Stories by Drew Altman, Kaiser Family Foundation

The detail that could make Medicare for All generous — and expensive

Adapted from a Peterson-Kaiser Health System Tracker chart. Spending is in purchasing power parity equivalents. Chart: Axios Visuals

Now that the Democrats have taken control of the House, their "Medicare for All" proposals are going to get hearings and scrutiny. One feature of Bernie Sanders' version that hasn't gotten a lot of attention yet, but it will: the plan has no deductibles or other forms of patient cost-sharing.

Why it matters: In a country where so many Americans are bedeviled by medical bills, especially people who are sick and use a lot of medical care, this would be a big deal. It would actually make our system more generous than any of the other developed nations that Democrats like to cite as models for our own.

The GOP's health problem: They like big chunks of the Affordable Care Act

A protester in New York holds a sign saying, "ACA saves lives"
A pro-ACA protest in New York in July 2017. Photo: Albin Lohr-Jones/Pacific Press/LightRocket via Getty Images

Now that a Texas judge has ruled that the entire Affordable Care Act is unconstitutional — all because of its individual mandate — Republicans may find themselves wishing for a different outcome.

The big picture: There is little hope of a deal with Democrats on health reform in a divided Congress if the decision is upheld. Democrats will now use the 2020 campaign to paint Republicans as threatening a host of popular provisions in the ACA. And here’s the kicker: protections for pre-existing conditions, the provision that played such a big role in the midterms, is not even the most popular one.

There is another pre-existing conditions problem — for seniors

Illustration of a broken orthopedic walker
Illustration: Aïda Amer/Axios

Pre-existing conditions are in the news again, now that a federal judge's ruling could wipe out the Affordable Care Act. But there's been a similar issue all along that's drawn less attention: Seniors with pre-existing conditions can be denied coverage in many cases when they apply for Medicare supplemental insurance policies, or Medigap.

The big picture: The Affordable Care Act prohibits most private health plans from denying coverage to individuals based on their medical history. Medicare and Medicaid also cover all eligible individuals regardless of their medical history. But Medigap doesn’t have this protection, at least not fully. The problem could be addressed, but with the expected side effect: premiums would go up.

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