Medicare for All Bill Introduced

March 6, 2019

On Feb. 27, a group of House Democrats introduced a sweeping “Medicare for All” plan that would guarantee health coverage for every American by turning Medicare into a universal single-payer system and eliminating nearly all private health plans. The House Budget Committee and Rules Committee plans to hold hearings on the legislation in March.

The bill, H.R. 1384, co-sponsored by 107 House Democrats, does not include a cost estimate or revenue-raisers for financing the new system, which could cost tens of trillions of dollars over a decade. Lead sponsor Rep. Pramila Jayapal (D-Wash.) has suggested options include a new tax on high earners or mandated employer contributions. It remains unclear when — or whether — the Congressional Budget Office (CBO) will evaluate the bill and assign a price tag.

Specifically, H.R. 1384 would create a single-payer, government-funded health care program within two years, eliminating the age 65 threshold for Medicare eligibility. If enacted, private policies would largely be eliminated, as the bill makes it “unlawful” for a private health insurer “to sell health insurance coverage that duplicates the benefits provided under this Act.” The bill also prohibits employers from doing the same.

Under the House bill, new government-funded coverage would become available at the end of the first transition year for a large segment of the population: current Medicare enrollees, people over age 55 and those under 19. Everyone else would be allowed to buy into the program that first year, and then the system would take effect for everyone in at the end of the second year.

Further, the proposal would expand Medicare coverage to include prescription drugs, dental and vision services, mental health, substance abuse, maternal care and long-term care, without charging co-pays, premiums or deductibles — and would provide federal funding for women’s reproductive health services. It would also provide universal coverage for long-term care for people with disabilities.

The bill also orders the creation of a national health budget requiring federal officials to negotiate annual payments to providers in advance. And, for the first five years, according to the bill’s author, at least one percent of that budget would go toward programs helping millions of health care workers displaced by the creation of a single government-run system, including “wage replacement” and retirement benefits in addition to job training.

The plan pits a progressive base eager to make single-payer health care a defining issue against the more moderate Democratic establishment. Democratic leaders are wary of advancing the plan—House Speaker Nancy Pelosi (D-Calif.) has not endorsed the health-care plan, which Republicans quickly attacked. Even if the Democratic-held House votes on and passes the legislation, the Republican-controlled Senate is unlikely to approve it.

Several Democratic contenders for the 2020 presidential nomination have embraced Medicare for All. Presidential candidate Sen. Bernie Sanders (I-Vt.), helped to put Medicare for All into the political mainstream during his 2016 bid. He introduced a similar bill to Rep. Jayapal’s in 2017, and four other declared 2020 presidential candidates — Sens. Cory Booker (D-N.J.), Kirsten Gillibrand (D-N.Y.), Kamala Harris (D-Calif.) and Elizabeth Warren (D-Mass.) — co-sponsored it. With opposition from President Trump, it is expected to be a major point of contention during the 2020 congressional and presidential elections.