There were two healthcare bills introduced in the Senate yesterday, which might surprise people who thought the healthcare fight was over—far from it. One bill would gut the Affordable Care Act (aka Obamacare) and another, from Bernie Sanders, would fundamentally change the way healthcare works in the US. Don't know what the hell is going on? Read this.
What bills were introduced yesterday?
A last-ditch bill to repeal Obamacare from Senators Bill Cassidy and Lindsay Graham, and Bernie Sanders' Medicare for All Act of 2017, which would transition the country to a single-payer healthcare system. Sanders' bill had no fewer than 16 co-sponsors, many of whom are considered presidential contenders for 2020.
How the hell are we still talking about repealing Obamacare? Wasn't that over in July when John McCain voted no?
Sadly, this is still a thing. Republicans have until September 30 to be able to pass budget-related bills with 51 votes rather than the standard 60, so they're giving it another shot.
What's in this latest "Trumpcare" bill?
The Cassidy-Graham bill would destroy Obamacare by undoing the requirement that every American purchase health insurance. This is known as the individual mandate and it's what keeps our system working: insurers need healthy people to sign up to subsidize the costs of less healthy people who use more healthcare services. (Kind of like how gym memberships work—some people sign up but never go; others are heavy users.) Currently, people who can't prove they have health insurance have to pay a fine when they file their taxes. If the fine doesn't exist, there will be no incentive for healthy people who don't get insurance through work to buy their own policy, leaving only the people in the insurance marketplace and with higher costs to boot.
But that's not the worst of it. The bill would repeal the tax credits and subsidies that help people afford their insurance payments and says states can let insurers stop covering the 10 essential health benefits required by Obamacare, including maternity care and mental health treatment; a move that would also affect employer plans through an unfortunate loophole.
Cassidy-Graham would also end funding for the Medicaid expansion in 2020 and shift Medicaid—the insurance program for people who are low-income, disabled, or pregnant—to a "block grant" system, or a pool of money that may not cover everyone's health costs.
It hasn't been scored by the Congressional budget Office but experts believe that it would cover millions fewer people than Obamacare. McCain says he supports the bill, which isn't exactly a good look for someone whose current brain cancer treatment is being funded by taxpayers.
Gross. Now what the hell is single payer?
It's the concept that the government should provide health insurance for every resident, funded by taxes. Basically, you get insurance for free (no premiums or deductibles) and the government pays doctors and hospitals a set price for your care. That means there's no need for private health insurance companies, and healthcare providers spend less time figuring out who owes them how much. Lots of countries have single-payer but it looks different in different places. In Canada, the government contracts with private providers; in the United Kingdom, the government employs its own doctors in the National Health Service.
What would Bernie's bill do?
In short, it would slowly put every American citizen on what we currently know as Medicare: the insurance program for people 65 and older. The plan would cover medical, dental, and vision with no premiums, deductibles, or co-pays, but there would be co-pays for prescription drugs (and incentives to use generics). Everything else—doctor's appointments, lab tests, maternity care, medical devices, substance abuse treatment, hospital visits—would be covered in full. The government would use current Medicare rates to reimburse providers for these services. It would effectively end Medicaid, since all Americans would be covered.
This coverage is even better than what seniors get on Medicare now: They still have monthly premiums, deductibles, and pay 20 percent of their healthcare costs after meeting their deductible. The plan is even more generous than Canada's system, per Sarah Kliff at Vox, as our northern neighbors don't cover dental, vision, or many prescription drugs.
The bill also repeals the Hyde Amendment, which blocks federal funds from being used to cover abortions outside the cases of rape, incest, and to save the mother's life; which means the plan would cover abortions. This is important: Since employers would be barred from offering plans that compete with the government option, the government needs to cover things that private plans do.
The bill doesn't foist this change on people right away. If it became law, it would immediately lower the Medicare eligibility age from 65 to 55 and allow people 18 and under to enroll for the first time ever. One year later, the age would drop to 45, then to 35 in the third year, and by the fourth year everyone would be eligible. During this four-year transition period, anyone could buy into Medicare coverage until they're eligible in what's known as the public option. (The Huffington Post reports that Senator Kirsten Gillibrand wrote this provision.)
How in god's name would the government pay for this?
With higher taxes. That fact right there turns a lot of people off, but then again, some other people really like the idea of having to pay almost nothing out of pocket for healthcare. But Bernie's bill doesn't detail exactly how it would pay for itself, which is partly why Kliff said it's more like a single-payer wish list. However, Sanders did release a white paper with funding options.
Does this have a shot in hell of passing?
No. And even if it somehow did get enough votes to pass the House and Senate, Donald Trump wouldn't sign it. (Trump himself seems to like single-payer, but his party hates it.)
Why? Well for starters, it would effectively eliminate the health insurance industry, so those companies would likely fight like hell against it. Plus, more than 55 percent of Americans get their health insurance through work and might be resistant to something new. (Still, more and more employers are shoving their employees onto high-deductible plans which might have people changing their tune.)
As Harry Cheadle wrote on VICE: "When push comes to shove, wiping out the insurance industry and jacking up taxes is a scary prospect for a lot of politicians, donors, and change-averse voters."
If the bill has no chance, why introduce it at all? Sanders is capitalizing on the fact that people really, really didn't want Obamacare repealed and in fact wanted even more people to have insurance. Having a universal healthcare bill with this amount of co-sponsor support will help push the conversation forward.
Are there any other legit ideas floating around?
Yes, several. Last week Michigan Senator Debbie Stabenow introduced a bill that would allow people ages 55 to 64 to buy Medicare coverage. It's a great idea that could lower healthcare prices for these people and also lower prices for younger, healthier people if adults 55 to 64 are no longer in their health insurance pools. (They're some of the most expensive customers.) There's also a House bill that would allow buy-in at age 50.
Senator Chris Murphy of Connecticut is working on a bigger public option plan that Politico described as a bridge to get to a single-payer system eventually. The legislation, set to come out this fall, would let all people and businesses buy into Medicare through Obamacare's marketplaces. (Hawaii Senator Brian Schatz is working on a somewhat similar plan that would give states the option to let people buy into Medicaid, not Medicare.)
"Bernie is setting a really important marker for where he and many people in our party think the health care system needs to be," Murphy told Politico, but he added, "We're not going to pass a single-payer health care bill any time in the next few years. And so we need to have a conversation about how we get there."