House Democrats to release ‘Medicare for All’ bill — without a price tag

Health Care

Government-run single-payer system would eliminate most private health insurance and cover abortion.

Progressive House Democrats will unveil their much-hyped “Medicare for All” legislation Wednesday, providing the most detailed blueprint yet for how they would upend the health care system to guarantee coverage for every American — a long-sought progressive dream that is already shaping the Democratic race to challenge President Donald Trump.

The bill, co-sponsored by just over 100 House Democrats, doesn’t include a price tag or specific proposals for financing the new system, which analysts estimate would cost tens of trillions of dollars over a decade. The lead sponsor, Washington state Rep. Pramila Jayapal, said she will release a separate list of suggested funding mechanisms, including a new tax on high earners or mandated employer contributions.

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The proposal calls for a two-year transformation of Medicare into a universal single-payer system, eliminating nearly all private health plans. It would also expand Medicare coverage to include prescription drugs, dental and vision services, and long-term care, without charging co-pays, premiums or deductibles — and would provide federal funding for abortions.

The legislation comes amid a furious debate within the Democratic Party over the scale of its health care ambitions, pitting a vocal progressive base eager to make Medicare for All a defining 2020 issue against its more wary moderate establishment. It’s an open question how far Democratic leaders will allow the bill to advance in the House, as Republicans clamor for hearings on what they deride as a “socialist” nightmare.

Medicare for All supporters say their 100-plus page bill is a meticulous road map to single-payer health care and hope its unveiling will silence critics who have dismissed the idea as a little more than a catchy slogan.

Republicans, eager for a showdown over Medicare for All, maintain that the system that would cost taxpayers tens of trillions of dollars and force hundreds of millions of patients from their private plans into government-run coverage. Powerful health care industry groups that joined with Democrats to help pass Obamacare almost a decade ago have also banded together to fight a concept that would rewire the health system and threaten their business models.

Still, several Democratic presidential contenders have embraced Medicare for All as a political rallying cry over the past year, as polls showed growing public support for universal health coverage and a broader leftward shift among Democratic voters. But aside from Sen. Bernie Sanders (I-Vt.), who brought the idea from the liberal fringes into the mainstream during his 2016 presidential campaign, most candidates have avoided offering specifics that could invite criticism.

Recent polling has found the public views the concept of a single-payer system favorably. But that support significantly erodes when voters learn it would eliminate most private health insurance and could raise taxes. Republican lawmakers are confident the policy will damage Democrats in the 2020 election, particularly among suburban moderate voters who helped the party retake the House in November.

But progressive lawmakers, led by Jayapal and Sanders, are equally confident the public will embrace a single-payer plan if Democrats make a strong enough case. They plan to pressure Democratic colleagues and 2020 contenders to fully embrace a revamp of a health care system they argue has failed the American people.

Two House committees will hold the first-ever hearings on Medicare for All next month, but leaders haven’t made any further commitments for advancing the legislation.

The House bill largely mirrors Sanders’ Medicare for All bill in the Senate. Both bills make an extensive argument for the feasibility of a costly transition that would overhaul the Medicare program and turn it into a universal insurer.

But unlike the Sanders plan, the government under Jayapal’s bill would fund long-term care, a particularly expensive part of the health system. The bill also calls for a two-year transition to single payer, faster than the four years in Sanders’ bill.

Additionally, the inclusion of abortion coverage would eliminate the long-standing ban on federal dollars for the procedure in almost all cases. States would also be barred from excluding abortion providers like Planned Parenthood, which some red states have sought to push out of Medicaid.

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. Some exceptions would exist for people covered through the Department of Veterans Affairs and the Indian Health Service.

Though the bill doesn’t include a cost estimate or funding specifics, House progressives are attempting to reckon with the financing of such a sweeping overhaul.

The bill 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, at least 1 percent of that massive 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 government would also be empowered to negotiate drug prices directly with pharmaceutical companies — a longtime policy priority for Democrats — and create a single list of covered drugs that encourages providers to use cheaper generics.

Medicare for All backers have long argued that Americans would ultimately pay less under a single-payer system even with tax hikes, because they would no longer need to shell out for premiums and co-pays or face the prospect of thousands of dollars in unplanned medical expenses. Currently, according to the Journal of the American Medical Association, Americans pay nearly twice as much per capita for health care than citizens of other industrialized countries, and have worse health outcomes.

But skeptics have dismissed the idea that Medicare for All would save Americans money, in large part because single payer proposals have yet to detail with the scale of tax increases and economic changes required — much of which they argue would hit the middle class and risk tanking support for Medicare for All.

It’s unclear when — or whether — the Congressional Budget Office will evaluate the bill and assign a price tag. On a call with reporters, a Jayapal staffer preemptively dismissed the congressional scorekeeper’s ability to evaluate this bill, echoing complaints House Republicans made about the office’s projections their Obamacare repeal legislation would cost millions of people health coverage.

The bill’s initial co-sponsors include a range of progressive Democrats, from high-profile freshmen like Rep. Alexandria Ocasio-Cortez (D-N.Y.) to prominent liberal stalwarts like Reps. Raúl Grijalva (D-Ariz.) and Jim McGovern (D-Mass.), the chairman of the House Rules Committee. Massachusetts Rep. Katherine Clark, the No. 6 House Democrat and second-highest-ranking woman in the caucus, also signed on.

Despite the base’s surging enthusiasm for the concept, the legislation initially boasts fewer co-sponsors than the 124 Democrats who signed onto a previous version of Medicare for All bill last year, when the legislation was just a broad outline that former Rep. John Conyers (D-Mich.) had repeatedly reintroduced for years before his resignation in late 2017. Jayapal took over the legislation last year and had been rewriting and expanding it for months.

While the House Rules and Budget committees are scheduled to hold Medicare for All hearings starting in March, the bill has gotten no firm commitments from the Energy and Commerce and Ways and Means panels, whose endorsements are required to get the bill on the House floor.

The Democratic establishment, wary of holding a vote on a potentially divisive policy that has no chance of becoming law under President Donald Trump, is instead pushing the caucus to focus on strengthening Obamacare and protecting the law’s protections for pre-existing conditions, a message that helped Democrats win back the House in November. Some are also embracing ideas to expand government coverage to smaller groups, like near-retirees, without overhauling the entire health care system.