Universal healthcare in the US: An examination of proposals

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A look at proposals for universal healthcare in the US

At a glance: Universal healthcare in the US: An examination of proposals

While no plans are on the horizon for the US to adopt universal healthcare, understanding the programs that have been proposed in the US can help payers, providers and pharmaceutical businesses prepare for incremental changes that could occur.


A look at proposals

The US has no shortage of plans for establishing universal healthcare. At least 16 plans have been introduced at the state or federal level since the 1980s. An analysis by PwC’s Health Research Institute (HRI) finds that most of these plans favor expanding existing federal programs rather than creating new ones. The only proposals that have gained any traction envision expanding access to care through public programs and private coverage.

The likelihood of federal universal healthcare legislation passing soon is vanishingly small, yet the issue likely will be debated during this election season and the next. Americans continue to name healthcare as a top concern, according to a Gallup poll.

Americans appear generally in favor of having more people covered by existing programs, though they show some ambivalence about how that might look, according to a 2018 HRI consumer survey on national health plans. In that survey, 48 percent of respondents supported a national health insurance program available to all Americans in which physician practices and hospitals would remain private, while 57 percent supported expanding Medicaid eligibility to any US resident.

Consumer support for a national health program vs. Medicaid-for-all varies dramatically

Even if sudden, dramatic change never arrives, American healthcare organizations making long-term plans should consider the possibility that government-sponsored health coverage will continue to grow, albeit slowly, providing fertile opportunities for private organizations to administer benefits, control costs and coordinate care for beneficiaries. Universal healthcare proposals also could make headway in some states, and payers should consider undertaking scenario planning to build resilience and to be able to capitalize on opportunities.


Action may come from the states

With encouragement from the Trump administration, states increasingly are going their own way to develop healthcare solutions. Idaho, Maine, Nebraska, New Hampshire, Utah and Virginia are engaged in efforts to expand Medicaid enrollment. Iowa and Idaho have sought to allow the sale of insurance plans that don’t conform to federal requirements, though Idaho’s attempt was limited by CMS. All-payer models, like ones in Maryland, Pennsylvania and Vermont, could help set the stage for later universal healthcare systems. It pays to understand what states are considering because they are as empowered as ever to tailor their own regulatory landscapes.



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Focus on efficiency

Consumers, employers and federal programs are committed to seeing value for the high healthcare costs they pay; companies that can trim fat and reduce costs while delivering the same products will excel. Providers should look to lock in administrative savings where possible, standardize processes and negotiate reimbursement rates if and where possible. Investment in analytics and accounting capabilities can help providers and payers gain a complete view of patient populations, identifying where prices can increase and decrease, and streamlining care delivery. Establishing partnerships could yield significant financial benefit for those involved. 




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Diversify product offerings

Most proposals would expand coverage using existing public and private frameworks. Most new growth has come in this area, as can be seen through the ongoing expansion of Medicare Advantage. This continuing shift creates opportunities for payers. Under new models, payers would likely maintain their presence in network and claims management, though they could expect to see administrative savings, increased regulatory burdens and greater compliance requirements. Remaining flexible, reducing redundant processes and capitalizing on opportunities for savings under new regulations are key. Payers that focus on developing supplemental products, investing in retail capabilities and expanding core competencies like fraud prevention will find themselves positioned to continue adding value even in the face of systemic change.




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Contact us

Benjamin Isgur

Health Research Institute Leader, PwC US

Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Jason Ranville

Senior Manager, Health Research Institute, PwC US

Kevin Muench

Research Analyst, Health Research Institute, PwC US

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