Thespecifics included in the new bill could play a role in theupcoming Democratic presidential primary campaign becausecandidates seeking support from the party's progressive wingleverage the phrase. (Photo: Shutterstock)

Members of the House on Wednesday offered their version of a “Medicare for All”bill that is broader than what's been put forth by Sen. Bernie Sanders (I-Vt.), whose 2016 presidential run pushedthe issue into the political mainstream.

Rep. Pramila Jayapal (D-Wash.) and Rep. Debbie Dingell (D-Mich.)unveiled the “Medicare for All Act of 2019,” which redefines whatthe change in health care coverage might mean. The specificsincluded in the bill could play a role in the upcoming Democraticpresidential primary campaign because candidates seeking supportfrom the party's progressive wing leverage the phrase. But often,they use it to mean various things.

Is this bill so different from Medicare for Allproposals that have come before? And why would those differencesmatter? Here are the essential takeaways:

In terms of the policy 411, the Jayapal-Dingell bill includesprovisions not in other proposals.

In many ways, the proposal sounds familiar: The government wouldestablish a health plan that pays for basically all forms ofmedical care for all citizens. That's how it gets the moniker“Medicare for All.”

Under this plan, patients would not be responsible for any costsharing of medical expenses, and the government coverage wouldinclude hospitals, doctors, preventive care, prescription meds anddental and vision care. Private insurers would not be allowed tosell plans that compete with the government program.

Senior citizens would be folded into the new Medicare plan,which would be more generous than their current coverage, and thegovernment would make sure any medical care they are getting is notdisrupted. The bill leaves two other government health care payersintact: the Veterans Health Administration and the Indian HealthService. Beneficiaries enrolled in these programs would have achoice of enrolling in the new Medicare-for-all plan or stickingwith their current coverage.

Just like the Sanders bill, the House legislation covers what itcalls “comprehensive reproductive health.” Backers say it is meantto cover abortion — a controversial provision. Right now,government-funded health plans are legally prohibited fromproviding funds for abortions.

There are differences, too. For one, the transition to the newMedicare-for-all system would take place over two years, whichwould be a fast turnaround for a substantial task. Sanders' billsuggested a four-year transition.

The biggest difference: This House vision of Medicare-for-allwould also cover long-term care. That isn't part of the Sandersbill, and it is not covered by Medicare. But for people withdisabilities and the elderly, it's a significant benefit — and onethat can get very expensive to pay for out-of-pocket. (TheAffordable Care Act included a long-term care provision that waseventually scrapped because of its high cost.)

The House bill also would take a swipe at high prices forprescription drugs by empowering the government to negotiate pricesdirectly with manufacturers and to take away and reissue drugpatents if such efforts faltered. This idea, known as “compulsorylicensing,” has appeared in drug-pricing bills, but not in otherMedicare-for-all legislation.

And the bill wades into one of the hottest Medicare-for-allcontroversies: the role of private health care. Notably, it permitsit. Private plans can cover services not included in the singlegovernment health plan. Doctors can also refuse to participate inthe program and charge patients cash for medical treatmentinstead.

“Whether there's someone out in Beverly Hills who sees the starsand doesn't partake — that would be possible,” said Dr. AdamGaffney, a doctor and president of Physicians for a National HealthProgram, a single-payer advocacy group that supports thelegislation. “The way the whole program is structured is to reallymake it such that that's a very insignificant overallphenomenon.”

And the legislation takes on wonkier questions, like health carecosts — proposing so-called global budgets that set a firm amount the federal governmentwould pay for hospitals, for instance, as a strategy to bring downspending.

Still, the legislation leaves a lot of meaningful details opento interpretation.

Three big ones: what precisely would be covered, what doctorswould be paid and how the program would be financed.

Generally, Medicare-for-all would provide “comprehensivebenefits,” accounting for health care needs as “medically necessaryor appropriate.” That means covering hospital and doctor visits,but also, for instance, mental health, maternity services,addiction treatment, pediatrics and medications.

Where it gets tricky is determining which specific servicesqualify as “necessary.” Sometimes that's obvious — insulin fordiabetics or a cast for a broken leg.

In other cases, it's not as clear. Examples include politicallycontroversial treatments, like gender confirmation surgery. Manyexperts do say the procedure is an important option for people withgender dysphoria. But specific components of it are sometimesdeemed cosmetic or unneeded — often by those skeptical of thetreatment to begin with.

There are also reconstructive surgeries that provide medicalvalue, but may be deemed cosmetic.

The Department of Health and Human Services would havesignificant discretion in interpreting what specific services are“medically necessary.” That means political leanings or scientificdebates could sway what's covered, even from administration toadministration.

“Reasonable people could disagree on certain things,” Gaffneyacknowledged.

The legislation also spells out steps for determining how to paydoctors — a tricky issue, since doctors often complain thattraditional Medicare pays them less than does private insurance.But the bill doesn't set up a reimbursement system.

Of course, there's the question of how the U.S. pays for the newprogram. Studies suggest Medicare-for-all would bring down nationalhealth care costs. Currently, though, much of that health spendingis borne by the private sector. Under the Jayapal-Dingell bill, themoney would have to come out of taxpayer dollars.

That would mean new taxes, and that's a subject that does notappear anywhere in the Jayapal-Dingell bill. (Jayapal has said shewill put out a separate list of potential taxes that could financeher single-payer proposal. Sanders also used this strategy — aseparate list of “pay-fors” — to make a case for his bill.)

The bill could resonate throughout the 2020 campaign.

The House bill keeps a spotlight on the Medicare-for-all issue —requiring Democratic presidential primary candidates to answer morequestions and spell out stances on this particular policy.

That could create some land mines. Medicare-for-all iscontroversial, and already major health industry groups have rampedup opposition to the broad idea. This bill's specific provisions,such as its coverage of abortion, would add more adversaries. Itslong-term care coverage would further drive up itsmultitrillion-dollar price tag

But Robert Blendon, a health care pollster at the Harvard T.H.Chan School of Public Health, pointed out that addressing concernssuch as the long-term care benefit could add to the measure'spolitical muscle. It could make the idea more attractive to oldervoters, who otherwise might be hesitant to change their coveragebut who do turn out disproportionately to vote in primaries.

That dynamic, he said, could skew primary results to favorcandidates who endorse Medicare-for-all, as opposed to moremoderate Democrats who have distanced themselves from the issue.(In a general election, he noted, costs could certainly diminishthat support.)

“The long-term care piece is unbelievably significant,” he said.“It surely will help [progressives] with older voters.”

Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

Read more:

• Forget Medicare for All; more states eye Medicaidbuy-in
• Next up for GOP: Shooting down Medicare forAll
• Single-payer gains momentum among AMAdoctors