Congresswoman Pramila Jayapal of Washington is a fervent supporter of Medicare for All, and is the lead sponsor of that legislation in the House. Amid the coronavirus pandemic, Jayapal has multiple introduced bills that would not only protect but dramatically expand health care: They would require Medicare to cover all non-elective health care costs, provide insurance to all who need it, and make the government cover all paychecks for three months, similar to programs in Europe, to prevent job losses and allow people to keep insurance they get through work. The paycheck proposal, an idea also introduced in the Senate, is not included in the House's $3 trillion relief package that's expected to be voted on soon.
VICE spoke to Jayapal, the co-chair of the Congressional Progressive Caucus and a Senator Bernie Sanders ally, about how our current health care system set us up for pandemic failure and how Republican lawmakers screwed us even more by not helping people get or keep insurance all while throwing workers in the virus' path without adequate safety measures.
This interview has been lightly edited for length and clarity.
We live in a country that doesn't guarantee health coverage. Many people get insurance through their jobs and now we have staggering job losses: More than 30 million people have filed for unemployment in recent weeks and millions of people and their families are expected to lose their insurance as this fallout continues. How much of a problem is that?
It's an enormous problem. The estimates range from 25 [million] to 35 million people will lose health insurance—and we already had 30 million that were without insurance, another 35 million underinsured [before coronavirus]. It's a bad enough indignity to lose your health insurance period, but to lose your health insurance in the midst of a pandemic, along with losing your job, is absolutely devastating for so many people. Today, we have an unemployment problem, but by tomorrow, we will have a massive uninsured problem.
We already know that people without insurance or who are underinsured, people who have high deductibles, are more likely to delay getting care when they're sick. I spoke to a nurse in New York who said a COVID patient was concerned about the cost of getting put on a ventilator. I'm curious for your take on what it means to delay care during a pandemic, or for people who lose their jobs and survive coronavirus to then get hit with big medical bills.
A Gallup poll said that one in seven Americans, even if they had the symptoms for COVID, that they still wouldn't seek care because of cost.
The thing about that is twofold. One, how horrendous that somebody wouldn't want a ventilator or wouldn't want to seek treatment when we know how serious this virus is, how fatal it is, because of costs. Number two, even if you didn't care at all about those people or their livelihoods or their rights, you should still care about yourself. Because at the end of the day, if anybody is not seeking treatment for the virus, then we are allowing it to continue to spread and you would be vulnerable to that spread.
I've been thinking a lot about the cruel irony of who's more likely to get the virus. Of course, [it's] elderly folks and people with specific age[-related] conditions, but it's also people who have chronic conditions and not all of those are older than 65, but they are often people who have delayed care, who haven't taken their medications because they had to cut their prescription drugs at their kitchen tables because they couldn't afford them. We have a whole population that is significantly less healthy than they would have been had we had [universal] health care to start with. [There's] this perverse irony that we're going to have a bunch of people who have conditions that make them vulnerable to COVID because we refuse to provide them with health care in the first place.
I'm also struck by the disparities in people who are more likely to be exposed to COVID. Certainly health care workers, but also people working at grocery stores who may not have insurance.
...on the front lines, and largely lower income. Most of the people that are essential workers are often low-income folks, people of color, women. They're putting themselves at risk and there are many of them, including immigrants, who don't have access to care, to treatment. On the other side, the people that are unemployed are largely folks of color and low income because they're the ones that can't shelter in place and work at the same time. On every spectrum, low-income people and people of color are being disproportionately burdened by the crisis.
Speaking of disproportionate burdens, there are 14 states that still haven't expanded Medicaid as part of Obamacare. Your office cited a report finding that one third of all jobs in the U.S. are in non-expansion states and people in those states are more likely to end up without insurance as a result of job loss. Plus many of the states that haven't expanded Medicaid are in the South where governors are already allowing businesses to reopen as the virus spreads and people now have to work or they won't get their unemployment checks.
That's exactly right. It's going to lead to a lot of deaths and those governors will have this on their hands and they will be liable for it. On so many levels, not providing health care, Republicans not allowing treatment to be available to everybody regardless of any category, whether it's citizenship or disability or anything else, no surprise bills, no out-of-pocket costs...these are all the things that we should be doing, not going the other way. Refusing to expand Medicaid, continuing to fight the Affordable Care Act—[they're] basically doing everything possible to strip health care away.
That's why [Democrats] have to have alternatives to that and really show the contrast between Republican [politicians]—whether it's governors or members of Congress or the Trump administration—who are literally willing to let people die. That is what is so clear to me. [We're] opening up too quickly and sending people back to work when we don't have testing, contact tracing, isolation, all the things that the public health people, the scientists, the researchers, the doctors have told us...and yet we're saying, "well, you know, too bad, people are just going to go have to go back to work." Most people who are smart will say, "Uh, I don't think I'm going back until it's a little bit safer." But the people who really don't have the economic means or don't have flexible employers are the ones that are going to end up going back and potentially comprising an even larger percentage of people who get the virus.
The administration and the president—who I have to note claim to be "pro-life"—have refused to reopen the Obamacare marketplaces so uninsured people can sign up more easily and then, as you mentioned, they're also actively supporting the lawsuit to overturn the entire health care law. You mentioned that some governors who are reopening their states are going to see more deaths and that blood will be on their hands. Is there going to be blood on the administration's hands as well?
Oh yeah, I think anybody who refuses to think about expanding health care right now versus cutting it will have that liability on their hands.
There are so many ways that we can protect health care. Senator Sanders and I have a proposal to basically cover all the costs of health care during the crisis through Medicare—it's simple, it's easy. Joe Kennedy and I have a proposal called the Medicare Crisis Program. It would expand the number of people that are eligible for both Medicare and Medicaid—so if you're unemployed, you would be covered by Medicare, if you're uninsured, you would be covered by Medicaid. The bill prohibits any cost sharing—copays, co-insurance, deductibles—for public or private plans related to COVID care. We eliminate those and then we cap the out-of-pocket costs for Medicare enrollees so that nobody's going to go bankrupt on these costs. We really need to make sure we're protecting everybody [even people with private insurance]. That's also a very simple way to ensure that everyone has coverage.
And then I have a Paycheck Guarantee Act, which would guarantee paychecks and benefits, which would include health care and, in that bill, we would at least keep people on their employer-covered health care for now. Obviously I'm a Medicare for All person, but I think this is not the time to be kicking people off their health care [from job loss].
[Those two bills] would essentially provide coverage for everyone most inexpensively. If we try to do COBRA subsidies [as other Democrats have proposed], if we push people to Medicaid, there are lots of problems: COBRA subsidies are incredibly expensive, pushing people to Medicaid has the problems you mentioned in states that haven't expanded Medicaid. The Paycheck Guarantee Act, combined with the Medicare Crisis Program, helps us to really move the needle on making sure that people have health care in this crisis.
I was also interested in the provision in the Medicare Crisis Program that it would remain in effect until the unemployment rate sort of returns to pre-pandemic levels. Tell me a bit about that.
We really need economic stabilizers as triggers. We don't want Congress to have to act over and over again. That might be appropriate when you're looking at a very short-term situation, but that's not what this is: We know that this crisis, in talking to most economists, is going to go on for a year at least. We know that it's going to be six to nine months before we return to any sort of higher level of stasis. People are projecting unemployment rates—particularly if we don't do the Paycheck Guarantee Act—of over 10 percent for potentially a year. It's really important that anything we do has these economic stabilizers and triggers built in so that we can really quickly address the needs that people have without waiting for Congress to act each time. We have economic triggers built into the Paycheck Guarantee Act as well.
You mentioned a different House proposal for the government to subsidize COBRA costs, that is, pay people's monthly premiums for temporary insurance after they lose their jobs. But correct me if I'm wrong, that bill doesn't do anything for the millions of people who didn't have insurance before the pandemic hit, right?
That's right. That is just to subsidize COBRA payments for people who have lost their jobs. I'm for anything that expands health care at the end of the day, but I also think that there are effective ways to do it and less effective ways to do it—there are costly ways to do it and less costly ways to do it. If we can keep 35 million Americans on health care by guaranteeing paychecks and do several other things along with it, but save the health care costs by keeping them tied to their employer, then to me that's the most effective way and the most inexpensive way. And then if you do the Medicare Crisis Act, that is far cheaper than trying to do COBRA [subsidies].
You're the lead sponsor of the Medicare for All bill in the House. Did you consider introducing a bill that would have put all uninsured people on Medicare during the pandemic?
We didn't consider that because we thought we would be more able to get across expanding both Medicare and Medicaid. However, if we bring more people onto [these] public plans, that really helps us get to the ultimate goal of having a Medicare for All-type system. We were trying to think about how you deal with this crisis with the system that we have and it makes the most sense right now to expand both [programs] and then to prohibit the cost sharing and cap expenses for Medicare. But we do need to cover the uninsured and we have a way to cover the uninsured through Medicaid. It's an existing program, it's easy to do.
But I will just say that on Medicare for all, I think there are several things we have learned from this crisis. Number one, it is a mistake to tie health care and access to affordable prescription drugs to employment, period. The whole argument about employer-covered health care providing so much choice—I heard from people who lost their jobs and lost their health care constantly, but we never saw it in the numbers that we have now. I would always say to people, "what choice do you have when you lose your employment and you lose your health care?" That's no choice at all. And we're seeing that now with the numbers.
The second thing is that, when you don't have universal health care, and when you have so many people who are uninsured, underinsured, and unable to afford the cost of health care, you have a population that is far more susceptible to these health pandemics, and that hurts everybody.
And then third, if we had a centralized Medicare for All system, I actually believe we would have responded far more quickly and effectively because the federal government would have had the ability to immediately ensure testing and treatment for everyone—that would have been a given. We would have immediately been able to coordinate the cost of drugs and other things we needed because we would have had that centralized power. I really believe that that would have put us in a much, much stronger stead.
I also think, by the way, that it would have gone a long way in addressing a lot of the racial disproportionality of the pandemic. So many folks of color are in the category of people who are uninsured or underinsured or can't afford their health care. We're seeing obviously the numbers be so significantly high for those communities in the pandemic.
One tiny silver lining out of all of this is that the numbers for Medicare for All have gone through the roof. The polls that I've seen have been [nearly] 90 percent of Democrats, 68 percent of Independents, and 69 percent across the board now support Medicare for All. I look at cities that, in the midst of this pandemic, are passing Medicare for All resolutions. New Orleans just passed a resolution supporting my bill. That community sees what we all see, which is that health care is a right and it should not be tied to employment. It should not be tied to any other condition. People should have the right to have health care.
Last question: I spoke to a former health insurance executive who talked up the global budgeting provision of your Medicare for All bill, saying that it would help hospitals get the supplies you mentioned in a pandemic situation. I know there were shortages of drugs needed to intubate people, but also things like ventilators, masks, gowns. Can you talk about that for a minute?
Global budgeting is an overall way to allocate expenses to hospitals with special provisions for these moments of crisis. It also, by the way, has incredible benefits for rural hospitals and smaller hospitals who have been really struggling through the pandemic because they don't have the money to stay open without elective surgeries [which have been canceled]. They really don't have the same kinds of resources as the large, urban hospitals have.
Global budgeting [helps] on many levels, both because there is a set amount of money that the hospitals get on a regular basis so they can plan—they're not worried constantly about where their money is going to come from—and then in these moments of crisis and pandemics, that number can be easily adjusted, the federal government can easily coordinate.
Now, it would still require a president who believed that we should actually invoke the Defense Production Act to manufacture [personal protective equipment] and all of those things. We wouldn't get rid of the supply problems, but you would get rid of the distribution problems and you would be able to quickly assign the ability for those hospitals to get what they need and to distribute it and be able to afford it. It wouldn't be The Hunger Games with one hospital fighting against another and one governor fighting against another.
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