Representative Pramila Jayapal (D-WA) and 106 original co-sponsors introduced H.R. 1384, the “Medicare-for-All” bill last Thursday. A Senate companion bill is forthcoming, and is expected to be led by Senator Bernie Sanders (I-VT) along with a dozen or more original co-sponsors. NAHU strongly opposes these bills, is deeply concerned about the damaging impact that a Medicare-for-All proposal could have on private-market coverage, and will continue our active campaign to oppose this legislation with our coalition, the Partnership for America’s Health Care Future. As a member of the Partnership, NAHU is actively advocating on behalf of your clients and the private health insurance market, and we will continue to promote the important role of health insurance agents, brokers, and consultants in providing valued guidance to understanding the choices available in the private market.
The Jayapal proposal would force all Americans into government run plans within two-years by expanding Medicare into a government insurance plan, gradually providing comprehensive health insurance coverage to all U.S. residents. The coverage would be available at the end of the first transition year for current Medicare enrollees, people over age 55 and those under 19, and to all Americans by the end of the second year. The plan would be based on an expanded form of Medicare coverage that would also include prescription drugs, dental and vision services, and long-term care, but without co-pays, premiums or deductibles.
Existing individual and employer-based coverage would be replaced by the plan, and it would be illegal for any private insurance to compete with the government run plan, although limited private coverage would be available for any services not covered by the plan. There would also be an exception for the Department of Veterans Affairs and the Indian Health Service to continue their existing coverage. Notably absent from the proposal was any specified funding mechanisms or a total valuation in cost to the federal government, although Jayapal suggested implementing a “wealth tax” on millionaires and billionaires, requiring contributions from employers and rescinding the 2017 Tax Cuts and Jobs Act. Previous third-party estimates of similar proposals have pegged the cost at roughly $32 trillion over ten years, but an official Congressional Budget Office study has not yet been prompted by this legislation.
This year’s iteration of the House Medicare-for-All bill has noticeably less support than under previous sessions of Congress, despite Democrats holding more than three-dozen additional seats this year. There are 26 members of Congress who signed-on as co-sponsors to H.R. 676 in the last session, but who have not signed onto this version. And while there are 17 freshmen cosponsors on the bill, only seven of the 42 Democrats who flipped a Republican-held district in the 2018 elections signed onto the bill. All of this signals that the momentum for Medicare-for-All portrayed by the media last year may not be translating into legislative support for the proposal.
Jayapal’s bill follows the introduction of Medicare buy-in legislation introduced last month in the House by Representatives Brian Higgins (D-NY) joined by 29 co-sponsors, and in the Senate by Senator Debbie Stabenow (D-MI) and 19 co-sponsors. That legislation would allow those aged 50-64 to buy into current Medicare coverage. Similar legislation is expected to be introduced in the coming weeks that had been previously introduced last session that would allow individuals to buy into Medicare, Medicaid, or a public option. NAHU strongly opposes these government-run insurance proposals, regardless if it is Medicare for All, Medicare buy-in, single-payer or a public option, given the consequences it would have for Americans who already have coverage, including the more than 180 million Americans who receive coverage through their employer.
NAHU is committed to ensuring that every American has access to affordable, quality health coverage. We believe that the free market and public programs can bring down the cost of care and expand access to high-quality care for every American and that instead of considering single-payer healthcare proposals, Congress should focus on bringing costs down for everyone, no matter where they get their insurance. We encourage you to share our single-payer infographic with your clients that depicts the consequences of adopting single-payer healthcare, compare the differences between the various proposals being debated, and read and share our public option position paper, adopted in September 2016.