Medicare for All is getting another day in the sun. Nearly four years after Senator Bernie Sanders launched an unlikely presidential campaign and pushed the notion of Medicare for everyone irrevocably into public view, progressive House Democrats unveiled their own comprehensive Medicare for All bill this week. While, of course, it has no immediate chance of passing, the legislation is likely to shape the ongoing debate among Democrats about what reforming the U.S. health-care system should look like in practice.
The Medicare for All Act of 2019 already has 107 co-sponsors, which seems to confirm that a partywide shift on health care is underway. Former Michigan representative John Conyers had introduced a Medicare for All bill every year since 2003, but in 2017, a record number of House Democrats signed on to co-sponsor the legislation. (Conyers later resigned over sexual harassment allegations and was replaced in office by Representative Rashida Tlaib, a democratic socialist who supports Medicare for All.)
The Conyers bill — which was vaguer than this year’s — likely owed its sudden popularity to the Republican Party’s failed attempts to repeal and replace the Affordable Care Act with legislation that didn’t protect people with preexisting conditions. In 2018, Representatives Pramila Jayapal, Debbie Dingell, and Keith Ellison launched the Medicare for All Caucus with 70 initial members. When Democrats took back control of the House in the midterms, the party’s newly flush ranks included a number of freshmen who, like Tlaib, supported Medicare for All — and they aren’t all from deep-blue districts. For instance, former Marine Jared Golden flipped Maine’s rural Second Congressional District from red to blue by running on a platform that included Medicare for All.
Here’s a closer look at what the bill entails, and the role it’s likely to play in the ongoing health care debate.
What’s in the Bill?
The legislation Jayapal introduced this week is more expansive than Sanders’s vision, as Jeff Stein reported for the Washington Post. Jayapal’s bill would move every American onto a single public insurance provider within two years, while Sanders has proposed a four-year transition process. Both would leave only a small role for private insurance.
Under the Jayapal bill, employers would be banned from offering their own private plans to compete with Medicare. There would be no out-of-pocket cost for medical care, though there would be some subsidized charges for prescription drugs. Other features include coverage for long-term home nursing care and abortion care. Existing Medicare and Medicaid enrollees would be transitioned onto the new plan along with everyone else. The Veterans Health Administration and the Indian Health Service would, as Sarah Kliff reported for Vox, continue to operate separately from this new Medicare system.
The Jayapal bill doesn’t explain how the U.S. government would pay for Medicare for All. That omission isn’t necessarily unusual for policy proposals and as Stein noted, other, similar plans have been estimated to cost around $30 trillion. The U.S., it should be noted, already spends more on health care than any other developed nation, with lower life expectancies and higher infant mortality rates to show for it. Advocates say that by eliminating premiums and co-pays, Medicare for All would boost the economy by leaving more money in a person’s bank account. Though Jayapal’s version of Medicare for All is more expansive than most single-payer systems in other countries, countries with single-payer systems tend to spend less on health care over all.
Who Supports It?
Jayapal is a left-wing Democrat, and she the co-chairman of the Congressional Progressive Caucus. But the CPC is more ideologically diverse than its name suggests, and the Medicare for All bill, similarly, has a list of co-sponsors that don’t fit perfectly into the party’s left flank. For instance, Representative Joe Kennedy of Massachusetts, a moderate who had expressed some reservations about 2017’s Medicare for All bill, co-sponsored Jayapal’s legislation.
Outside the House, a broad coalition of unions and advocacy groups has endorsed the bill. Some groups — the American Federation of Teachers, SEIU, and MoveOn — might be familiar. The Association of American Flight Attendants, which made headlines recently when its president, Sara Nelson, called for a general strike in response to the government shutdown, has endorsed the bill, too. That’s a lot of firepower, and Democrats who want the party’s nomination in 2020 will likely face pressure to run on a version of Medicare for All that at least resembles the bill.
Still, Jayapal’s bill faces opposition even from some members of her own party. Some have suggested less radical alternatives, like a Medicare “buy-in” for Americans ages 50 to 64, and on Wednesday a group of 101 centrist Democrats urged Congress to focus on improving the Affordable Care Act and expanding private health coverage. It’s also notable that a number of influential groups have declined to comment on the bill, including the Center for American Progress, AARP, and Protect Our Care.
Is It Socialism?
The GOP will say it is. Some conservative Democrats might, too. (Conservatives deployed the same line of attack against the Affordable Care Act.) Like the ACA, M4A responds to our heavily privatized system’s general failure to provide care that everyone can afford. But where the ACA tried to work within the private market, M4A undercuts that market and creates a larger role for government intervention. While democratic socialists like Tlaib and organizations like the Democratic Socialists of America have embraced Medicare for All, the bill’s list of co-sponsors indicates that this an area where the party’s democratic socialists and members of its more nebulously defined progressive wing can agree.
For Americans facing rising drug prices, high premiums, and medical debt, these ideological alliances may be welcome news. Polling steadily indicates that Americans broadly support an expanded version of Medicare, and are concerned about health-care costs, though they remain divided on specific solutions. With more backing from voters and politicians, and more concrete policy proposals, it might not be so easy for the GOP to dismiss M4A as evidence of nefarious Bolshevik creep.