Author: Enson Pan

Introduction to Organ Donation

As of September 2024, more than 100,000 individuals nationwide were on the waiting list for organ transplants. Despite the fact that over 46,000 organ transplants were performed in the U.S. last year, thousands of Americans still die annually waiting for a new organ. While some believe financial incentives for living donors may improve the organ shortage crisis, any type of direct monetary transaction for an organ is punishable under the National Organ Transplant Act (NOTA) of 1984. NOTA prohibits the sale of human organs and tissues, with fines up to $50,000 and/or 5 years of imprisonment, citing altruism as the sole permissible motivator behind organ donation in America. 

However, some living donors are eligible for reimbursement under the National Living Donor Assistance Center (NLDAC). NLDAC covers up to $6,000 of a living donor’s donation-related expenses such as traveling or lodging. Living organ donors may only be eligible for reimbursement if their organ recipient’s income does not exceed 350% of the HHS Poverty Guidelines, or $52,710 in the U.S. mainland. In September 2020, former President Donald Trump issued an executive order that expanded covered expenses to lost wages, childcare, and eldercare on top of travel and lodging costs. Today, many legislative efforts to mitigate the organ shortage crisis have been entertained by Congress, including the Honor Our Living Donors Act. 

What is the Honor Our Living Donors Act?

The Honor Our Living Donors (HOLD) Act was introduced to the House on October 24th, 2023 by Representative Jay Obernolte [R-CA-23]. The bill proposes that donation-related reimbursements for living donors should be considered based on the organ donor’s income rather than the organ recipient’s income. The latest action on the bill was on July 23rd, 2024, when it was placed on the Union Calendar. 

Arguments in Favor

Proponents of the HOLD Act argue that potential donors may be more inclined to help patients on the waiting list when they incur less costs related to organ donation. In the status quo, economic barriers deter low-income individuals from donating organs, as the average donation requires $5,000 in out-of-pocket expenses. Thus, organs are disproportionately donated by those with high median household income. If enacted, supporters argue, the HOLD Act would render organ donation a cost-neutral endeavor and thus increase the pool of potential donors. 

Those in favor of the bill also claim that the HOLD Act may decrease government expenditures on organ-related healthcare. Currently, Medicare allocates $150 billion—or roughly 18% of the program’s total spending—on individuals who suffer from kidney diseases. If the organ shortage crisis improves with the help of the HOLD Act, proponents believe less money would have to be allocated toward curative or diagnostic care, saving the government billions of dollars in the long run.

Arguments in Opposition

Critics of the HOLD Act point to ethical and legal issues with the HOLD Act’s reimbursement system. Opponents believe that financial incentives may deter living donors from donating out of altruism, taking away from what they argue is the core tenet of organ donation. They point to research on the overjustification effect, a phenomenon in which individuals become less compelled to exhibit an intrinsically-motivated behavior when external rewards such as money are offered. Critics worry that reimbursements for organ donation might induce this effect and deter altruistically-motivated donors from giving. They also warn that potential donors may avoid donating due to a fear of being perceived as financially desperate rather than generous. 

Opponents of the HOLD Act also argue that the bill does not adequately address the core causes of the nationwide organ shortage crisis. They believe that Americans do not donate their organs due to several reasons including a lack of information, religious exemptions, and fear of objection on top of financial inability. Critics also argue that the Act’s expanded coverage of donation-related expenses does not provide enough financial relief to spur organ donation nationwide. 

Conclusion

Given the HOLD’s Act current bipartisan support and President-Elect Trump’s previous executive order to expand reimbursement for living organ donors, the bill is likely to receive both congressional and presidential support during Trump’s second term. As the HOLD Act moves forward, the debate over the root causes of America’s organ shortage crisis will continue.

Introduction

Today, health insurance in America is decentralized. Private insurance companies—composed of  employer-sponsored health insurance (ESI) and the non-group market—make up 54.8% of health insurance coverage nationwide, while government-issued programs like Medicare and Medicaid cover 35.9% of the population. Private health insurance options operate as follows:

• ESI encompasses any health insurance option selected by an employer, in which employees and their dependents can opt into the plan. Employers and employees share the cost of deductibles, co-pays, and premiums. 
• Non-group insurance is an option for households who do not qualify for public programs or employer-sponsored healthcare. These households shop for insurance plans directly from private insurers.

Still, 7.9% of Americans, or roughly 26 million people, remain uninsured as of 2023. Legislators have proposed insurance expansion policies such as the Medicare-For-All Act of 2023 to fill this gap. 

What is the Medicare-For-All Act of 2023?

The Medicare-For-All Act of 2023, commonly referred to as M4A, proposes a single-payer universal health insurance program in the United States. In single-payer healthcare systems, the government is the sole payer for the eligible population’s healthcare costs. Single-payer programs like M4A would use public funds to support Americans in accessing medical services that are provided through the private sector. M4A would expand the single-payer models of Medicare and Medicaid, government-funded health insurance plans primarily for senior citizens and low-income individuals, to all U.S. residents.

The Medicare for All Act has been reintroduced to Congress multiple times with the backing of Senator Bernie Sanders [I-VT] and Representative Pramila Jayapal [D-WA]. The bill’s provisions include covering primary, dental, vision, mental health, rehabilitation, gender-affirming and reproductive care for all U.S. residents. Under M4A, Americans would not have to pay deductibles, co-pays, nor premiums. The program would roll out over a four-year implementation period, prioritizing senior citizens, individuals with disabilities, and children as the first enrollees. 

Arguments For The Medicare-For-All Act of 2023

Proponents of M4A argue that the bill will decrease healthcare costs, increase healthcare access for vulnerable populations, and increase economic mobility. 

First, proponents contend that by covering previously uninsured residents, M4A will increase the accessibility of preventative care and thus decrease expensive late-term healthcare costs. They cite research that suggests diverting patients from emergency rooms to preventative care sites could save U.S. residents roughly $4.4 billion each year. Bill sponsor Sanders explained that the pandemic shed light on the shortcomings of healthcare in the status quo, contending that many Americans realized the benefits of preventative care, such as vaccinations, in preventing the sizable costs of hospitalization. Moreover, proponents argue that M4A’s coverage of preventative healthcare could cut the cost of all medical expenses in the long run. By increasing access to preventative check-ups, studies suggest M4A could save the U.S $450 billion each year. Proponents refute the claim that M4A would raise taxes to an extent that cancels out these healthcare savings for the average American, pointing to Sanders’ progressive taxation plan and the fact that federal taxes already fund single-payer systems like Medicaid in the status quo.  

Supporters of M4A also praise the bill’s inclusion of all U.S. residents. Bill sponsor Senator Sanders emphasizes that M4A would provide health insurance to every person in the United States, including undocumented immigrants. This addition differs from Medicare and Medicaid programs, where “undocumented immigrants are not eligible to enroll in federally funded coverage.” Proponents of M4A argue that the bill would help the U.S. government to fulfill its duty to protect all of its residents equally, especially vulnerable populations. They contend that since undocumented immigrants pay taxes – 96.7 billion dollars in taxes in 2022 – they should not be left out of government healthcare services. 

In addition, proponents argue that M4A will decrease job locks, the phenomenon in which workers are compelled to keep working a job they would otherwise leave due to their reliance on job- or employer-specific health benefits. Since employers can differentiate benefits of ESI plans based on the job title and seniority of their workers, a switch in careers may threaten a worker’s access to quality healthcare. In this system, proponents argue, career mobility and job searching are discouraged. With 48.6% of Americans covered by an employer-sponsored health insurance (ESI) plan as of 2023, job locks are highly influential on the U.S. economy. Proponents of M4A emphasize that workers give up shorter commute times, higher wages, or more relevant positions to maintain their healthcare, which can decrease life satisfaction and worker productivity. Under M4A, they argue, Americans would have more flexibility to seek jobs that leverage their skills without the pressure of obtaining adequate healthcare. 

Arguments Against The Medicare-For-All Act of 2023

Opponents of The Medicare-For-All Act of 2023 cite funding and longer wait times as concerns for the proposal. 

Critics argue that while the prospect of a no-cost sharing health insurance program is promising at first glance, under the $30 trillion Medicare-For-All project, households and businesses will pay more in taxes than they would save in premiums and other health expenditures. To fund M4A, the government would leverage a 21.2% tax on worker’s wages while employers would undergo a 7.5% income-based premium. While Senator Sanders’ funding plan proposes a progressive tax rate, with a wealth tax on the top 0.1% of American earners, critics maintain that increasing taxes for the purpose of increasing healthcare coverage is not justifiable. In particular, some argue that small businesses, which hire within the regional economy and partner with local charities, may face closures amid M4A-related tax hikes. In turn, critics believe this may harm community identity, competition, and local employment.

Another common critique of M4A is that the bill will create longer wait times for patients. Opponents highlight that past efforts to expand Medicaid in certain states resulted in a 10% increase in hospital wait times compared to states that did not expand the program. They argue that even though M4A will increase the number of people who can afford healthcare, the accompanying increase in wait times will render healthcare inaccessible for those whose jobs do not allow them time to wait for service. They contend that delayed healthcare is just as harmful as expensive healthcare, because both have the effect of deterring low-income populations from seeking services. Since M4A covers a range of services, critics claim that patient numbers will surge and the finite numbers of hospitals, doctors, and resources will not be able to meet the demand. Critics point to research suggesting that the expansion of Medicaid in certain states decreased hospital efficiency, arguing that M4A would exacerbate this inefficiency nationwide. 

Conclusion 

Healthcare in America remains a contentious topic in the domestic political climate, and the future of the Medicare-For-All Act of 2023 remains unclear. Supporters of the bill argue it will increase healthcare access and decrease job locks, boosting the economy. Opponents of the bill argue high taxation and longer wait times under M4A cancel out any potential economic or health accessibility benefits. Moving forward, legislators will continue to debate the relative importance of these factors in improving Americans’ day-to-day lives.