For seven years, Republicans dined out a promise to repeal and replace Obamacare, and in the fall the slogan finally helped the party capture both chambers of Congress and the White House. Turns out, the Affordable Care Act was a lot more popular with Americans than Republicans realized before their offices were inundated with phone calls, letters and emails and their town halls bombarded by constituents imploring them not to strip away their health care benefits.
At least one good thing came out of that painful and prolonged national health care debate: a growing consensus among Americans that not only do they want the government involved in health care – they want the government more involved, not less. One of the major indicators of the changing political landscape was apparent on Wednesday, when Sen. Bernie Sanders unveiled a Medicare-for-All bill with a record 15 Democratic co-sponsors in the Senate. With Republican majorities in both chambers and Trump in the White House, it's unlikely the bill will garner broad enough support to become law, but the fact that the proposal is being enthusiastically embraced by front-runners for 2020 is a signal that the party is slowly moving toward support for a more comprehensive universal health care system.
How would it work?
The government already guarantees health care to anyone over age 65 – that's Medicare. Sanders' bill proposes extending the same benefit to all Americans, regardless of age, and expanding the benefits covered by the program to include dental, vision and hearing care. It would be phased in over four years. The first year, everyone under 18 and over 55 would be covered; that would expand to everyone over 45 in the second year, everyone over 35 in the third year, and every U.S. resident in the fourth year.
How would it be paid for?
That remains the biggest unresolved issue both in this discussion, and historically, in any debate over implementing a universal health care system in the U.S. California – which, of the four states currently considering single-payer, has come the closest to passing it – hasn't yet figured out how it would finance its system. Likewise, a single-payer bill introduced earlier this year in the House garnered large support, but contained no specific details on how the program would be funded.
An independent analysis by the Urban Institute found the proposal Sanders popularized on the campaign trail would, if implemented, cost $32 trillion over ten years. That sounds like a big number – and it's one Sanders' campaign contested – but, as Paul Waldman of the Washington Post recently pointed out, $32 trillion would actually represent a savings compared to the $49 trillion the U.S. is on track to spend over the next decade. The bill Sanders just introduced doesn't include specifics about funding, but the Vermont senator has promised to release a white paper exploring funding options Wednesday.
Who supports it?
Just about every high-profile Democratic senator rumored to be running in 2020 has joined Sanders as a co-sponsor of the bill: Kamala Harris, Elizabeth Warren, Cory Booker, Kirsten Gillibrand and Al Franken. They're joined by Sheldon Whitehouse, Jeff Merkley, Brian Schatz, Ed Markey, Mazie Hirono, Richard Blumenthal, Tammy Baldwin, Tom Udall, Martin Heinrich and Patrick Leahy. The last time Sanders introduced a single-payer bill, he couldn't find a single co-sponsor. Even Joe Manchin, widely considered the Senate's most conservative Democrat, said that while he was "skeptical" of single-payer, he thought Congress should "carefully consider all of the options."
In the House, more than 60 percent of the Democrats have already backed a single-payer bill introduced by Rep. John Conyers in January – the largest proportion of the Democratic caucus ever to support such a measure.
Progressive Senate stalwart Sherrod Brown said he was focused on advancing his own Medicare-related bill, one that would lower the eligibility age to 55. Former VP nominee Tim Kaine said he would rather see "more choices, not fewer" in the insurance industry. Claire McCaskill, Debbie Stabenow and Jon Tester were likewise skeptical of the proposal.
Senate Minority Leader Chuck Schumer, who said as recently as this summer that single-payer was "on the table," has not signed on to support Sanders' bill. House Minority Leader Nancy Pelosi also declined to offer symbolic support to Sanders' bill. She's said she supports the idea in theory, but is reluctant to give a single-payer system her full-throated endorsement while Republicans are still working to dismantle Obamacare, the key piece of legislation the party has been oriented around for the past decade. As Pelosi put it this summer, "It isn't helpful to tinkle all over the Affordable Care Act right now."
Polls show support for single-payer began gradually increasing around the start of the 2016 campaign. Today, the share of the electorate that believes health coverage is a government responsibility is at the highest level it's been in nearly a decade, according to the most recent figures from the Pew Research Center. In a New York Times op-ed Wednesday morning, Sanders cited an Economist/YouGov poll that shows 60 percent of Americans want to "expand Medicare to provide health insurance to every American" – including three quarters of all Democrats and nearly half of all Republicans.
Even former Montana Sen. Max Baucus, who, as chair of the Senate Finance Committee, played an outsized role in creating the Affordable Care Act – and refused at the time to entertain discussion of a single-payer system – said last week "the time has come" for universal health care. "Back in '09, we were not ready to address it," Baucus said. "It would never have passed."