Medicare for All fever

0:00Noel King:In the spring of 1970, Republican Senator Jacob Javits of New York proposed a fix for America's health care system, which he said was uneven. And for many, particularly the poor, it is abysmally low, if not non-existent. His fix? Expand Medicare. Medicare for all. This idea bounced around Congress for years. And then in 2016, Senator Bernie Sanders made it the cornerstone of his presidential campaign. Count me in as one of those people who believes that health care is a right, not a privilege. Newshounds may recall Senator Sanders did not win the presidential election. And for a time, Medicare for All was viewed as another improbable progressive fantasy.

0:44Noel King:You stopped hearing much about it. Until this year, when a bunch of Democratic candidates seizing on frustration over the high cost of health care started talking about it once again. On Today Explained from Vox, is it Medicare for All's moment?

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2:18Noel King:I'm Noelle King with Julie Appleby. She's a senior correspondent with KFF Health News. So as this conversation about Medicare for All heats up, it's worth remembering that health care in the U.S. has long been a mess. Sixteen years ago, President Obama signed the Affordable Care Act into law trying to fix some things. Julie, what was the situation at the time that made it feel so necessary? What did the Affordable Care Act aim to do? You know, there was a lot going on. So we had a lot of people who were uninsured. We had premiums going up. Many times in the past, there had been some effort to do some kind of health reform, but nothing ever really passed.

2:57We had Medicare and Medicaid in the 60s, right, but no major legislation since then. So people had employer coverage, which like they do now, but there were a lot of people who were on their own and buying in what's called the individual market. The individual market was really tough. They could tell people, hey, you've got a health condition. We're not taking you. So you could sign up for an individual plan. And later, if you did get some kind of health condition, they could go back through your medical records and see, hey, did they tell us about every single thing that had happened to them in the past five or 10 years?

3:31And if not, they could retroactively cancel your plan.

3:35Noel King:And so top line, what did the Affordable Care Act, which came to be called Obamacare because Obama passed it. Thanks, Obama. What did it do exactly? You know, it did a lot of things. So it allowed young people to stay on their parents' insurance plan up to age 26. And that was a really big deal and also a very popular provision in the Affordable Care Act. Health care plans are required to let young adults stay on their parents' plan until they're 26. It created these subsidies to help people purchase coverage on the individual market. Tax credits that have given about eight in 10 people who buy insurance on the new marketplaces the choice of a health care plan that costs less than$100 a month.

4:18It pays for part of your premium after after you pay a certain percentage of your household income. The subsidies kick in and it picks up the rest up to a certain up to a certain income level. It did some other things like, OK, they can't tell you you have a preexisting condition, so we're not going to take you. They've got to take you. Insurance companies, they can't deny somebody coverage or change them simply because they have a pre-existing condition like diabetes or asthma. It created sort of a benefit package that covers all these essential things like hospitalization and drug costs and maternity care, which might not have been in plans before that.

4:56They used to be able to charge women more than men. They can't do that anymore.

5:03Noel King:What was the conversation around passing the Affordable Care Act? And remind us how and why it got so toxic and pitched. It was super polarized, kind of like what we have now, right? I mean, a lot of people really, yay, we have the Affordable Care Act. This will be the most important piece of social legislation since the Social Security Act passed in the 1930s. I'm going to give you my five top reasons why you should enroll in marketplace health insurance, also known as the Affordable Care Act, also known as Obamacare. I received chemotherapy at Johns Hopkins and the Affordable Care Act literally saved my life.

5:43There was a lot of discussion around whether this is going to be too much government or if it was just the right amount. And a lot of people thought, oh, no, this is terrible. It's going to destroy things. How did Obamacare destroy our health care system? You got an hour and a half. You got an hour and a half. Individual state exchanges, 28 medical excise taxes, not allowing health insurance to be bought across state lines. Hey, do you have that Obamacare? Obamacare? What's that? What's that? Oh, it's great. It's great? It's great. What is it? I started signing up last Thursday and I'm almost done.

6:18Obamacare has to go. For the first, you know, four or five years or more of the Affordable Care Act, it was pretty evenly divided. And when you looked at opinion polls between people who thought it was a good thing and people who didn't think it was a good thing in more recent years, that has changed. And the favorability ratings have gone up for the Affordable Care Act. And now majorities do favor the Affordable Care Act. I noticed, by the way, that since it's become popular, they don't call it Obamacare no more.

6:50Noel King:Okay, okay. Majority's favorite. Wow. If you had told me that 16 years ago, I would not have believed you. Here we are. And majority's favorite. And so how is the Affordable Care Act doing? Well, you know, sort of use medical terminology. You know, is it on life support? No, it's actually doing fairly well. But you know what? There are some symptoms that there's some problems, right? Remember at the end of last year, there was all the discussion about these things called enhanced premium tax credits and whether they were going to be extended or not. House Democrats will fight to extend the Affordable Care Act tax credits.

7:28This fight is not over. We're just getting started. Government shut down over this, if you remember at the end of last year. Those were not extended. As a result, it costs more this year for most people in the plan. So those expired January 1st. And overnight, the average payment people were making jumped almost 60%. I need insurance, okay? Oh my God, this is not happening to me. At marketplace pricing, qualifying for a subsidy, it was$170 a month, which I'm very thankful that that was so low. I'm aware of that that was low. It is jumping to$1 ,000 a month. $1 ,000 a month for a single income family.

8:18And what we've seen is during open enrollment last year, we had about a million people fewer sign up. Wow. And that was about a 5 % drop. So that was a 5 % just in signups at the end of last year. And then since then, this year, the first few months of the year, we've seen another about 3 million people drop off. So some people, I think, are finding they can't afford it and they are not paying their bills and they are getting dropped off. So a 3 million person drop off is pretty substantial. A lot of policy experts say, look, when you raise the price of something, demand goes down. And that's what's happening here.

9:00It's the prices. People are dropping out. There's actually no effing way that I'm paying for health insurance. Insurance is absolutely asinine. The cost of insurance is not reasonable. People are skipping health care not because they're irresponsible. They're skipping it because they can't afford to stay alive. But there's also a group of folks, many people, particularly conservatives and Republicans, who say, you know what, the numbers were inflated. There was all this improper enrollment. People were getting these zero premium plans. And so there was fraud. There was improper enrollment. The subsidies were too generous or there were other factors that led to some fraudulent activity.

9:43And so these drop-offs just represent people who were fraudulently rolled dropping out for one reason or another. Hi, I'm Robert F. Kennedy, Jr., your HHS secretary. I'm joined today by my good friend and anti-fraud warrior, CMS administrator Dr. Mehmet Oz. Healthcare fraud and corruption affect millions of Americans and maybe even you. The Obamacare marketplace is plagued by fraud. If you're a fraudster, here's our advice to you. Do not walk away from us. Run, because we are going to find you. There's this real split right now between what are the reasons for the drop-off, but most policy folks, most people who study the situation here say the main reason is people just aren't being able to afford it.

10:30Noel King:Why is it so expensive? Why are health care costs so high? You know, that's the$64 ,000 question, right? And if you get it right, you win. You're in charge. You win. You win. That's been the question since I've been covering this debate. Look, it's not just Affordable Care Act costs going up. Employer plans are going up. Everything's going up. Generally, health care costs go up faster than inflation. And that's driven by a lot of things, right? It's driven by drug costs. It's driven by hospital costs. It's driven by labor costs. So all of those things go into the mix with the Affordable Care Act.

11:05But also this year, there's this additional factor of the subsidies went away. So insurers were looking at that saying, you know what, the subsidies are going down. We expect to have lower enrollments next year. The people most likely to stay enrolled, right, are the ones who have health problems because they don't want to take the risk of being uninsured. So insurers were calculating that in when they set their premium rates for this year. We might have sicker people in our pool that we're going to have to cover. So that's part of what we've seen with costs in the Affordable Care Act. But look, everybody is seeing health inflation go up right now, and that's affecting premiums.

11:49Noel King:All right. So here we are 16 years later, 16 years after the passage of the Affordable Care Act. Has it accomplished – did it accomplish what it set out to do? You know, you got to look at that in a number of ways. So it aimed to expand coverage, right, and reduce the uninsured. I think the answer there is yes. The number of uninsured have gone from that 13 or 14 percent. It dropped to as low as like, you know, just under 8 percent a couple of years ago. It's ticked up a little bit since then. So we have far fewer people who are uninsured. So yes to that. Did it control costs? That's a harder one to answer.

12:24And it's back to that$64 ,000 question. How do you do that? And costs have continued to go up. Premiums are higher. Premiums are definitely higher than they were pre-ACA. To be fair, the plans are very different. They cover more. They're more generous. They're better coverage, but they are more expensive. The big question is, what is going to be put forward as an alternative? And how palatable will that be to both consumers, lawmakers, the healthcare industry? It's going to be challenging. But I think we're going to hear certainly a lot more discussion this year. Whether or not we see actual proposals that could pass, I think that's a little more questionable.

13:14Noel King:She's Julie Appleby. She's a senior correspondent with KFF Health News. When we come back, once upon a time, Medicare for all was a popular slogan on the left. but it never came close to being a reality. This midterm cycle, some Dems are reviving the idea, and they sound serious.

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17:04This is Today Explained. My name is Rachel Booth. I am a senior policy correspondent at Vox. Medicare for All, well, it's become really a rallying cry for the progressive left. We're hearing voters talk about it a lot. Voters want action on health care. 92 percent. That's the share of American adults who say they've delayed or skipped medical care because they couldn't afford it. For five stitches,$3 ,800. Health care in general is horrible. Insurance is bad. It's like we need to find something better. It's become a rallying cry for a lot of progressive candidates that have won key primaries across the country.

17:44I'm Claire Valdez, and I'm running for Congress to make billionaires and corporations pay their fair share so we can fund Medicare for All, good union jobs. What are your five main policy proposals? Medicare for All, housing first, universal child care. We show the world what people of Florida are all about. Medicare for All. Most notably, it's become a really big part of Abdul Al-Sayed's campaign in Michigan. He has been a champion of Medicare for All for a long time. Medicare for all is guaranteed health insurance for every single American. Guarantee every single person the health care they need and deserve.

18:23Medicare for all does that. Look, y 'all, the answer to this is easy. Medicare for all. He, along with Bernie Sanders and IOC, has become sort of one of the leading figures elevating this and putting it into the conversation. What Medicare for all will do is save the average American substantial sums of money. Substantial. Be much less expensive than your plan. We need Medicare for All right now. People ask me, what would Medicare for All feel like? But I think everyone is really talking about health care right now. It's ranked as one of the top, if not the top concerns for voters. And it's a really big part of the Democratic Socialist for America platform.

19:03Noel King:When people say Medicare for All, obviously, this is something that we've been hearing for a long time. Also, as acknowledged earlier in this show, health care in the United States is very confusing and complicated. When people say Medicare for all, does everybody mean the same thing? So there is a slogan, you know, Medicare for all, which most Americans hear as something like universal health care backed by the government. And then there is the Medicare for all Act, which is a real live federal bill. And that is a much more specific thing. Bernie Sanders, when he ran for president in 2016, he campaigned explicitly on guaranteeing Medicare for every American.

19:43In my view, we must move forward toward a Medicare for all single payer program. You know, he lost, obviously. And once again, asking for your financial support. But since 2017, he's been the lead Senate sponsor of the Medicare for All Act, which would replace most private health insurance with a single public plan and everyone would be covered under the same plan. It's interesting because Bernie and AOC, they've both endorsed El-Sayed and he is known as a really big champion of Medicare for All, of single payer health care and the importance of that. But right now, if you look at his Senate campaign website, he is running right now on a vision of Medicare for all that does not advocate for eliminating employer or union health insurance.

20:31Oh. Which is basically essentially the same thing that Pete Buttigieg called for when he ran for president in 2019. Sort of a Medicare for all who want it. Medicare for all who want it means lower costs. Everyone gets the coverage they need and it leaves the choice with you. The left was really unsupportive of that. The position of the Sanders wing was just if you allow for private insurance, then you shouldn't have the right to associate yourself with Medicare for all. But the left today is behind El-Sayed. And so it raises this question that maybe they're open to a different path going forward.

21:06But the fact that you have someone like El Sayyad running on Medicare for All, championing the issue, making it a huge issue, but also supporting a version that doesn't call for banning private insurance, that is new and that is pretty big.

21:20Noel King:Universal health care is, it's very controversial in this country, but many other developed nations have it. And I think this leads Americans sometimes to question, why is that? What goes on here? What is going on here that is not going on elsewhere? Yeah, so, I mean, Americans have actually supported the idea for a long time. Truman proposed national health insurance in 1945. and polls often show that most Americans support it, you know, depending how the question is worded. Americans really do hold broadly progressive views on health care. 64 percent of Americans told Gallup that it's the responsibility of the federal government to make sure all Americans have coverage.

22:03But what's killed it over the years has been Congress and campaigns from doctors and private insurers and disagreements from Democrats. I think that Americans really do believe that your ability to see a doctor shouldn't depend on if you can afford it. Now, with respect to other countries, nearly all of them are universal in that they cover everybody. But most haven't gotten rid of private insurance. You know, France, Australia, Germany, they have universal coverage with a private layer on top.

22:36Noel King:I wonder if there is something different about this time that we're living in. I mean, as somebody who's been around for a while and seen the debate over Medicare for All go through many different iterations, in the U.S., we are rethinking a lot of things. Populism is ascendant on the left. Is it possible that now is the time for Medicare for All, that this time really is different? I think that there is real recognition from Americans and from people across at least the Democratic Party that there are untenable components of our health care system that will get even worse if left unaddressed.

23:16There is growing appetite to take big new action because we know Americans are super concerned about affordability and cost of living. And people are really worried that they could slip and fall or get sick one day and then be in financial ruin. 2027 is shaping up to be a really brutal year for health care. Cuts from the big beautiful Bill Act from 2025. A lot of them start to take effect on January 1st. It slashes Medicaid by$930 billion over 10 years. and as work requirements for adults that they enrolled. So the way that work requirements work, and we know this because some states have implemented work requirements in the past, and so we have data on this, work requirements do not increase the number of people working.