Sen. Bernie Sanders launched a revamped "Medicare for All" plan on Wednesday, highlighting a divide among Democrats over one of their bedrock 2020 campaign issues — the future of health care in America.
As before, the Democratic presidential candidate's signature proposal would replace job-based and individual private health insurance with a government-run plan that guarantees coverage for all with no premiums, deductibles and only minimal copays for certain services. In this latest version, Sanders added coverage for long-term care.
Some Democratic 2020 hopefuls point to their support of Medicare for All to prove their progressive bona fides. But other Democrats say it's not politically or economically feasible because of the large tax increases required, preferring instead to stabilize the Affordable Care Act and use it to expand coverage.
House Speaker Nancy Pelosi has sounded skeptical about Sanders' plan.
Republicans, meanwhile, cite Medicare for All as Exhibit A in their own 2020 narrative depicting a radicalized Democratic Party steering toward "socialism."
Several independent studies of Medicare for All have estimated that it would dramatically increase government spending on health care, in the range of about $25 trillion to $35 trillion or more over a 10-year period. But a recent estimate from the Political Economy Research Institute at the University of Massachusetts in Amherst suggests that the cost could be much lower.
Sanders and his supporters say it's a matter of principle.
"Health care is a human right, not a privilege," declared the Vermont Independent, who is again seeking the Democratic nomination for president, as he unveiled his bill at a Capitol Hill event crowded with nurses and advocates for patients. Fellow Democratic presidential candidate and co-sponsor Sen. Kirsten Gillibrand of New York also spoke, saying "this has to become the next social safety net."
Four of Sanders' fellow senators and rivals for the Democratic nomination have signed onto the updated single-payer health care proposal. In addition to Gillibrand, they are Sens. Cory Booker of New Jersey, Kamala Harris of California and Elizabeth Warren of Massachusetts.
The latest edition of Medicare for All adds coverage for long-term care in home and community settings, on top of its basic promise of comprehensive health coverage, including dental and vison. Brand name prescription drugs would be subject to copays totaling no more than $200 annually.
"It is not a radical idea to say that in the United States, every American who goes to a doctor should be able to afford the prescription drug he or she needs," Sanders said. As with previous versions of the plan, he did not include details on how to pay for it, offering instead some general options.
Capitalizing on Sanders' unveiling, Sen. John Barrasso, R-Wyo., fired off a letter to the Congressional Budget Office requesting a detailed cost estimate of Medicare for All bills in the House and Senate.
"The American people deserve a complete and thorough vetting of this proposal," Barrasso wrote to the nonpartisan number crunchers.
Some Democrats seem to be trying to change the conversation inside the party to build consensus around "coverage for all" as distinct from the Sanders plan. They aim to reach that goal through various incremental steps, while preserving the traditional U.S. mix of public and private insurance.
Indeed, a Democratic co-sponsor of an earlier version of Sanders' bill was among those having second thoughts. Sen. Jeanne Shaheen of New Hampshire did not re-up this time, saying in a statement "there are faster ways to reach universal coverage by building on the progress we've made through the Affordable Care Act."
Democratic presidential candidates who don't back the Sanders plan are focused on safeguarding popular provisions of the Obama-era ACA, such as the one that protects coverage of pre-existing conditions.
"Of course, our No. 1 goal should be to make sure we keep in place those protections so people don't get kicked off their insurance," Sen. Amy Klobuchar, a Minnesota Democrat who isn't signed onto Sanders' bill, said Tuesday. "Then we also have to see the Affordable Care Act as a beginning and not an end."
She supports a so-called public option, versions of which would allow Americans to buy into Medicare or Medicaid. Klobuchar wants to draw a sharp distinction with President Donald Trump, who is still trying to repeal "Obamacare."
The Democratic senators who support Sanders' bill and are running for president also have signed on to various incremental plans, hedging their bets.
Among them is Booker, who Wednesday offered Sanders and all other single-payer health care supporters a reality check.
While telling WCBS Radio that Medicare for All is "the best way" to achieve universal coverage over the long term, Booker said fellow Democrats who campaign on it also "should be talking to people about, in a split Congress, what are you going to actually do in your first year to make health care more accessible and affordable?"
With Sanders' idea returning to the forefront, Republicans have a fresh opportunity to slam his plan as too costly and unworkable.
Calling the Vermonter "a self-proclaimed socialist," White House press secretary Sarah Sanders said in a statement that his plan would entail "a total government takeover of health care that ... (would) cripple our economy and future generations with unprecedented debt."
The Trump administration, meanwhile, is arguing in court to strike down the Obama health law, which provides coverage for about 20 million people. Trump has said he'll take up health care after next year's election , essentially making it a central campaign issue.
Earlier this year, a poll from the nonpartisan Kaiser Family Foundation found that Americans like the idea of Medicare for All but that support flips to disapproval if it would result in higher taxes or longer waits for care.