The print column that grew out of this post is here
U.S. House Resolution 676 — the Expanded & Improved Medicare For All Act — pretty obviously isn’t going anywhere in the Republican-controlled lower chamber. But it sets forth a bold and increasingly intriguing idea:
The establishement of a “Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care …
“The program (would be) funded: (1) from existing sources of government revenues for health care, (2) by increasing personal income taxes on the top 5% of income earners, (3) by instituting a progressive excise tax on payroll and self-employment income, (4) by instituting a tax on unearned income, and (5) by instituting a tax on stock and bond transactions. Amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), are transferred and appropriated to carry out this bill.”
The bill has 109 supporters in the House all Democrats. This includes, as co-sponsors, 5 out of the 11 Democrats in the Illinois delegation — Rep. Jan Schakowsky (Evanston), Rep. Robin Kelly (Matteson), Rep. Luis Gutierrez (Chicago), Rep. Danny Davis (Chicago) and Rep. Bobby Rush (Chicago).
The bill also has 84 holdouts — Democratic congressional representatives who aren’t putting their names on this effort. I queried each of the offices of the six Illinois Democratic hoidouts to ask why:
Rep. Mike Quigley (Chicago): “Implementing a single-payer system is an ambitious and worthy goal, but any comprehensive overhaul to our healthcare system requires thoughtful consideration to understand the potential benefits, as well as the costs. That means holding Congressional hearings, soliciting expert analysis, and obtaining a CBO score — a distinctly different process than we just witnessed in the House’s passage of TrumpCare. As we continue to pursue the goal of ensuring care that is both accessible and affordable, I would encourage my colleagues to consider a public health insurance option on the ACA exchanges to provide individuals with an alternative to private coverage.”
Rep. Dan Lipinski (Western Springs): “The description most commonly used with this bill, “Medicare for all,” is not very accurate. Unlike the system that would be implemented under the bill, Medicare is not no-cost healthcare treatment for everyone who is covered by it, and there are private insurers who are involved with Medicare Advantage. So even from the insurance side, H.R. 676 is not like Medicare. In addition, Medicare does not require all providers to be non-profit to participate in it as H.R. 676 requires.
“There is also not enough detail in H.R. 676 for an analysis of the impact that it would have on healthcare for individuals in the United States, what the American healthcare provider system would look like if it was enacted, or how much it would cost. These are all critical questions. In regards to cost, we know that the Medicare Hospital Insurance Trust Fund will be depleted in 2028 and we must make changes to keep it funded. Recently, Vermont rejected a single-payer system because of cost and Colorado voters also rejected it.
“In the immediate future, we need to fight to stop Republican attempts to repeal the ACA (Obamacare) and replace it with the AHCA. As we do this, we also need to focus on making the ACA work better for people by reining in costs. This is how we can best work right now to help provide better healthcare to the American people.”
Rep. Bill Foster (Naperville): ” I am still reviewing the legislation, which has not yet received a score from the Congressional Budget Office. However, I note the Affordable Care Act already allows states to experiment with universal health care, which is an appropriate venue to help determine the trade-offs and true costs of this and similar proposals. Right now, I am focused on contending with the passage of the disastrous American Health Care Act yesterday. More than 24 million Americans stand to lose their insurance, and our first priority must be preventing this legislation from becoming law.”
Rep. Cheri Bustos (East Moline): “Cheri’s complete and total focus on health care is on stopping Trumpcare which would raise out of pocket costs on working families, impose an age tax on older Americans and make it easier for insurance companies to price people with pre-existing conditions out of the market. She thinks the best path forward right now is to keep what is working and fix what isn’t by reducing the cost of prescription drugs and making health care more accessible and affordable.” Via spokesman Jared Smith.
Rep. Raja Krishnamoorthi (Schaumburg): “If we were starting from scratch, single-payer would make sense. But 75 percent of adults are now covered by employer-sponsored plans, and the vast majority of them like those plans. To switch to a Medicare For All system would require a tremendous change that hasn’t succeeded where it’s been tried in the United States. The most recent attempt was in Vermont — they tried to go to a single-payer systen in 2011, and in 2014 they terminated the experiment. The shock to the system was too great.
“I haven’t said yes or no to HR 676 yet. But I’m looking for the way to get to universal coverage that makes the most sense. To me that involves retaining the best parts of Obamacare and building a public-option on top of it. In fact, I’m a co-sponsor of a bill to include a public-option as a much better way to go forward. We need to guarantee that everyone has an affordable plan where profit is not a motive. I’m also studying a way to allow for early buy-in for Medicare.” (from a telephone interview)
Rep. Brad Schneider (Deerfield) — “In its current form, the bill is far too short on important details including the overall cost of the program, how much of that cost will be passed onto taxpayers, and how doctors and other health care providers will be adequately paid. I share the belief that healthcare is a right rather than a privilege, and right now I’m working to achieve that goal by protecting the progress of the Affordable Care Act from irresponsible repeal and building on the successes of the law.”
Additionally I solicited a comment/explanation from Rep. Schakowsky about why she is a co-sponsor of HR 676:
“Medicare for All has been carefully analyzed and has been shown to be the most cost-effective approach to providing universal coverage, which is why support for it remains high. In the meantime, I am the sponsor of H.R. 635, the CHOICE Act, to build upon the ACA’s solid foundation by adding a public option. The public option will not only guarantee choice but, according to the non-partisan Congressional Budget Office, will lower premiums and result in federal taxpayer savings. That is why it was included in the version of Obamacare that first passed the House of Representatives. Both the public option and Medicare for All would improve access and affordability, and we should be debating them instead of having to defend against Trump Administration and Republican attempts to move us backward. My fellow Democrats and I are committed to ensuring that does not happen.”
I additionally and later asked about HR 635, the Consumer Health Options and Insurance Competition Enhancement (CHOICE) Act providing for a public option, a bill that Shakowsky is sponsoring and Krishnamoorthi is co-sponsoring:
Foster: I supported and voted for the public option in the version of the Affordable Care Act passed by the U.S. House. Had it been incorporated into the final version of the ACA, it would have done much to increase the competitiveness of ACA Exchange Marketplaces. At present, given the complete refusal of the Republican Majority to consider any improvements to the ACA, we are focusing our attention on limiting the disastrous impact of TrumpCare on seniors and those with pre-existing conditions.
Bustos: Right now, Cheri’s focus is on stopping Washington Republicans’ from gutting protections for pre-existing conditions, throwing 24 million Americans off of their health insurance and killing an estimated 60,000 jobs across Illinois. With President Trump in the White House and Republican majorities in Congress, she’s concentrating on stopping them from undermining the health and economic security of millions of hardworking families. (via spokesman)
Lipinski: We were not aware of this bill, but will certainly take a closer look at it. (via spox)
