Introduction:
Medicare for All (MFA) has become the subject of national debate recently and two separate bills were formally introduced to Congress last year. The fundamental objectives of the Medicare for All Acts of 2019 include: 
	Establishment of a national health insurance program administered by the government covering all U.S. residents
	Creation of a nation health budget
	Elimination of cost sharing (deductibles, coinsurance, copayments) and balance billing for covered services
	Outlaw duplicate benefits offered by private health insurers
The purpose of this research was to explore potential financial implications for neuroradiologists in transitioning to a MFA system. 

Methods
CPT codes for brain CTs and MRIs were used to obtained volumes of those exams in 2018 within a large health system in Louisiana that provides both inpatient and outpatient services. LA Medicaid fees for non-hospital services in 2018 are published on LA Medicaid’s website whereas hospital-based Medicaid fees are not openly published and vary based on hospital cost-to-charge ratios. We derived hospital Medicaid fees using institution specific averaged Medicaid to Medicare reimbursement ratio for radiology procedures, which was 0.9. Data was provided by the institution's radiology finance department. Commercial insurance fees were estimated as 200% of Medicare based on data from the Congressional Budget Office and Health Care Cost Institute. A third scenario was modeled with an inpatient payer mix since the general population's insurance coverage often does not accurately reflect the payer mix of patients undergoing imaging. Payer mixes were derived from public health databases. These are presented in Table 1. 

Results
The neuroradiology case mix of brain CTs and MRIs is presented in Table 2. With all uninsured patients, Medicaid, and privately insured patients transitioned to Medicare, we observed a 20-36% reduction in PC fees for this case mix and locale. The change is smaller in the inpatient model since Medicare is more prevalent in this population. 

Conclusion
As key stakeholders in healthcare, physicians should carefully scrutinize healthcare legislations. Transitioning from the current multi-payer system to the proposed MFA model could result in significant reductions in neuroradiology reimbursements. This study examined a narrow area of reimbursement and the estimates are specific to the study institution; however, the principles of MFA apply to broadly to practices. Further research is needed to examine other factors, e.g. cost savings opportunities, in evaluating MFA's impact on neuroradiology.  This study has been expanded and the full article is published in the AJNR May 2020 issue.

Medicare for All Legislation: Potential Financial Implications for Neuroradiologists.

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