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What Is It and How Will It Work?

Ask someone what they think about the idea of “Medicare for All” — that is, one national health insurance plan for all Americans — and you’ll likely hear one of two opinions: One, that it sounds great and could potentially fix the country’s broken healthcare system. Or two, that it would be the downfall of our country’s (broken) healthcare system.

What you likely won’t hear? A succinct, fact-based explanation of what Medicare for All would actually entail and how it could affect you.

It’s a topic that is especially relevant right now. In the midst of the 2020 U.S. presidential election, Medicare for All has become a key point of contention in the Democratic Party primary. From Senators Bernie Sanders and Elizabeth Warren’s embrace of single-payer healthcare to former Vice President Joe Biden and Sen. Amy Klobuchar’s embrace of reforms to the Affordable Care Act (ACA), how to best improve healthcare in America is a divisive issue for voters.

It also can become confusing and difficult to parse out differences between different policies in order to assess how they might impact your day-to-day life if enacted. The other question in this divisive political climate: Will any of these plans be enacted in a Washington D.C. that has been defined more by its partisan divides and policy inaction?

To try to make sense of Medicare for All and how the politics of the day are impacting America’s approach to health coverage, we asked healthcare experts to answer your most pressing questions.

What is the overall plan?

One of the biggest misconceptions about Medicare for All is that there’s just one proposal on the table.

“In fact, there are a number of different proposals out there,” explained Katie Keith, JD, MPH, a research faculty member for Georgetown University’s Center on Health Insurance Reforms.

“Most people tend to think of the most far-reaching Medicare for All proposals, which are outlined in bills sponsored by Sen. Bernie Sanders and Rep. Pramila Jayapal. But there are a number of proposals out there that would expand the role of public programs in healthcare,” she said.

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Although all of these plans tend to get grouped together, “there are key differences among the various options,” Keith added, “and, as we know in healthcare, the differences and details really matter.”

According to the Kaiser Family Foundation, Sanders’ and Jayapal’s bills (S. 1129 and H.R. 1384, respectively) share many similarities, such as:

  • comprehensive benefits
  • tax financed
  • a replacement for all private health insurance, as well as the current Medicare program
  • lifetime enrollment
  • no premiums
  • all state-licensed, certified providers who meet eligible standards can apply

Other bills put a slightly different spin on single-payer health insurance. For instance, they may give you the right to opt out of the plan, offer this healthcare only to people who don’t qualify for Medicaid, or make it eligible to people who are only between the ages of 50 and 64.

When it comes to the current Democratic presidential primary, out of a field that initially numbered nearly 30 candidates, support for Medicare for All offered something of a litmus test for who would be considered a “progressive” along the lines of Sanders and who would fall more on the side of building upon the existing system put forward by the Obama administration.

Out of the remaining candidates in the Democratic field, Warren is the only top-tier contender who embraces a full-on implementation of a Medicare for All Plan over the course of a hypothetical first term. Outside of that top tier, Rep. Tulsi Gabbard, Congresswoman from Hawaii, also embraces a Medicare for All approach.

Warren’s plan essentially has the same objectives of Sanders’ bill. She’s advocated for phasing in this system. In the first 100 days of her presidency, she would use executive powers to reign in high insurance and prescription drug costs while also introducing a pathway for people to opt in for a government Medicare system if they choose. She says that by the end of her third year in office, she would advocate to pass legislation for a full national transition to a Medicare for All system, according to the Warren campaign website.

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So far this election cycle, there has been contention over how these plans would be implemented. For instance, other top candidates might not advocate for a stringent Medicare for All policy like that promoted by Warren and Sanders. Instead, the focus of this other group of candidates is building upon and expanding coverage provided by the ACA.

Former South Bend, Indiana, Mayor Pete Buttigieg has advocated for what his campaign calls “Medicare for All who want it,” adding a public option to the ACA. This means a government-supported public Medicare option would exist alongside the choice of keeping one’s private health plan, according to the candidate’s website.

The other top candidates support possibly working toward this goal. Biden is campaigning on improving upon the ACA with the potential goal of a public option down the line. This incrementalist approach is also shared by Minnesota Sen. Amy Klobuchar and former New York City mayor Michael Bloomberg.

John McDonough, DrPH, MPA, a professor of public health practice in the department of health policy and management at the Harvard T.H. Chan School of Public Health and director of executive and continuing professional education, said since Medicare for All discussions…

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