Read Jon Walker’s series on health care for a greater understanding of why this plan was designed this way.
Read our supplemental explanation for certain sections and provisions of MICA.
Short description – The government-created Medical Insurance and Care for All program (MICA) is a public health insurance program based on Medicare but open to all individuals. Employers will be required to buy their employees MICA or equally good private coverage. If one does not receive employer coverage, they will automatically be enrolled in MICA and charged for it in their taxes.
Part A – Eligibility
Section 1 – All Americans and legal residents are eligible – All individuals and legal residents under the age of 65 within the United States are entitled to receive coverage under the Medical Insurance and Care for All program (MICA).
Section 2 – Reciprocal coverage for nonresidents – All nonresidents who are currently in the United States but are nationals of a foreign country that provides health benefits to Americans abroad are eligible for MICA.
Section 3 – MICA card – All qualified individuals under the age of 65 are automatically enrolled in MICA. The Secretary of Health and Human Services provides all enrolled individuals a smart MICA card to process claims, track payments, and track records.
Section 4 – Opt Out – Anyone who directly buys qualifying private coverage or is enrolled in a group health plan that provides comparable or better coverage than MICA can contact the Secretary to opt out of the MICA coverage and premiums.
Part B – Benefits and Cost Sharing
Section 5 – Scope of Benefits – MICA will effectively cover the benefits provided by Medicare Part A and Part B as well as prescription drug coverage. This does not include some vision and dental. It does not cover private hospital rooms.
Section 6 – Cost sharing – MICA will not have deductibles or coinsurance. The Secretary can create a system of co-pays for MICA to encourage a more efficient use of health care.
$5 co-pay for health clinic visit
$15 co-pay for primary care visit
$15 co-pay for specialist visit referred by primary care provider
$40 co-pay for specialist visits not referred
$20 co-pay major diagnostic test
$45 co-pay ER visit
$30 co-pay Ambulance ride
$20 co-pay a day hospital stay in non-private room
Section 7 – Prescription drugs – MICA will provide prescription drug benefits equivalent to current federal employee plans. The Secretary will negotiate directly to provide drug benefits. The Secretary will create a series of tiers with co-pays ranging from $1-$50 per prescription based on encouraging the use of generics, drugmakers offering lower prices, and the most effective medication.
Section 8 – Limiting out of pocket costs – The amount an individual spends on co-pays for approved services and medication shall not exceed $600 per quarter (this would result in a maximum $2,400 per year) per individual.
Section 9 – Help for low income individuals – For individuals below 300% the Federal Poverty Level (FPL), the Secretary will create reduced co-pays and out of pocket limits indicated by the smart MICA card. Co-pays and out of pocket limits would be reduced by:
80% for those under 100% FPL
60% for those 100-150% FPL
40% for those 150-250% FPL
20% for those 250-300% FPL
Section 10 – Exempt from co-pays – The following are exempt from co-pays: preventive care, necessary prenatal care, delivery, necessary care for anyone under the age 18, or any procedure/medication where the use of co-pays causes a net increase of long term health care spending by reducing timely utilization.
To this end, the Secretary will fund studies to find out the impact of different co-pay structure on overall health and determine which changes would benefit the system as a whole.
Part C – Network and Providers
Section 11 – Medicare rates – MICA will use the same provider reimbursement rates, network, and system for determining new rates as Medicare.
Section 12 – MICA Coordinated – The Secretary may negotiate with hospital networks, coordinated care organizations (CCO), accountable care organizations (ACO), and health maintenance organizations (HMO), or local government agencies to offer individuals the choice of MICA Coordinated during a yearly open enrollment. These entities must be run on a non-profit basis. They can offer individuals lower co-pays, out-of-pocket limits, premiums, or coverage of non-covered procedures in exchange for limiting provider choice to the network. These organizations will receive a global payment with any reduction in average spending tol be split between the organization and the government. Any such plan will be immediately suspended if shown to make individuals worse off medically or the government worse off financially.
Part D – Financing
Section 13 – Employer mandate – All companies with three or more employees must purchase for their employees MICA coverage, comparable private insurance coverage, or pay a fee.
Section 14 – Affordability of employer coverage – Employees cannot be required to pay more than 3% of their income towards their share of premiums or 40 percent of the total cost of the premium, whichever is lower.
Section 15 – Employer mandate penalty – For every employee who does not take part in the employer’s plan, Medicare, or another employer’s plan via a family member, the employer must pay an hourly penalty equal to the average cost of an employer contribution to MICA ($2.60 per hour).
Section 16 – Part-time employees – Employers will receive a proportional subsidy for every part-time employee who receives coverage via that employer based on hours they work.
Section 17 – Children on family policies – Employers will receive a subsidy equal to 80% of the premium cost of every child covered by a private insurance policy that covers families.
Section 18 – Individuals without employer coverage – Any qualified individual over the age of 18 without employer coverage, Medicare, or private coverage will automatically have a fair community rating premium charge added to their taxes to pay for their MICA.
Section 19 – Reduced premiums for low income individuals – Premiums charged on taxes will be reduced for low income individuals so that they do not exceed this percentage of their income using this sliding scale:
1% income for those under 150% FPL
2% income for those 150-200% FPL
3% income for those 200-250% FPL
4% income for those 250-300% FPL
5.5% income for those 300-400% FPL
6.5% income for any individual over 400% FPL up to the full cost the premium
Section 20 – Individual exemption – Any individual under 65 with qualified employer health insurance or who purchases qualified private insurance is exempt from the MICA premium charge on their taxes.
Section 21 – Religious exemption – The Secretary will create an exemption system only for those with sincere religious beliefs against the entire concept of social insurance. The money collected from their taxes will not pay for MICA premiums; instead, it will be placed in a special account for these individuals to use on medical care.
Part E – Private Insurance
Section 22 – Supplemental coverage – The Secretary will create rules governing a market for supplemental private insurance that covers benefits not covered by MICA such as vision, dental, and private hospital rooms. Employers and individuals can purchase supplemental coverage.
Section 23 – Private health insurance – The Secretary will create rules governing qualifying private health insurance. Private health insurance must provide benefits and cost sharing limits comparable or better than with MICA. No non-qualified health insurance policy can be sold in the United States. Private health insurance must have a medical loss ratio of 85%.
Section 24 – Community rating – All private and supplemental coverage must be sold on a pure community rating basis to anyone under the age of 65. They must charge the same price for all adults regardless of age, gender, health status, etc.
Section 25 – Risk adjustment – All private health insurance policies must take part in a market-wide risk adjustment program to prevent insurers from trying to game the system by only trying to attract healthy individuals.
Part F – Medicaid, the Affordable Care Act, and the State Children’s Health Insurance Program (SCHIP)
Section 26 – Medicaid – Medicaid will continue to exist in a reduced role to provide supplemental coverage for low income individuals and long term care. Matching funds will be reduced to correspond to the diminished role of Medicaid. Some of the federal funds used on Medicaid will be redirected to MICA.
Section 27 – The Affordable Care Act – The State Children’s Health Insurance Program (SCHIP), the Affordable Care Act (ACA) exchanges, and the ACA tax credits/cost sharing will be ended and the funding used for MICA.
Part G – Medicare
Section 28 – Medicare patients buying into MICA – The Secretary will determine an appropriate premium charge for anyone eligible for Medicare who would prefer to be on MICA.
Section 29 – MICA drug benefits on Medicare Part D – The MICA prescription drug program will be offered as an option under Medicare Part D.
Part H – Cost Control
Section 30 – Doctor immigration – Doctors and dentists from countries, such as Canada, France, Japan, UK, Ireland, Germany, and other highly industrialized countries with comparable health care outcomes are immediately allowed to practice in the United States. The Secretary will also create a more streamlined process for all other countries on a country-by-country basis that would allow sufficiently trained doctors to practice in the United States without needing to go through an American hospital residency.
Section 31 – Scope of practice – The Secretary will study and implement ways to eliminate unnecessary scope of practice restrictions on other healthcare providers. The issue should be reviewed every 4 years based on new technology and research.
Section 32 – Health care monopoly prevention – The Secretary will be charged with the power to deny any health care industry merger or acquisition if it would reduce the quality of care or increase cost.
Section 33 – Ending abuse of patents – The Secretary will have the power to revoke any patent or exclusivity for a drug or medical device if the patent holder is found to engage in abusive pricing. The Secretary also has the power to allow individuals to directly import specific drugs or devices from other countries where they are cheaper if the manufacturer is engaged in abusive pricing in the United States.
Section 34 – Fair pricing – No medical facility that offers emergency services or individual practicing at such a facility at the time can charge anyone more than 200% of the MICA rate regardless of their insurance status.
Part I – State Flexibility
Section 35 – Waivers – States can apply for a waiver from running part or all of the program, only if they are able to provide an equal or greater level of coverage, benefits, and affordability for individuals. Large employer coverage can be included in the waiver. Any cost savings will be shared between the federal government. For example, a state could get a waiver to continue to provide full coverage for its current Medicaid population or the state could create its own single-payer system.
Part J – Phase In
Section 36 – Retraining help – $20 billion will be set aside for job placement, temporary salary replacement, and retraining assistance for individuals whose jobs in health care are made obsolete.
Section 37 – Phase in – All existing private insurance plans that aren’t comparable to MICA will qualify as coverage for the next five years. Any insurance plan governed by a union contract that is longer than five years will qualify until that contract ends.
Section 38 – Department of Veterans’ Affairs – The Department of Veterans’ Affairs health program will count as qualified coverage for exemption from the MICA premium for the next five years while the Secretary devises a plan to integrate it into MICA. Individuals covered by the VA can choose to take part in MICA instead. The plan for integration should, as much as possible, be structured around the goal of leaving no one who currently qualifies for care through the Department of Veterans’ Affairs with higher cost or worse access to care.
Section 39 – Indian Health Service – Indian Health Service eligibility will count as qualified coverage for exemption from the MICA premium for the next five years while the Secretary devises a plan to integrate it into MICA. Individuals covered by the Indian Health Services can choose to take part in MICA instead. The plan for integration should, as much as possible, be structured around the goal of leaving no one who currently qualifies for care through the Indian Health Service with higher cost or worse access to care.