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'Medicare for all' bill unveiled: 'Complete transformation' of health care

The legislation's most contentious provision would end private health insurance and replace it with a government system.
Image: Rep. Pramila Jayapal, D-WA, speaks to reporters on Capitol Hill on Jan. 29, 2019.
Rep. Pramila Jayapal, D-Wash., speaks to reporters on Capitol Hill on Jan. 29, 2019.Salwan Georges / The Washington Post via Getty Images file

WASHINGTON — As the debate over "Medicare for all" heats up on the 2020 trail, House progressives are opening a new front in Congress with a detailed single-payer bill that they plan to aggressively push this year.

"We intend to make sure that Americans across this country know that we are standing up and fighting for them and for health care to be a right and not a privilege," Rep. Pramila Jayapal, D-Wash., the lead sponsor of the bill and co-chair of the Congressional Progressive Caucus, said in a call with reporters on Tuesday.

"I think this 'Medicare for all' bill really makes it clear what we mean by 'Medicare for all,'" she said. "We mean a complete transformation of our health care system, we mean a system where there are no private insurance companies that provide these core comprehensive benefits that will be covered through the government."

The legislation, which sponsors will formally introduce Wednesday, is meant to build on H.R. 676, a more bare-bones bill that served as a marker for House Democrats backing "Medicare for all." Jayapal said they have 107 initial co-sponsors, fewer than the 124 who backed H.R. 676 by the end of the last Congress.

If passed, "Medicare for all" would replace all existing private and public coverage with a more generous version of Medicare that would cover essential medical services, vision and dental benefits with no premiums, copays, or deductibles. The new bill does not contain provisions to offset its cost, arguably the most contentious topic in the single-payer debate, but Jayapal said they'd work out financing further down the line.

There are hearings on "Medicare for all" planned in the House Budget Committee and Rules Committee, though it’s not clear if the bill will come up for a full vote this session. Speaker Nancy Pelosi, D-Calif., has not endorsed "Medicare for all," but progressive members say they've come to an understanding with the leadership that their bill will get a prominent look this Congress.

The legislation is broadly similar to a "Medicare for all" bill by Sen. Bernie Sanders, I-Vt. The House version has some additions, however, most notably new long-term care benefits that are currently only covered by Medicaid. The Sanders bill is also backed by several 2020 Democratic presidential contenders, including Sens. Kamala Harris of California, Elizabeth Warren of Massachusetts, Cory Booker of New Jersey and Kirsten Gillibrand of New York.

These sponsors, including Sanders, are also signed onto more modest bills that would expand public coverage without eliminating private insurance. That's created some confusion on the trail, where support for single-payer "Medicare for all" versus more incremental versions often seems like a matter of emphasis. Harris might lean harder into eliminating private insurance, while Warren might be more reluctant to discuss that element, but they're both signed onto the same legislation.

By introducing a concrete new bill, holding hearings on its features and producing more detailed reports on its costs and benefits, progressives are hoping to build a party consensus around their version and work out any policy kinks before the next Democratic president takes office. Jayapal has also created "Medicare for all" PAC, an outside group that will support candidates who embrace her maximalist vision for one universal plan that covers all residents.

Jayapal said she expected opposition from private insurers and health providers to be the bill's biggest obstacle to passage.

The Partnership for America’s Health Care Future, an alliance of health care industry groups opposed to "Medicare for all," decried the bill Tuesday.

"We can all agree that more should be done to improve access to quality, affordable care — but this costly, disruptive one-size-fits-all proposal is the wrong path forward," Lauren Crawford Shaver, the group’s executive director, said in a statement.