Bernie's latest Medicare for All bill has a key difference from his last one

Sen. Bernie Sanders (along with a handful of other 2020 Democrats) introduced a new Medicare for All bill Wednesday morning that has a key difference from his last single-payer bill.

The 2019 bill would ensure that Medicare for All includes benefits for at-home long-term care for people with chronic illnesses or disabilities. It’s a significant expansion of previous Medicare for All efforts, which have been pushed in Congress for decades. Medicare, as it exists, does not cover long-term care, which includes nursing homes and home-based assisted living. Sanders’ plan doesn’t come with a price tag, although the inclusion of long-term care will likely raise the cost for single-payer healthcare, which could reach as high as $30 trillion over a decade, although that’s contested.

Where the funding would come from is a common attack on Medicare for All efforts, even from within the Democratic Party, and could widen the rift between moderate Democrats and the party’s popular progressive wing. Another 2020 candidate, Sen. Amy Klobuchar, for example, endorsed a more moderate bill that would provide Medicare to people at age 50, lowering the age from 65. That bill does not account for long-term care.

But Sanders and his 2020 counterparts do have plans in the works to fund their ambitious healthcare proposals: taxing America’s hyper-wealthy, through bills like one introduced by Sen. Elizabeth Warren. Supporters of Medicare for All, like Rep. Alexandra Ocasio-Cortez, also point to the United States’ bloated military budget as evidence that the U.S. could finance the project.

Just a handful of Americans (about 7 or 8 million) are estimated to have private long-term care insurance, even though more than half of people over 65 will likely need it, according to the AARP. Disability advocates previously criticized single-payer efforts over their exclusion of long-term care benefits. Sanders’ campaign said the expansion will allow people with disabilities to remain in their homes and communities while receiving care. Under Sanders’ bill, nursing home and other institutional coverage would fall under Medicaid.

Sanders’ bill also maintains its four-year timeline for implementing Medicare for All, unlike a separate, more aggressive Medicare for All bill introduced in the House by Rep. Pramila Jayapal in February, which called for a 2-year implementation.

Sens. Kamala Harris, Cory Booker, Elizabeth Warren, and Kirsten Gillibrand, all of whom are running for president, signed on to Sanders’ bill, as they did in 2017. In February, Booker notably backed away from supporting the abolition of the private insurance industry. Sanders’ 2019, however, bill will still functionally eliminate the private insurance industry by outlawing private insurers from offering coverage already provided in the sweeping legislation.

The nation’s top Democrat, House Speaker Nancy Pelosi, has refused to endorse Medicare for All and instead called for building upon Obamacare.

“I’m agnostic. Show me how you think you can get there,” Pelosi said in an interview with the Washington Post last week. “We all share the value of health care for all Americans — quality, affordable health care for all Americans. What is the path to that? I think it’s the Affordable Care Act, and if that leads to Medicare for All, that may be the path.”

Sanders' bill, however, has been endorsed by 58 national organizations and labor unions, which his campaign said is double the amount of the 2017 legislation.

The benefits covered by the bill include:

• Hospital services, including inpatient and outpatient hospital care, 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, and biological products, like vaccines and blood agents
• Mental health and substance abuse treatment services, including inpatient care
• Laboratory and diagnostic services
• Comprehensive reproductive, maternity, and newborn care
• Pediatrics
• Dental, audiology, and vision services
• Rehabilitative services and devices
• Dietary and nutritional therapies
• Podiatric care
• Emergency services and transportation
• Early and periodic screening, diagnostic, and treatment services
• Transportation to receive health care services for persons with disabilities or low-income individuals
• Long-term care services and supports

Cover image: Democratic presidential candidate Sen. Bernie Sanders, I-Vt., speaks at a convention of the International Association of Machinists and Aerospace Workers, Monday, April 8, 2019, in Las Vegas. (AP Photo/John Locher)