CAUSE: Years 6-10

In this phase the new national basic care system for children gets more intensive cost control while adults 19-64 will get Part II basic outpatient, primary, and preventive care with the option to purchase Part I coverage at full cost. This will cause private supplement markets to further expand.

The plan will remain the same for children ages 0-18, but covered services may be modified based on recommendations from the national health board.

Individuals ages 19-64 will all become beneficiaries of what is currently Medicare Part B, with the option to purchase private coverage for hospital and catastrophic care. Individuals will pay income-adjusted premiums. There will be a variable deductible based on the value of services in promoting health, and the national health board’s research findings will modify coverage for services. Employers and individuals will still have the option to buy into a public plan modeled after the current Medicare Part A (inpatient care).

Specific to individuals 65 and older, CAUSE will remain in the year 1-5 phase of plan implementation.

State and sub-state boards will receive a budget based on the cost information for children ages 0-18, as related to CAUSE, for years 2010-2015. State boards will work within a budget that has been adjusted for population and health care costs. The national health board will negotiate rates and contracts with providers and health care systems. Most plan elements from years 1-5 will remain the same; the administrative modifications to the current Medicare system, the insurance market reforms, and the modifications to promote health remain intact.