BernieCare = Bernie Sanders HealthCare Reform

The Basics of Bernie’s Medicare-For-All Single Payer Bill

We explain the basics of the Bernie Sanders Medicare-for-all bill, a bill to expand universal coverage to all Americans by expanding Medicare.

TIP: Medicare is currently a hybrid single payer healthcare system. Bernie’s plan expands the Medicare system, and is therefore a type of single payer bill. Learn more about what single payer healthcare is and isn’t.

FACT: On September 13, 2017, Bernie Sanders introduced his Medicare for all bill (“A BILL To establish a Medicare-for-all national health insurance program”) into the Senate with 16 cosponsors. This bill would transition the US to a Universal Healthcare System over 4 years if enacted. Even if the bill doesn’t pass as written, there are a lot of smart provisions which future healthcare reform plans (including state-based plans) can draw from in the future. So its worth taking the time to familiarize yourself with.

What Does Bernie’s new Medicare for All Bill Do?

As the title of the bill indicates, it is intended to expand Medicare eligibility to all US citizens over 4 years. The bill would also expand existing Medicare coverage while nearly eliminating all out-of-pocket costs.

Medicare for All Expands Benefits for All

Sanders’ Medicare for All Act of 2017 (S. 1804) would expand Medicare benefits to create a new set of “Covered Health Benefits” (a more robust version of the ACA’s minimal essential benefits) which can only be limited by a providers clinical judgement.

Individuals would be entitled to reimbursement to an eligible provider whenever a covered benefit is medically necessary and appropriate for the maintenance of health or for the diagnosis, treatment, or rehabilitation of a health condition.

Universal Health Benefits (S. 1804)

Universal Covered Health Benefits include:

  • Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
  • Ambulatory patient services.
  • Primary and preventive services, including chronic disease management.
  • Prescription drugs, medical devices, biological products, including outpatient prescription drugs, medical devices, and biological products.
  • Mental health and substance abuse treatment services, including inpatient care.
  • Laboratory and diagnostic services.
  • Comprehensive reproductive, maternity, and newborn care.
  • Pediatrics.
  • Oral health, audiology, and vision services.
  • Short-term rehabilitative and habilitative services and devices.

Additional benefits guidelines provided for in this bill include a directive for the Secretary of HHS to consult with organizations and institutions for constant improvement in integration and coordination of  benefits. In addition, it would push for evolution of benefits offered based on medical evidence over time.

The baseline benefits offered by Sanders’ proposal would dramatically improve most Americans access to healthcare. However, just in case that isn’t enough for a specific state, states are given authority to provide additional benefits using it’s own funding resources.

Medicare for All Expands Eligibility to All

This proposal would expand Medicare eligibility to all lawful residents of the US and it would protect a States right to expand eligibility further so long as they use their own state resources to fund it.

This proposal does this by incrementally lowering Medicare eligibility requirements over 4 years. Those eligible would be able to buy into any current Medicare program (Part A, B, C, D) during the transition.

Universal Entitlement (S. 1804)

After the four year transition the full program would be implemented to universal automatic entitlement with full benefits and protections funded through the Universal Medicare Trust.

Medicare for All Lowers Healthcare Cost for All

This proposal would eliminate all premiums, copays, and deductibles for the Universal Health Benefits, but it would allow some cost-sharing for prescription drugs and state administrated long term care coverage.

Minimizes Out-Of-Pocket Costs & Eliminates Premiums (S. 1804)

Medicare for All Act of 2017 would eliminate all forms of cost-sharing for the main covered benefits. However, there are some exceptions:

  • It would allow copays and coinsurance for a state administrated long term care coverage plan, but the plan must meet or beat the current Medicaid coverage guidelines. The state administered long term care coverage is a new program (part of the bill) and would replace the long term care aspect of the Medicaid program as it stand now.
  • It would allow a cost-sharing mechanism for medications to encourage use of evidence-based practices and generic drugs, but out-of-pocket costs are limited to $200 annually and can’t include preventive medicine.

Medicare for All Expands Rights & Protections

If enacted as is, this bill would expand upon patient rights and protections for Individuals and for Providers.

Individual Rights and Protections (S.1804):

  • Freedom of Choice (SEC. 103.) – “Any individual entitled to benefits under this Act may obtain health services from any institution, agency, or individual qualified to participate under this Act.” Individual choice of providers is specifically protected, unlike with most insurers which often restrict provider choice to networks.
  • Non-discrimination (SEC. 104.)- “No person shall, on the basis of race, color, national origin, age, disability, or sex, including sex stereotyping, gender identity, sexual orientation, and pregnancy and related medical conditions (including termination of pregnancy), be excluded from participation in, be denied the benefits of, or be subjected to discrimination by any participating provider as defined in section 301*, or any entity conducting, administering, or funding a health program or activity, including contracts of insurance, pursuant to this Act.” *Section 301 essentially requires providers to be qualified and to provide services without discrimination. It doesn’t mandate providers to provide services they would not normally provide or aren’t qualified to provide. It also stipulates that participating providers can not charge any eligible person for any eligible benefit.
  • Enrollment (SEC. 105.)- This section charges the Secretary of HHS of providing a mechanism for enrollment that is as automatic and streamlined as possible in an effort to reduce administrative costs related to enrollment.

Provider Rights and Protections (S.1804):

  • Participating Providers and contracts can’t be terminated for any honest attempt to report, testify against, or otherwise correct violations of the law.
  • Participating Providers can’t charge eligible residents for covered benefits, but they can still offer supplemental benefits and accept supplemental health insurance coverage for those benefits.
  • Protects the right of institutions and providers to enter into contracts with enrolled individuals for supplemental healthcare services.

More

There are many other elements to Sanders’ Medicare for All Act of 2017 and we will be providing a more detailed look into each section soon. Additional elements include fraud prevention, appeals processes for nearly every aspect, regional health administration, negotiated drug prices, and a beneficiary ombudsman.

On Funding: A critical element missing from the legislation is the funding, but Bernie did release an extensive fiscal study with many potential revenue sources identified. The funding mechanism is meant to be debated and added during the legislative process or voted on as separate legislation altogether. In other words, the bill isn’t “ignoring funding” as some critics have suggested, rather it is leaving the funding mechanisms open to debate and offering a list of options in a separate document. This avoids having the bill’s progress sidetracked by arguments over specific funding mechanisms. Learn more about the bill and funding.

What do you think?

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Kathryn Lewandowsky on

I think that we have waited a long time for this bill and dammit it was worth the wait! This is a very well thought out, reasonable plan! Thank you Bernie ! You did not disappoint us!

Lael White on

It is heartening, but since it cannot pass yet, what is the strategy around the ACA? How is the urgent push to save ACA integrated with the push for support for S.1804?