September 14, 2017

A record number of senators—17—endorse Sanders' 'Medicare-for-All' plan

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    Sen. Bernie Sanders (I-Vt.) on Wednesday unveiled his so-called "Medicare-for-All" legislation, which would transition the United States to a single-payer health system.

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    According to the Associated Press, Sander's bill, which differs slightly from one he released during his 2016 presidential campaign, is not likely to gain enough support to pass the Senate at this time and President Trump likely would not sign the measure if it did pass through Congress.

    Bill details

    Sanders' bill essentially would eliminate private health insurance and over a four-year period replace it with a government-run health system would expand Medicare to cover all U.S. residents, Politico reports.

    During the first year, the bill would expand eligibility for Medicare to all U.S. residents up to age 18 and lower the current age threshold from 65 to 55. The Medicare eligibility age would then drop to 45 in the second year and 35 in the third year. Coverage would be expanded to U.S. residents of all ages—including those enrolled in Medicaid and some other government-run health programs—in the fourth year. According to Vox, the Veterans Affairs health system and Indian Health Services would not be eliminated under the bill.

    The bill would expand the health care services covered under Medicare. According to CNN, U.S. residents would receive a "Universal Medicare card" that would serve as their insurance and cover a comprehensive set of health care services, including:

    • Dental care;
    • Doctor visits;
    • Emergency department care;
    • Hospitalizations;
    • Mental health care;
    • Substance use disorder treatment;
    • Prescription drugs;
    • Reproductive health care services, including abortion; and
    • Vision care.

    The bill also proposed eliminating out-of-pocket costs, including copayments and deductibles, for the majority of covered health care services. However, CNN reports U.S. residents could be responsible for paying up to $250 out-of-pocket for prescription drugs. The coverage also would not pay for long-term care or cosmetic and elective procedures. A Sanders adviser said long-term care coverage would be addressed in a separate bill, CNN reports. According to the Washington Post's "PowerPost," private insurers likely would cover cosmetic and elective procedures.

    Further, the bill proposed changing how the federal government pays for Medicare. Under the bill, Medicare would receive an annual budget, and spending on the program essentially would be capped at that amount. Currently, Medicare spending increases based on how many individuals are enrolled in the program and how much care they use, meaning there are no caps on the program's spending, the New York Times' "The Upshot" reports.

    Though the measure did not include specific details on how much it would cost or how the federal government would fund the program, Sanders said the proposal likely would be paid for via taxes.  

    His office on Wednesday released a white paper suggesting potential ways to pay for the legislation, including:

    • A new 7.5 percent tax on employers;
    • A new 4 percent tax on employees with annual incomes above the federal poverty level;
    • A new wealth tax on individuals with annual incomes falling in the top 0.1 percent of U.S residents;
    • A tax on businesses' offshore profits;
    • A tax on financial institutions worth more than $50 billion;
    • A tax increase for U.S. residents with annual incomes higher than $250,000; and
    • An estate tax increase.

    The white paper also proposes eliminating "several tax breaks that subsidize health care," such as those that are given to employers who provided health care benefits.

    Despite the potential for new taxes, Sanders said U.S. residents ultimately would pay less for health care. "Under Medicare for All, the average American family will be much better off financially than under the current system because you will no longer be writing checks to private insurance companies," Sanders said Wednesday. He added, "While, depending on your income, your taxes may go up to pay for this publicly funded program, that expense will be more than offset by the money you are saving by the elimination of private insurance costs."

    Democratic support varies

    According to The Hill, at least 16 Senate Democrats have expressed support for the bill, including several who are rumored to be contenders for the 2020 presidential election. In addition, 117 Democratic lawmakers are co-sponsoring a similar measure in the House.

    However, some more moderate Democrats have expressed concerns about the bill, citing the tax increases that would be needed to fund universal coverage and apprehension toward eliminating employer-sponsored health coverage in the United States. Many Democratic leaders, including Senate Minority Leader Chuck Schumer (D-N.Y.) and House Minority Leader Nancy Pelosi (D-Calif.) have not expressed support for the measure, though Pelosi said it "captures" the notion that Democrats "want to have ... as many people as possible, everybody, covered," adding, "I think that's something that we all embrace."

    Separately, Schumer said, "Democrats believe that health care is a right for all, and there are many different bills out there. There are many good ones." He added, "We're looking at all of these."

    GOP responds

    Some Republican lawmakers criticized Sander's effort, which they said would give the federal government too much power.

    Sen. John Barrasso (R-Wyo.) said, "It seems a complete government takeover of health care is becoming a litmus test for the liberal left." He added, "What's i[t] going to cost the American people—in terms of money, in terms of time and in terms of their freedom of choice—when it comes to health care?"

    Sen. Bill Cassidy (R-La.) called Sander's bill "laughable," citing how much the measure could cost.

    White House Press Secretary Sarah Huckabee said Trump thinks transitioning the United States to a single-payer health system is a "horrible idea." She continued, "I can't think of anything worse than having the government be more involved in your health care instead of less involved." Instead, Huckabee said Trump "is focused on looking at ways where government gets out of the way, people have more control over their own health care and looking at ways to fully repeal and replace [the Affordable Care Act] will be a priority, but we want to move the system forward and make sure we are in a place that's actually sustainable."

    Stakeholders react

    Industry stakeholders had mixed reactions to implementing a single-payer health system in the United States.

    Before Sanders released his bill, America's Health Insurance Plans President David Merritt cautioned against taking a "theoretical, one-size-fits-all approach" to health coverage in the United States. "Whether it's called single-payer or Medicare for All, government-controlled health care cannot work," he said, adding, "It will eliminate choice, undermine quality, put a chill on medical innovation, and place an even heavier burden on hardworking taxpayers."

    While patient advocates did not directly endorse the bill, some said it could spark reforms that would increase access to care, Politico's "Pulse" reports. For instance, Families USA's Frederick Isasi said, "Universal coverage has always been at the core of Families USA's mission and we are excited about the opportunities this bill presents to move us closer to that goal."

    Meanwhile, other large industry groups, including the American Hospital Association, said they were still reviewing the measure, "Pulse" reports (Guild, CBS News, 9/13; AP/CNBC, 9/13; Krieg, CNN, 9/13; Armour/Hackman, Wall Street Journal, 9/13; Weigel, "PowerPost," Washington Post, 9/12; Roubein et al., The Hill, 9/12; Carney, The Hill, 9/12; Fram, AP/Sacramento Bee, 9/12; Kliff, Vox, 9/13; Sanger-Katz, "The Upshot," New York Times, 9/13; Armour, Wall Street Journal, 9/13; Weigel, "PowerPost," Washington Post, 9/13; Livingston, Modern Healthcare, 9/13; Nelson, Politico, 9/13; Kamisar, The Hill, 9/13; Sanders white paper, 9/13; Diamond, "Pulse," Politico, 9/14).

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