The broad new Medicare for All bill unveiled Wednesday by a group of House Democrats led by Rep. Pramila Jayapal (D-WA) likely has no chance of being enacted by Congress this term, but that doesn’t render it irrelevant. Here are three big reasons the new bill matters:
1. It’s more ambitious than other Medicare for All plans: It proposes to provide every American with comprehensive medical, vision, dental and even long-term care under a government-run, single-payer system that would replace most — but not all — private insurance. (Private plans would be allowed to cover services not included in the national system.) No premiums, deductibles or co-pays. “I think this Medicare-for-all bill makes it clear what we mean by health care for all,” Jayapal told reporters. “We mean a complete transformation of our health-care system.”
And she proposes to overhaul the U.S. health-care system in two years, compared to the four-year transition envisioned in Sen. Bernie Sanders’ (I-VT) plan. “Some health policy experts fear that dramatically disrupting the health markets over four years could lead prices to explode in the private market, increasing the urgency of a quicker transition,” The Washington Post’s Jeff Stein explained.
Long-term care isn’t part of the Sanders bill or the current Medicare system, Kaiser Health News notes, and it can be very expensive. “The long-term care piece is unbelievably significant,” Robert Blendon, a health care pollster at the Harvard T.H. Chan School of Public Health, told Kaiser. “It surely will help [progressives] with older voters.”
2. It highlights the huge questions around Medicare for All: Details like what the new plan would cover and what doctors would be paid still need to be clarified, but the biggest questions, of course, are about how much the new system would cost and how it would be paid for.
Supporters of the new bill say it could bring down national costs by reducing administrative and bureaucratic expenses involved with the current insurance and health care systems. The bill calls for the secretary of health and human services to establish an annual “national health budget” detailing how much would be spent, with separate budgets for operating expenses and capital costs. And it calls for the secretary to negotiate drug prices directly with manufacturers.
“We will negotiate prices. We will have cost controls. And we will ensure that we are putting patients over profits,” Jayapal said. She reportedly has said she will issue a list of potential taxes that could finance the proposal, including the possibility of a wealth tax.
“Until you come up with a revenue mechanism, you have unserious legislation that CBO would score as adding $30 trillion in deficits over the decade, and as much as $200 trillion over 30 years,” Brian Riedl of the conservative Manhattan Institute said on Twitter.
3. It highlights a tense split within the Democratic Party: Not all Democrats support such a dramatic overhaul of the health-care system. “Even though Democrats hold 40 more seats in the House and majority control, the new ‘Medicare for all’ bill has 18 fewer sponsors than its legislative predecessor, H.R. 676, did in the previous Congress,” HuffPost noted. “Over two dozen incumbent Democrats who signed on to H.R. 676 have declined to do so this time around. Their backtracking raises the prospect that the closer single-payer comes to reality, the more squeamish it makes some Democrats.”
To wit: Just hours after Jayapal and her more than 100 cosponsors introduced their bill, a caucus of 101 more centrist Democrats known as the New Democrat Coalition called for Congress to stabilize Affordable Care Act markets and bring down premiums and prescription drug prices under the existing law. And some lawmakers prefer more modest policy shifts, such as allowing Americans to buy into Medicare or Medicaid. But the new bill only adds to the certainty that Democrats and Republicans will keep talking about Medicare for All through the 2020 election.