Jayapal’s Medicare-for-all would move every American onto one government insurer in two years, while providing everyone with medical, vision, dental and long-term care at no cost. Similar proposals have been projected to increase federal expenditures by at least $30 trillion but virtually eradicate individuals’ health spending by eliminating payments such as premiums and deductibles. About 30 million Americans do not have insurance, while tens of millions more are “underinsured,” meaning they cannot afford or do not seek care, according to the nonpartisan Kaiser Family Foundation.

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The bill has 106 co-sponsors but essentially no chance of passing the House or Republican-controlled Senate this term. It comes amid a wider debate about the meaning of Medicare-for-all in Democratic policy circles, as some presidential candidates and center-left think tanks have said they support both Medicare-for-all while also aiming to preserve private insurance that currently enrolls about 150 million Americans. Jayapal’s plan would leave only a minimal role for private insurance in the United States, similar to Sanders’s bill in the Senate.

“We have a plan. We have a real plan,” Jayapal told reporters, calling the state of U.S. health care “atrocious” and dominated by a handful of wealthy corporate interests. “Americans are literally dying because they cannot afford insulin and can’t get the cancer treatments they need . . . I think this Medicare-for-all bill makes it clear what we mean by health care for all. We mean a complete transformation of our health-care system.”

The plan is, in a number of ways, more aggressive than the Sanders plan co-sponsored by more than a dozen Democratic senators, including presidential candidates Sens. Cory Booker (D-N.J.), Kamala D. Harris (D-Calif.) and Elizabeth Warren (D-Mass.). It is also significantly more detailed than the previous single-payer bill in the House introduced by then-Rep. John Conyers Jr. (D-Mich.), which at about 30 pages outlined only a set of goals with few legislative specifics.

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Tim Faust, a single-payer advocate, said it was the first “comprehensive, battle-ready” single-payer plan to be introduced in Congress.

“The idea of Medicare-for-all has become extremely popular, but it’s at risk of being co-opted by those who want modest, incremental proposals that fall well short of true universal health care,” said Adam Gaffney, president of Physicians for a National Health Program, a group of doctors supporting single-payer that provided input to the Jayapal plan. “What we’re doing here is a big step forward to clarify exactly what Medicare-for-all means.”

Critics say the plan would require impossibly large new taxes, given its estimated $30 trillion price tag, and question the political wisdom of forcing nearly half the country to switch from the current private plan to a public insurer. Conservatives have also argued that a single-payer system could impede quality of care for those who have it, pointing to the potential for longer wait times.

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Supporters point out that U.S. health-care spending per capita is more than two times as large as the average for developed nations, even as Americans have below-average life expectancy at birth and lag on a number of other key health outcomes. Single-payer advocates say one government insurer would have the bargaining power to drive down costs, while giving free health care to those who lack coverage.

Jayapal’s plan, about 120 pages, would transition every American to Medicare-for-all over two years, cutting the four-year transition in Sanders’s Senate bill in half. Sanders is currently working on an updated version of his legislation, according to Josh Miller-Lewis, a spokesman for the senator.

Some health policy experts fear that dramatically disrupting the health markets over four years could lead prices to explode in the private market, increasing the urgency of a quicker transition.

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Jayapal’s bill also includes two big new provisions left out of the Senate legislation: a crackdown on the pharmaceutical industry aimed at lowering drug prices, and new government-run long-term care to help people with disabilities. It does not specify how it would finance the new legislation.

The number of Americans who require long-term care is expected to explode over the next few decades as the baby-boom generation ages, with the number of Americans with a disability projected to more than double from 2015 to 2065. Jayapal’s new Medicare-for-all bill, unlike the one Sanders introduced in the Senate in 2017, would guarantee free long-term care, including home health care, for Americans with disabilities as part of the single-payer system.

“This one part of it is, in some ways, as complicated and expansive as the Affordable Care Act itself,” said Harold Pollack, a University of Chicago health expert. “It’s an unbelievably complicated and fraught issue."

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Jayapal’s bill will include a proposal from Rep. Lloyd Doggett (D-Tex.) aimed at bringing down prescription drug prices by allowing Medicare to negotiate the price of drugs. The bill would give the government the ability to issue a generic license to produce the medication if negotiations fail, a provision known as “compulsory licensing.”

The previous version of the Medicare-for-all bill called for the elimination of all for-profit hospitals, and it called on the government to give financial compensation to providers that would be forced to become nonprofits. That provision was removed from the new Jayapal bill, in part because House aides feared it would lead the government to compensate hospital shareholders. In December 2018, Politico reported that hospitals, insurance companies and other health-care lobbies had launched a unified front to beat back the push for Medicare-for-all, raising the political stakes for Democrats who embrace the plan.

The new bill specifies that funds from the government’s Medicare-for-all could not be used “for profit,” union-busting, marketing or federal campaign contributions. Many hospitals with the biggest budget surpluses are also nonprofit, which seems to diminish the case for converting all hospitals to that model.

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Jayapal also said between 1 million and 2 million people currently work in the private health insurance system, and that 1 percent of the new Medicare-for-all fund would go to a five-year transition program to pay for pension benefits, job training programs and other assistance for affected workers.

Congressional Democrats have proposed a number of incremental health reform provisions recently, including a plan by Sen. Debbie Stabenow (D-Mich.) and Tammy Baldwin (D-Wis.) that would create a public option for Americans from ages 50 to 64 to buy into Medicare. Sen. Brian Schatz (D-Hawaii) has proposed a Medicaid expansion via a state-based buy-in program. The recent push leftward on single-payer has made those plans, which would still use the federal government to expand health insurance to millions of people, seem more modest by comparison.

“Even though it’s still extremely unlikely to pass, Medicare-for-all has moved the political landscape so suddenly, it’s created a window for these other proposals to seem quite feasible,” said Pollack, a single-payer skeptic.