The measureproposed by Pramila Jayapal would eliminate all premiums,deductibles and co-pays while guaranteeing universal health careaccess to “every person living in the United States.” (Photo: AlDrago/Bloomberg)

A leader of House Democrats' progressive wing is proposing“Medicare for all” legislation that wouldreplace almost all private health insurance, an idea that'sgalvanizing the party's liberal base and winning endorsements frommany of its top presidential contenders.

The legislation by Congressional Progressive Caucus co-chairPramila Jayapal would steer all Americans — not just those 65 andolder — into the Medicare program in two years. It would covercomprehensive health care services and, in a radical departure fromthe existing system, limit private insurance to supplementalbenefits not provided by the government-run program.

“The state of our health care system is absolutely atrocious,”Jayapal of Washington told reporters on a conference call Tuesday.“Americans are literally dying because they can't afford insulin orthey can't get the cancer treatment they need. Americans are goingbankrupt.”

Related: Poll shows growing support for Medicare forAll

She said the measure will be introduced Wednesday with more than100 co-sponsors.

Jayapal didn't say how much it would cost or how it would befunded. The measure would eliminate all premiums, deductibles andco-pays while guaranteeing universal health care access to “everyperson living in the United States,” according to a summaryprovided by Jayapal's office. The summary said combining allcoverage into one program would reduce administrative costs and letMedicare set doctors' fees, hospital budgets, and negotiate drugprices.

A member of Jayapal's staff said options for financing the planinclude a wealth tax, higher marginal tax rates and repealingportions of the 2017 Republican tax cuts. While the proposal woulddramatically raise the government's tab on health care, the staffmember, who spoke on condition of anonymity, suggested that overallU.S. spending on health services would fall.

Presidential contenders

A small private insurance market for services not covered byMedicare wouldn't receive any federal funding under Jayapal'splan.

Democratic presidential contenders who support the idea ofMedicare for all include five senators — Vermont's Bernie Sanders,Massachusetts's Elizabeth Warren, New York's Kirsten Gillibrand,New Jersey's Cory Booker and California's Kamala Harris — as wellas Julián Castro, a former cabinet secretary in the Obamaadministration. Candidates are being quizzed about the issue on thecampaign trail.

Harris drew applause Saturday at a town hall in Ankeny, Iowa,when she touted Medicare for all as a mechanism to cut costs onemergency room visits by people who currently lack coverage. Shesaid it would also let the government take on drug companies that“dictate prices” to make money.

“The pharmaceutical companies have been gouging us, guys,” shesaid. “With Medicare for all, when fully achieved, everyone wouldbe in the system and then we can negotiate as a big group againstthe pharmaceutical companies to bring down those prices.”

Not all Democratic presidential contenders endorse the idea.Minnesota Senator Amy Klobuchar, who portrays herself as apragmatist, said at a recent CNN town hall that Medicare for all“could be a possibility in the future” but she doesn't view it asrealistic now.

No realistic chance

For now, Medicare for all has no chance of becoming law in adivided Congress. Democrats control the House but Speaker NancyPelosi and a number of party moderates are resisting the idea. OnTuesday, a member of the House Democratic leadership, HakeemJeffries of New York, kept his distance from the proposal, sayingthe Democratic caucus supports universal coverage but wants tofocus on strengthening the 2010 Affordable Care Act and loweringdrug costs.

Even if it passed the House, the proposal would be doomed in theRepublican-controlled Senate. President Donald Trump has arguedMedicare for all would have a disastrous impact.

He said in an October USA Today op-ed that the Democrats would“gut Medicare with their planned government takeover of Americanhealth care.” He said the proposal would put doctors and hospitalsout of business and create “long wait lines for appointments andprocedures.”

It's a high-risk idea. A January 2019 poll by the nonpartisanKaiser Family Foundation found that Americans favor the idea of“national health care, sometimes called Medicare-for-all” by amargin of 56 percent to 42 percent. But public opinion fluctuatesdramatically depending on what respondents hear about it. When toldit would guarantee health insurance as a right, 71 percent supportthe idea; but when told it would eliminate private insurers andrequire most Americans to pay more taxes, just 37 percent supportit.

Perhaps the greatest political danger for Democrats is thatMedicare for all would disrupt coverage for about 156 millionAmericans who get their insurance from an employer. The proposalwould face fierce objections from the health-care industry,including doctors, insurers and pharmaceutical companies.

'So much unknown'

Brian Marcotte, president of the National Business Group onHealth, which represents large employers, said, “There are so manyquestions about this, so it's really hard to take Medicare for allseriously when there's so much unknown about how you would makethis transformation and actually make it work.”

The American Medical Association, the doctors' organization thatsupported the Affordable Care Act, said in a statement that it is“opposed to Medicare for all based on a mountain of evidence aboutthe cost, counterproductive disruption, and degradation of choice,quality and innovation that Americans deserve and want.”

For-profit, publicly traded health insurers employ more than ahalf million people in the U.S. The companies' combined stockmarket value is worth more than one-half trillion dollars,according to data compiled by Bloomberg.

Insurance companies including UnitedHealth Group Inc., AnthemInc., Humana Inc., and CVS Health Corp.'s Aetna unit do substantialbusiness with the government. They contract with Medicare toprovide health plans for more than 21 million beneficiaries whochoose private Medicare Advantage plans. People who opt in toprivately managed Medicare plans constitute more than one-third ofMedicare's total enrollment of about 60 million people.

75 million enrolled

Private companies and nonprofits also manage health plans formore than two-thirds of the 75 million people enrolled in Medicaid.Much of their business would be replaced by a government programthat would bar private companies from selling coverage thatduplicates government benefits, and prohibit employers fromoffering such plans.

Advocates of single-payer health coverage count on savings fromeliminating insurance companies as intermediaries between patientsand doctors. Government estimates put the administrative cost ofprivate health insurance at $229 billion, less than 7 percent ofthe $3.5 trillion the spent on U.S. health care in 2017.

Jayapal said Americans who worry about losing private insurancewill come around to Medicare for all once they're told they'llstill have access to their preferred doctors and hospitals underthe government-run plan.

“People are not saying they're dying to have health insurancecompanies in their lives,” she said.

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

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