillibrand arrived at her 8 percent estimate is hard to say. It’s not included in any legislation, or is there an explanation on her campaign website.

The transitional buy-in system included in Bernie Sanders’ Medicare for All bill – which Gillibrand says she helped to write – specifies that premiums would be based on a projection of per-person claims, not a percentage of income.

Sanders has developed a list of revenue-raising ideas to finance Medicare for All, including a 4 percent tax on income and a 7.5 percent payroll tax on employers. But those are just two of 10 items on the list, and account for only about half of the total revenue his proposals would generate.

 

About the Author

Bill Hammond

As the Empire Center’s senior fellow for health policy, Bill Hammond tracks fast-moving developments in New York’s massive health care industry, with a focus on how decisions made in Albany and Washington affect the well-being of patients, providers, taxpayers and the state’s economy.

Read more by Bill Hammond

You may also like

The Attorney General’s MFCU SNAFU

Attorney General Letitia James' latest fight with the Trump administration focuses on New York's Medicaid Fraud Control Unit, a federally funded agency housed in James' office. On T Read More

Healthcare Revelations in the Enacted Budget Financial Plan

The state financial plan published on June 10 disclosed key information about healthcare revenue and spending that lawmakers had not made public when approving the annual budget two weeks before. Read More

Federal Suit Traces Medicaid Fraud to the Top of NYS Government

The Trump administration's latest salvo against Medicaid fraud takes aim at a different kind of target – two high-ranking New York officials along with a major state contractor. A Read More

Healthcare Highlights in the New State Budget

Governor Hochul's focus on affordability seems to have skipped over the healthcare portions of the new state budget. The deal finalized May 27 Read More

Lawmakers Consider Hiking Fees for Filling Prescriptions

UPDATE: The proposal discussed below passed the Assembly Friday evening by an unofficial vote of 133-0. Having previously been approved by the Senate, the bill will head to Governor Hochul's desk for her signature or ve Read More

Budget Deal Reportedly Earmarks $100M for 1199 and Extends MCO Tax

As Governor Hochul and legislative leaders rush to finalize the overdue state budget, outlines of some healthcare-related deals have begun to emerge from the closed-door negotiations. Read More

Albany Wavers on Shutting Down a Medicaid Racket

As Washington threatens to crack down on fraud and abuse in New York's Medicaid program, state legislators are doing their best to demonstrate why federal intervention is needed. A Read More

Getting to the Bottom of the 340B Drug Discount Boondoggle

Some of New York's largest and most prosperous hospitals are reporting rapidly growing amounts of revenue from pharmacy sales – most of it apparently flowing from a controversial drug discount program known as 340B. Read More