5 Things to Know About Medicare for All

"Medicare for All" refers to a bill originally introduced to Congress in September 2017 by Senator Bernie Sanders, I-Vermont, with 16 Democratic cosponsors that would create a single, federal, government-administered program to provide healthcare to all US residents. In February 2019, Representative Pramila Jayapal, D-Washington, introduced the Medicare for All Act of 2019, with 106 cosponsors. This bill builds upon the legislation that Sanders introduced, with a few key differences. Here are 5 things to know about the bills.

1. Time frame

Jayapal’s bill establishes the Medicare for All program in half the time that Sanders’ bill proposed. Sanders allotted 4 years for the full implementation of the program. Under his bill, on January 1 of the first calendar year after the bill was enacted, the coverages would take effect for children, and 3 years later for adults. Jayapal’s bill extends benefits to younger and older individuals more quickly: People younger than 19 years and those 55 years and older would be able to enroll in coverage 1 year after the bill was enacted.

2. Effect on current government healthcare programs

After either bill took effect, most benefits would no longer be available under the traditional Medicare program, Medicaid program, the Children’s Health Insurance Program (CHIP), the Federal Employees Health Benefits Program, or the TRICARE program. The sale of private health insurance, employer-sponsored insurance, and retiree coverage, if that coverage duplicates payment for any item or service covered under Medicare for All, would effectively be banned. However, employers and insurers could still offer coverage of additional benefits that are not covered under Medicare for All, and the Department of Veterans Affairs and the Indian Health Service would remain intact.

3. Impact on the Affordable Care Act

Jayapal’s bill would also replace the Affordable Care Act’s marketplaces and eliminate its pay-for-performance and value-based programs. This includes eliminating the Center for Medicare and Medicaid Innovation (CMMI), incentive payments for quality reporting, accountable care organizations, bundled payments, hospital readmission programs, and other value-based purchasing programs. Conversely, Sanders’ proposed bill maintains CMMI and does not include the elimination of these programs.

4. How is it paid for?

Under Jayapal’s bill, funding for Medicare for All was notably not mentioned. Sanders’ bill estimated the cost of the program to be around $1.38 trillion per year and laid out the following sources of funding: $630 billion for a 6.2% income-based premium paid by employers; $210 billion from a 2.2% income-based premium paid by households making more than $28,800; $110 billion from progressive income tax rates for Americans with yearly earnings over $250,000; $92 billion from taxing capital gains and dividends in line with employment income; $15 billion from limiting tax deduction for Americans with yearly earnings over $250,000; $21 billion from a new Responsible Estate Tax applied to the homes of Americans inheriting more than $3.5 million; and $310 billion from savings as health-related tax expenses become obsolete.

5. What’s covered?

In both bills, the following services would be covered: hospital services (including inpatient and outpatient hospital care, emergency services, and inpatient prescription drugs); ambulatory patient services; primary and preventive services (including chronic disease management); prescription drugs, medical devices, and biologics; mental health and substance abuse treatment services (including inpatient care); laboratory and diagnostic services; comprehensive reproductive, maternity, and newborn care; pediatrics; and oral health, audiology, and vision services. Listed in Jayapal’s bill, but not explicitly included in Sanders’ bill, were the following: emergency services and transportation; early and periodic screening, diagnostic, and treatment services covered under Medicaid; transportation to receive healthcare services for persons with disabilities or low-income people (as determined by the HHS secretary); and long-term care services and support.