Congress weighs Medicare for All single-payer health insurance program

Rep. Carolyn B. Maloney, chairwoman of the Committee on Oversight and Reform, and Rep. Cori Bush, convened a hearing to examine legislative solutions to expand access to affordable health care and move towards universal coverage—including proposals like the Medicare for All Act, which would establish a national, single-payer health insurance program.

Gallup and West Health unveiled new surveys based on the opinions of 6,600 American adults questioned last fall, during the ongoing Covid-19 pandemic.

Those surveys revealed that about 44 percent of American adults—or roughly 112 million people—are struggling to pay for healthcare and a full 93 percent feel they “are paying too much for the quality of care received.”

Bush said the committee’s first hybrid hearing to evaluate the path forward for Medicare for All recognized that historically marginalized communities in the United States—including Black and brown communitiespeople with disabilitiesmembers of the LGBTQ+ community, people in rural communities, and low-income people —are uninsured and underinsured at disproportionate rates.

Congressional Democrats have enacted sweeping policies like the Affordable Care Act and the American Rescue Plan, which expanded access to affordable health care coverage to millions of people in the United States, and continue to champion policies that will build upon this progress—including by guaranteeing access to public coverage to every person in the United States.

Bush invited Christopher Wilcox, MSW, a Mutual Aid and Policy Associate at A Red Circle in St. Louis, to testify before the committee. 

The congresswomen directed questions to Dr. Jamila Michener, PhD, Associate Professor at Cornell University Department of Government & Co-Director at the Cornell University Center for Health Equity, as well as Dr. Uché Blackstock, MD, Emergency Physician and Founder & Chief Executive Officer at Advancing Health Equity.

This hearing assessed how uninsurance and underinsurance negatively impacts health outcomes and examines how moving toward universal coverage could advance health equity in the United States. 

The hearing also set out to evaluate reforms that would expand access to affordable health care and move the nation toward universal coverage, including the Medicare for All Act.

“I have proudly supported Medicare for All since it was first introduced in Congress nearly two decades ago, and I will continue to push for this vision of the American health care system,” said Maloney. “At the same time, my Democratic colleagues and I will continue to fight for every bit of progress we can make in moving our nation toward universal coverage.  While Republicans raise barriers to affordable health care, Democrats will continue working tirelessly to ensure that no person’s financial circumstances keep them from obtaining quality care.”

“I have personally borne witness to the stark inequities faced by uninsured and under-insured patients during my tenure as a registered nurse. For some people, it’s hard to imagine rationing expensive medication like insulin; skipping dialysis appointments; forgoing surgical procedures; or refusing medical care entirely. People are having to choose between their life or a lifetime of medical debt and that’s not okay,” said Bush.

The committee heard testimony from Christopher Willcox, MSW, from St. Louis, Missouri; Leslie Templeton from Boston, Massachusetts; Bishop Walter Starghill, Jr., from Inkster, Michigan; Nicole Lyons from New York City, New York; and Chris Briggs, from Woodburn, Virginia.

Witnesses shared their firsthand experiences on how the current health care system—particularly amid a global pandemic—and how some have made it harder to afford health care services or have made the difficult decisions to forego preventive and routine care because of skyrocketing costs.

Willcox testified: “We know what we need to do to make sure everyone gets the care they need. Problems exist because we choose not to make the commitment to care for every person who needs it.”

Lyons testified: “Like so many Americans, Medicare for All would’ve changed so many aspects of my life. Had I had regular access to health care, I would have known I needed to be looking for a donor, rather than spending months going into kidney failure. Instead of preserving the little energy I did have, I was working 50 hours a week to afford my doctor’s appointments and medications.”

Starghill testified: “For one doctor’s visit, it took me 7 to 8 months to pay back the bill. As a person who doesn’t have insurance, you are susceptible to worry, worry, worry. With insurance, I’m actually able to live a life, go to the dentist, go to specialists.”

Templeton testified: “I wonder if I’ll always have access to my health care and treatments. I wonder, if I lose my health care, what will happen to me. With Medicare for All, these aren’t concerns I’d have to live with every day of my life. I am fortunate enough to be able to access lifesaving health care, but that is a privilege. Being sick is expensive and that expense can make it inaccessible to so many people. Being able to access health care is not enough, it’s being able to afford it too. What people don’t talk about enough is the cost of being alive. Just look at Go Fund Me. People shouldn’t have to rely on charity to stay alive.”

During the second panel, the Committee heard testimony from Ady Barkan, JD, Founder, Be a Hero; Dr. Uché Blackstock, MD, Emergency Physician, Founder and Chief Executive Officer, Advancing Health Equity; Dr. Sara R. Collins, PhD, Vice President of Health Coverage and Access, The Commonwealth Fund; Dr. Jamila Michener, PhD, Associate Professor, Cornell University Department of Government, Co-Director, Cornell University Center for Health Equity; and Dr. Jeffrey D. Sachs, PhD, Director, Columbia University Center for Sustainable Development, President, United Nations Sustainable Development Solutions Network. Minority witness, Grace-Marie Turner, President, Galen Institute, also testified.

Witnesses and Committee Democrats discussed efforts to build on the success of the Affordable Care Act (ACA) in closing the health care coverage gap over the last twelve years.

In response to a question from Congresswoman Norton, Dr. Collins described how the success of the ACA has improved the economic security of patients and families who have struggled to access health care: “The Affordable Care Act has not only led to enhanced insurance coverage and dramatically reduced uninsured rates—but it’s also lowered barriers to care, reduced people’s medical debt burdens, reduced out-of-pocket spending for a lot of people who had pre-existing conditions prior to the Affordable Care Act’s reforms. So this has been a substantial change—both for coverage rates, but also for improving people’s financial security.”

Rep. Gomez highlighted how the American Rescue Plan built on on the ACA’s financial support for consumers seeking coverage with a provision he introduced with Rep. Underwood: “The Affordable Care Act helped narrow the coverage gap through premium tax credits, which have allowed working families to purchase high-quality coverage through the Marketplaces…. We expanded eligibility for the premium tax credits, which has on average lowered existing premiums by 40%. Over one-third of the consumers who have taken advantage of the new lower rates provided by the American Rescue Plan have joined plans with monthly premiums of $10 or less. Many individuals have seen their median deductible fall by as much as 90%.”

Witnesses highlighted how structural inequities in our current health care system continue to leave millions of people in the United States uninsured and underinsured, a fact that is especially true in historically marginalized communities.

Dr. Michener explained: “There was a time before Medicare, there was a time before Medicaid, and it was a dark and dismal time where many more people had much worse outcomes. The private side of the market could not address the fundamental needs of the American people.”

Dr. Blackstock testified: “As Black people and people of color, just living in this country is an act of survival, let alone being able to access quality and culturally responsive health care. The ongoing COVID-19 pandemic and the country’s presumed reckoning with racism has only exposed the preexisting fissures in our health care and public health system. Despite advances in health care innovation and technology over the last 75 years, Black men still have the shortest life expectancy, Black women have the highest maternal mortality rates, and Black babies have the highest infant mortality rate. Overall black Americans have a 6-year life expectancy gap compared to white Americans. The widest gap since 1998 and widening even more by the pandemic.”

Dr. Michener explained: “Much of this is grounded in systemic racism. Systems of racial stratification shape whether you live in a neighborhood that will promote your health, whether you have access to resources like health insurance to sustain your health, whether you have daily experiences with things like discrimination that might undermine or threaten your health, and importantly I’ll address this shortly, whether you have influence over the political process that can be activated to protect your health. Inequitable health insurance is a key factor that contributes to this range of disparities. So, the fact that people of color have lower access to health insurance is a significant life-threatening polity-altering problem. Unequal, unstable, unaffordable, and constrained access to health insurance contributes to people of color experiencing the health care system as profoundly discriminatory and difficult to navigate.”

Members and witnesses examined how reforms such as Medicare for All, can help move our country towards ensuring all Americans have access to quality health care while reducing national health expenditures.

Dr. Sachs explained the shortcomings of our current health care system: “We are broken. We spend far more on health care; we get far less. Because we don’t even have a health care system. We have a hodgepodge of private overpriced monopolies, whether for profit or not-for-profit. But this is a broken, unfair, out of control cost system that doesn’t deliver.”

Dr. Blackstock explained that Medicare for All, “will enable us as health providers caring for our patients to more efficiently care for our patients, to prioritize the primary preventive services that we provide them. It will not result in more administrative effort and cost—in fact, it will do the reverse. It will help remove barriers for our patients to seek care, and doing so will enable us to provide the best care and to do so even more efficiently than we can do that now.”

Rep. Porter explained how Medicare for All would support patients and reduce costs: “Medicare for All would save money on administrative costs—$200 billion a year. Medicare for All would give patients the most choices—99 percent of nonpediatric providers. And Medicare would let doctors practice medicine. Not surprisingly given these three things, what do we get with Medicare for All? Better health outcomes. And that’s why I support Medicare for all. Because I support patients over paperwork.

Mr. Barkan described his support for Medicare for All: “The American people deserve so much more, and so much better. Our seniors and disabled children and adults deserve to live at home, not be warehoused in institutions. Working people deserve high quality care regardless of their income or their employer Marital status. The people of rural America deserve good mental health care options, good community clinics, good accessible hospitals. And so do the residents of poor urban American, and the people who live on Indian reservations. And seniors on Medicare deserve care also for the parts of their body above their necks, which means their teeth and eyes and ears and minds. We can and must do better. We know what the solution is. A system that brings everyone in, and abandons no one. Where we are patients and people, not opportunities for profit.”

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