Senator Bernie Sanders (I-VT) and 14 co-sponsors introduced S. 1129, the “Medicare-for-All” bill on Wednesday. A House companion, H.R. 1384, was introduced in February by Representative Pramila Jayapal (D-WA) and 106 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 Sanders bill would implement a single-payer system and eliminate the private insurance market coverage while providing additional benefits not currently covered by Medicare, such as dental, vision and long-term care. Similar to the House version, Sanders’ bill would provide for a transition period—four years in his version, two in the house version—after which everyone would be automatically enrolled. The transition provides for everyone over age 55 and those under 19 to be eligible to enroll in the public plan coverage after the first year, while other individuals could buy into coverage through the ACA marketplaces and employers would be able to purchase the public plan for their workers. It specifically does not indicate citizenship requirements for eligibility, instead deferring to the HHS secretary to set guidelines.
A change to the Sanders bill from previous iterations is that it would provide coverage for LTC, conforming to the House companion legislation. This would include nursing home coverage, in-home, and community-based care, which the Congressional Research Service estimated in 2016 would cost $366 billion, increasing annually. The Sanders bill would cover home and community-based care, with Medicaid covering a portion of nursing home coverage. It’s unclear if private LTC insurance would still be permissible under these plans. The ACA had included a voluntary long-term care provision, the CLASS Act, but it was never implemented by the Obama administration due to its infeasibility and was ultimately repealed by statute as part of the fiscal cliff negotiations in 2012.
Existing individual and employer-based coverage would be replaced by the plan, and it would be illegal for any private insurance to offer coverage for the same services as the single-payer plan, although limited private coverage would be available for any services not covered by the plan. It also includes a provision that allows providers and patients to independently enter into contracts for services that are already covered by the public plan, under the condition that the patients pay the full cost out-of-pocket without the provider receiving reimbursement from the government. There would also be an exception for the Department of Veterans Affairs and the Indian Health Service to continue their existing coverage.
As expected, Sanders’ bill attracted the support of several Democratic contenders for president in 2020: Senators Elizabeth Warren (D-MA), Kirsten Gillibrand (D-NY), Cory Booker (D-NJ) and Kamala Harris (D-CA). And with the exception of Senator Jeanne Shaheen, (D-NH), every senator who co-sponsored last session’s bill and remains in the current Congress has also co-sponsored this version. This is a contrast to the House bill, where there were 26 members of Congress who signed-on as co-sponsors to H.R. 676 in the last session, but who did not sign onto this year’s version as original cosponsors.
The Medicare-for-All legislation follows the introduction of Medicare buy-in legislation introduced 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. Similarly, Senators Michael Bennet (D-CO) and Tim Kaine (D-VA) introduced S. 981, the Medicare-X Choice Act that would establish a public option plan parallel to Medicare coverage for all Americans to be able to buy-into, including those who already have employer-sponsored coverage. Their bill is expected to be joined be several other introductions in the coming weeks of legislation that was proposed in the last session of Congress for Americans 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 NAHU members to share our single-payer infographic with your clients that visually depicts the consequences of adopting single-payer healthcare, compare the differences between the various proposals being debated in this chart, and to read and share our public option position paper, adopted in September 2016.