Sen. Bernie Sanders has been pushing a single-payer health care system for decades. It’s the centerpiece the his vision for a more democratic socialist America. There are numerous such proposals because that a single-payer system, but what’s listed below is from the 100-page breeze bill most recently introduced, through tweaks, through Sanders in 2019.

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The Medicare for All arrangement would leave intact the existing infrastructure of doctors, hospitals and other health treatment providers, however nationalize the health insurance industry. Practically all the money individuals and also employers currently pay into the system as well as much that the money claims pay would, under Sanders’ plan, instead go through the federal government.


S. 1129 To create a Medicare-for-all national wellness insurance program. IN THE SENATE of THE UNITED states APRIL 10, 2019 Mr. SANDERS (for himself, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. BOOKER, Mrs. GILLIBRAND, Ms. HARRIS, Mr. LEAHY, Mr. MARKEY, Mr. MERKLEY, Mr. SCHATZ, Mr. UDALL, Ms. WARREN, Mr. WHITEHOUSE, Ms. HIRONO, and also Mr. HEINRICH) presented the adhering to bill; which was read twice and referred to the Committee ~ above Finance


The first thing to keep in mind is the Sanders’ proposal has only 14 co-sponsors in the Senate. It is not also a majority of Democrats. That’s less than a third of the 60 votes usually forced to get over a filibuster and pass major legislation, back he has actually said he would certainly use budget plan rules come maneuver about the practice of the filibuster in bespeak to acquire Medicare for every passed.


SEC. 102. Universal ENTITLEMENT. (a) IN GENERAL.—Every individual who is a resident of the United states is entitled to benefits for health treatment services under this Act. The Secretary chandelier promulgate a preeminence that gives criteria because that determining residency because that eligibility functions under this Act. (b) therapy OF various other INDIVIDUALS.—The Secretary— (1) may make standard for benefits for health care services under this plot other individuals not defined in subsection (a) and also regulate their eligibility to ensure the every human being in the United claims has accessibility to health and wellness care; and also (2) chandelier promulgate a rule, constant with federal immigration laws, to avoid an individual from traveling to the United claims for the sole function of obtaining health treatment services listed under this Act.


In Sanders’ proposal, everyone that is a us resident, consisting of undocumented immigrants, gets coverage. That would certainly be a likely point of contention v this plan. Over there is a prohibition on traveling to the united state for totally free medical care.


SEC. 103. Flexibility OF CHOICE. Any kind of individual licensed has been granted to benefits under this action may achieve health solutions from any institution, agency, or individual qualified to get involved under this Act.


Medicare for all is intended to be an extremely egalitarian proposal in which anyone has accessibility to any kind of provider. That’s definitely not the present system in the US, in which over there are extreme differences based upon the top quality of a patient’s insurance and also wealth.


SEC. 104. NON-DISCRIMINATION. (a) IN GENERAL.—No human being shall, top top the basis of race, color, nationwide origin, age, disability, or sex, consisting of sex stereotyping, sex identity, sex-related orientation, and also pregnancy and also related medical conditions (including termination of pregnancy), be excluded from participation in, be denied the services of, or be subjected to discrimination by any participating provider as characterized in ar 301, or any type of entity conducting, administering, or resources a health and wellness program or activity, consisting of contracts that insurance, pursuant come this Act.


This is a general nondiscrimination statement other than it contains the language “including discontinuation of pregnancy.” The concern of exactly how the federal government should (or must not) provide accessibility to abortion virtually sank i of the Affordable treatment Act in 2009 and also 2010. Below Sanders appears to walk in the opposite direction and enshrine abortion civil liberties in the language.


The bill also says the health and also human services secretary will lay the end a system whereby claims of discrimination must be adjudicated and also that court can approve damages.


SEC. 105. ENROLLMENT. (a) IN GENERAL.—The Secretary shall administer a device for the enrollment of individuals eligible for benefits under this Act. The mechanism shall— (1) include a procedure for the automatically enrollment of individuals at the time of bear in the United claims or top top the facility of residency in the joined States;


Americans would be instantly enrolled for services at birth or when they move to the US. A succeeding section explains a global Medicare Card.


SEC. 106. EFFECTIVE date OF BENEFITS. (a) IN GENERAL.—Except as listed in subsection (b), benefits shall very first be accessible under this Act because that items and also services furnished top top January 1 of the 4th calendar year that starts after the date of enactment of this Act.


Sanders envisions a four-year transition period. Children under 19 would gain universal coverage one year ~ the bill is signed into law. Anyone else would have actually the alternative of keeping their current coverage throughout the shift or the buying right into Medicare or a transitional publicly plan. Four years to shift from a mainly private device to an totally public one would certainly be a rapid pace. Automatic enrollment is likewise a leave from the present Medicare system. There would be no precedent for administering this kind of federal program in the US.


SEC. 107. PROHIBITION versus DUPLICATING COVERAGE. (a) IN GENERAL.—Beginning top top the effective day described in section 106(a), it shall it is in unlawful for— (1) a private wellness insurer come sell health insurance coverage that duplicates the benefits provided under this Act; or (2) an employer to provide benefits because that an employee, former employee, or the dependents of one employee or previous employee the duplicate the benefits noted under this Act.


This is the many controversial aspect of this bill. Sanders would certainly make the illegal to offer private health insurance the covers the benefits offered by Medicare for All. This provision would definitely be topic to lawsuits. A subsequent section says additional benefits not covered by Medicare for all (cosmetic surgery, because that instance) can be covered by a supplemental insurance plan.


This is the nationalization the an industry in an unmatched way. It’s crucial to note here that about one-third that the American seniors who currently get Medicare obtain it through exclusive Medicare advantage plans offered by health and wellness insurance companies. Those plans would certainly go away.


SEC. 201. Considerable BENEFITS. (a) IN GENERAL.—Subject to the various other provisions of this title and titles IV with IX, people enrolled for benefits under this Act room entitled to have actually payment make by the Secretary to an eligible provider for the complying with items and services if medically important or proper for the maintain of health or because that the diagnosis, treatment, or rehabilitation of a wellness condition:


There is a generous list of covered health, vision and also dental benefits, and also some long-term treatment benefits including:


(1) Hospital services, including inpatient and outpatient hospital care, consisting of 24-hour-a-day emergency services and also inpatient prescription drugs. (2) Ambulatory patient services. (3) Primary and preventive services, including chronic an illness management. (4) Prescription drugs, clinical devices, biological products, including outpatient prescription drugs, clinical devices, and also biological products. (5) psychological health and also substance abuse therapy services, including inpatient care. (6) Laboratory and also diagnostic services. (7) comprehensive reproductive, maternity, and also newborn care. (8) Pediatrics, consisting of early and also periodic screening, diagnostic, and treatment solutions (as defined in ar 1905(r) of the Social protection Act (42 U.S.C. 1396d(r))). (9) dental health, audiology, and also vision services. (10) short-lived rehabilitative and habilitative services and also devices. (11) Emergency services and also transportation. (12) vital transportation to get health treatment services for individuals with disabilities and also low income individuals. (13) Home and community-based permanent services and supports


The HHS secretary would certainly be in charge of consistently recommending improvements and also adjustments to the services package for Congress to consider. States have the right to offer their inhabitants supplementary benefits, but can’t sell their own version that Medicare for every benefits.


SEC. 202. NO COST-SHARING. (a) IN GENERAL.—The Secretary chandelier ensure that no cost-sharing, consisting of deductibles, coinsurance, copayments, or comparable charges, be imposed on an separation, personal, instance for any kind of benefits noted under this Act, other than as defined in subsection (b). (b) EXCEPTIONS.—The Secretary may set a cost sharing schedule because that prescription drugs and also biological products—


People who get Medicare because that All would not pay for any part of their health care except, in part cases, up to $200 because that prescription drugs for people making an ext than $25,200 every year or family members of four making more than $52,400 (200% of the commonwealth poverty level in 2020). The average price of medicine per human per year in the united state is currently an ext than $1,000 because that drugs bought in ~ pharmacies, however the median out-of-pocket spending per person is only $144. However, the current costs are concentrated more on some civilization than others. This would spread out those costs.


SEC. 203. EXCLUSIONS and also LIMITATIONS. (a) IN GENERAL.—Benefits for services are not available under this Act unless the services meet the standards specified in ar 201(a), as defined by the Secretary. (b) treatment OF experimental SERVICES and DRUGS.— (1) IN GENERAL.—In applying subsection (a), the Secretary candlestick make national coverage determinations v respect to services that are speculative in nature.


The HHS secretary has a many power in this setup to determine what is covered, including what speculative and new services space covered. Currently, for people with private health and wellness insurance, those determinations room made by insurance money companies.


SEC. 204. COVERAGE that INSTITUTIONAL LONG-TERM care SERVICES UNDER MEDICAID. Title XIX the the Social security Act (42 U.S.C. 1396 et seq.) is amended by inserting the following section after section 1946: “STATE arrangement FOR giving INSTITUTIONAL long TERM treatment SERVICES


Sanders changed his setup in 2019 to encompass home- and community-based long-term treatment after lobbying by impairment rights groups and to come an ext in line with a single-payer insurance setup put forward by progressives in the House. However this portion of his proposal, which stretches over multiple pages, would depend on a state arrangement to administer institutional long-term treatment services. Separately, he gives states the capability to collection their very own standards under Medicare for every as long as they space not less generous than the commonwealth system.


SEC. 301. PROVIDER PARTICIPATION and also STANDARDS. (a) IN GENERAL.—An individual or various other entity furnishing any covered organization under this act is not a default provider uneven the separation, personal, instance or entity— (1) is a standard provider the the services under section 302; (2) has actually filed with the Secretary a participation agreement described in subsection (b); and (3) meets, as applicable, such other qualifications and also conditions through respect to a provider of services under location XVIII the the Social protection Act as explained in ar 1866 of the Social defense Act (42 U.S.C. 1395cc).


Sanders guarantees Americans access to the medical professionals they right now see and more. However his device assumes that doctors will take part. Just as many doctors do not take part in the current Medicare and insurance systems, part would most likely sidestep the federal government program and also seek payment ~ above a fee-for-service basis external Medicare for All.


While carriers would have protections under the plan, lock would additionally have responsibilities. And it is an either-or scenario. One of two people they enroll together a Medicare for every provider or castle go external the system.


SEC. 303. Use OF private CONTRACTS. (a) IN GENERAL.—Subject to the provisions of this subsection, nothing in this plot shall prohibit an institutional or separation, personal, instance provider from entering into a exclusive contract v an enrolled separation, personal, instance for any item or service—


The invoice does especially envision private agreements — not insurance — in between individuals and providers or teams of providers exterior of Medicare because that All. Yet providers, as soon as they enter into such agreements, cannot get involved in the federal government program for a year.


SEC. 401. ADMINISTRATION. (a) general DUTIES that THE SECRETARY.— (1) IN GENERAL.—The Secretary shall construct policies, procedures, guidelines, and requirements to bring out this Act, consisting of related to— (A) eligibility because that benefits; (B) enrollment; (C) services provided; (D) provider authorized standards


This would be a massive new federal bureaucracy, replacing, by some estimates, 2 million us insurance and health industry jobs. Setup up, enforcing and evolving a health treatment system for around 320 million people and transitioning an ext than 200 million from a private mechanism to a windy one would certainly be a gargantuan undertaking. Sanders’ proposal imagines a local administration mechanism that would coordinate individual states and also filter up to the HHS secretary, that would it is in in charge of setting policies. An main ombudsman would certainly collect and hear grievances.


SEC. 411. Application OF federal SANCTIONS TO every FRAUD and also ABUSE UNDER universal MEDICARE PROGRAM. The following sections that the Social defense Act shall use to this action in the same manner together they use to State medical aid plans under location XIX of together Act:


When the federal federal government takes end trillions of dollars in spending, over there is a real hazard of waste, fraud and also abuse. Sanders envisions using existing protections the govern Medicaid capital to protect this Medicare for every investment. Over there are additionally sections that mandate the development of an annual health care budget and a focus on cost containment.


A crucial selling suggest of a single-payer device is that the federal government can keep expenses down by setting prices to pay doctors, hospitals and drug companies. It’s also why the sectors will struggle this tooth and nail. It would practically definitely collection lower payment to doctors and hospitals than private insurers. More on the in a moment.


(4) momentary WORKER ASSISTANCE.—For up to 5 years following the date on which benefits an initial become accessible as explained in section 106(a), approximately 1 percent the the budget may be allocated to programs providing assistance to workers who perform attributes in the management of the health insurance system and also who may experience financial dislocation as a an outcome of the implementation of this Act.


By instead of the whole health insurance industry, the government can displace 2 million workers, according to part estimates. Several of those would discover jobs in the new government systems. Others could be eligible because that up to 5 years of short-lived assistance.


(5) reserve FUND.—The Secretary shall establish and maintain a reserve money to respond to the prices of treating an epidemic, pandemic, organic disaster, or other such wellness emergency.


(a) applications OF PAYMENT processes UNDER location XVIII.—Except together otherwise listed in this section, the Secretary shall establish, through regulation, fee schedules that develop payment quantities for benefits under this action in a manner the is continuous with procedures for identify payments for items and also services under location XVIII the the Social defense Act


One reality of united state health treatment is that American physicians make an ext money than their counterparts in other countries. There are plenty of reasons because that that, yet one clear way to save the expense of health care is to contain the amount physicians are paid. Granted, they should have a much much easier time being reimbursed under a single-payer mechanism and more of their time will be spent treating patients. Yet their bottom lines might likewise shrink. It is one reason some doctors might opt out. Hospitals too. In the present system, private insurance pays greater rates to hospitals and doctors 보다 Medicare and also Medicaid do.


SEC. 613. OFFICE that PRIMARY health and wellness CARE. (a) IN GENERAL.—There is created within the agency for healthcare Research and Quality one Office of Primary health and wellness Care, responsible because that coordinating through the Secretary, the health Resources and Services Administration, and also other workplaces in the Department together necessary,


The federal federal government would take it a lot bigger function in assessing the landscape of educating doctors and determining how plenty of specialists are essential in a provided field. The US right now has a mechanism that prioritizes field of expertise over general medicine. And also that’s not saving anyone money.


SEC. 614. PAYMENTS because that PRESCRIPTION DRUGS and also APPROVED DEVICES and EQUIPMENT. (a) NEGOTIATED PRICES.—The price to be payment for covered pharmaceuticals, clinical supplies, and also medically vital assistive tools shall be negotiated annually by the Secretary.


Drug suppliers are going come fight this with all their might (and they have a many money). Rather of setting a price in the market for a drug, they’d have fewer civilization to negotiate with and may have to accept what the government provides them. The no coincidence the Americans salary a lot an ext for the same prescription medicine than civilization in nations with single-payer systems. So, yes, this would remove some the the profit motive that the pharmaceutical industry. ~ above the various other hand, it’s no at every an agreed-upon truth that drug providers should be able to charge exorbitant prices for lifesaving drugs.


SEC. 701. Universal MEDICARE trust FUND. (a) IN GENERAL.—There is hereby developed on the publications of the Treasury that the United claims a trust fund


This is a massive brand-new program and also paying for it no going to it is in easy. Sanders has actually plenty that ideas, however. For starters, whatever that goes into the Medicare trust fund would now enter this new, bigger fund. So would certainly money that currently goes toward the health treatment of veterans and also pays claims to administer Medicaid.


The federal government offers tax breaks to employers for providing health insurance. V those benefits now outlawed, the to save in tax breaks would get in the to trust fund.


But it’s definitely not clear just how the number would add up. Sanders has proposed a food selection of choices to counter the costs of this program. They space not every outlined in this text. The dollars and also cents the this are less essential to Sanders than the ethical imperative. Here’s a look at Sanders’ math.


There are numerous pages the this bill that address sunsetting the bramble of means the united state government currently helps Americans v health care — Medicare, Obamacare, Tricare, commonwealth employee services and more — and also unifying castle in this brand-new plan.


During the four years throughout which Sanders envisions the Medicare because that All system being set up, there is a rolling join to traditional Medicare, v its low premiums, beginning with 55-year-olds in the first year after the legislation is passed, 45-year-olds in the second and 35-year-olds in the third.


There would an in similar way be a public health and wellness insurance option offered on the individual sector for those not yet qualified because that Medicare.


The remainder of the bill comes to this change period. The zeroes out part Medicare premiums during that duration and accounts because that subsidies part Americans acquire under Obamacare.


But the meat the the invoice is what wake up after the commonwealth government starts to pay for every American’s wellness insurance.

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CLARIFICATION: This story has actually been updated to reflect Sanders’ place on using budget rules come get about a likely filibuster of Medicare for All.


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