Advertisement

SKIP ADVERTISEMENT

As Over 100 House Democrats Embrace ‘Medicare for All,’ a Party Division Appears

Demonstrators in Los Angeles rallying for “Medicare for all” this month. There are several gradations of Democrats’ proposals.Credit...Ronen Tivony/NurPhoto, via Getty Images

WASHINGTON — Denouncing the profit motive in health care, more than 100 House Democrats rallied on Wednesday around a bill to replace most private health insurance with a national single-payer system, “Medicare for all.”

The chief sponsor of the bill, Representative Pramila Jayapal, Democrat of Washington, said it would cure “a deep sickness within our for-profit system” of health care.

But the bill highlights Democrats’ split over health policy going into the 2020 elections.

Supporters of the bill, under which health care would be available to all Americans without premiums, co-payments, deductibles or “similar charges,” did not say how much it would cost or how they would pay for it. They said their proposal could save huge sums by cutting administrative costs and the bill-paying bureaucracy that works for insurance companies and health care providers. And Ms. Jayapal mentioned the possibility of levying “a wealth tax on the wealthiest Americans.”

But only two hours after she introduced the bill, leaders of a more centrist group known as the New Democrat Coalition said Congress should initially focus on shoring up the Affordable Care Act, stabilizing insurance marketplaces and holding down prescription drug costs.

“We’re going to be very practical,” said Representative Kurt Schrader of Oregon, a chairman of the New Democrats’ health care task force.

Another lawmaker in that coalition, which has 101 members, said it might make more sense to allow people to voluntarily “buy into” Medicare or Medicaid.

That approach, said the lawmaker, Representative Kim Schrier, Democrat of Washington, “would not cause as many seismic effects” as the shift to a single-payer system.

Ms. Jayapal, who is a chairwoman of the Congressional Progressive Caucus, said that Senator Bernie Sanders’s Medicare for all bill had provided a template for hers. But in some ways, she went further, with a faster expansion of Medicare and broader coverage of long-term care.

“Instead of giving hundreds of billions of dollars to insurance companies and pharmaceutical companies, and letting them profit off of people’s illness, we are saying that the government will pay,” Ms. Jayapal said. “We will negotiate prices. We will have cost controls. And we will ensure that we are putting patients over profits.”

President Trump and other Republicans have derided such proposals as socialism.

Ms. Jayapal said she was in good company. “A lot of our previous presidents were called socialist when they proposed Medicare,” she said. In 1961, when he was a Hollywood actor, Ronald Reagan warned that proposals for a program like Medicare could lead to socialism.

Health insurance companies, which have reinvented their business models to comply with the Affordable Care Act in the past nine years, blasted Medicare for all as a threat not just to their business.

“This bill will hurt patients, consumers and taxpayers,” Kristine Grow, a spokeswoman for America’s Health Insurance Plans, said on Wednesday. “Americans will pay more to wait longer for worse care.”

Senator Bill Cassidy, Republican of Louisiana, taunted the Democrats pushing Medicare for all.

“I welcome Democrats to the coalition to repeal and replace Obamacare,” Mr. Cassidy said on Twitter. “Only took 9 years!”

Under the bill, people who are 18 and younger or 55 and older could enroll in Medicare for all one year after the legislation was enacted. Benefits would be available to other people two years after enactment. In the future, people would be automatically enrolled at birth.

Highlights of the new Medicare for all bill show how it would remake health care in America:

• It would be unlawful for a private health insurer or an employer to provide the same medical insurance benefits as the new program.

• The secretary of health and human services would establish a “national health budget” specifying the total amount to be spent each year, with allocations for each region of the country. There would be separate budgets for operating expenses and capital costs like hospital construction and major equipment purchases.

• Doctors practicing on their own would generally be paid on a fee-for-service basis. The health secretary would establish a national fee schedule.

• Hospitals, nursing homes and community health centers would receive quarterly lump-sum payments from the federal government for the services they provide.

• The government would specify “optimal staffing levels for physicians” and could set standards for the ratio of registered nurses to patients at hospitals and nursing homes.

• The federal law known as the Hyde Amendment, which restricts the use of federal funds for abortions, would not apply to the new program of national health insurance.

• The health secretary would directly negotiate drug prices with manufacturers. If they could not agree on the price for a particular drug, the government could issue a license authorizing another company to produce it.

• For up to five years, the federal government could provide financial assistance to workers in the health insurance and health care industries who lose their jobs or experience other “economic dislocation” as a result of Medicare for all.

The bill was endorsed by liberal advocacy groups like Physicians for a National Health Program, Social Security Works and Public Citizen, as well as by labor unions, including National Nurses United, the American Federation of Teachers and the International Association of Machinists and Aerospace Workers.

A version of this article appears in print on  , Section A, Page 21 of the New York edition with the headline: Divided Democrats Offer Single-Payer Health Bill. Order Reprints | Today’s Paper | Subscribe

Advertisement

SKIP ADVERTISEMENT