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You're Hired: Tracking the Trump Administration Transition - September 13, 2017

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This is the September 13, 2017, edition of an email sent from November 2016 to September 2017 that covered Donald Trump's presidential transition, cabinet appointees, and the different policy positions of those individuals who may have had an effect on the new administration. Previous editions of "You're Hired" can be found here.

Today, Sen. Bernie Sanders (I-Vt.) introduced the “Medicare for All Bill of 2017,” a plan to change the American healthcare system to a single-payer form of healthcare in which all citizens are enrolled in Medicare, a system to be funded by taxes.

The bill has sizeable support from Democrats in the Senate, but it is not expected to have a close vote. The bill is still significant, as Axios reported this morning that “for so many powerful, viable Democrats to endorse just the conceptual idea of single-payer is still a huge political shift.” When Sanders introduced similar legislation in 2013, he had no co-sponsors.

Sanders’ proposed legislation comes after months of debate over the future of the Affordable Care Act, with Republicans and conservative groups proposing a number of repeal and replace options. This bill would replace the ACA in favor of a single-payer system.

What is single-payer healthcare?

Single-payer healthcare refers to a system in which one agency (typically governmental or semi-governmental) is responsible for financing the healthcare of everyone. The healthcare system—including the cost of prescription drugs—is financed through taxes.

What does Sanders’ bill propose?

Sanders’ bill is to institute a program he calls Medicare for All—it’s a version of single-payer healthcare. Private insurers would remain to pay for elective procedures under Sanders’ proposal.

In an opinion piece for The New York Times this morning, Sanders explained how his bill would transition the current healthcare system to a Medicare for All system. He wrote, “The transition to the Medicare for All program would take place over four years. In the first year, benefits to older people would be expanded to include dental care, vision coverage and hearing aids, and the eligibility age for Medicare would be lowered to 55. All children under the age of 18 would also be covered. In the second year, the eligibility age would be lowered to 45 and in the third year to 35. By the fourth year, every man, woman and child in the country would be covered by Medicare for All.”

The bill does not account for how the government will pay for this program, but Sanders has said it would be funded through higher taxes. He told The Washington Post that the size of the tax increase, though, would be determined by a separate bill.

Who supports this bill and what does that support mean?

The bill has 16 Democratic co-sponsors:

Senate support for this bill can be seen in a few different frames:

  1. As an effort to endorse the idea of single-payer healthcare for those looking towards a potential presidential run in 2020. The Washington Post suggests that many of these cosponsors—including Booker, Gillibrand, Harris, and Warren—are doing just that, writing, “The last thing any of them want is to see another candidate get to their left on this, so each of them are quick to go on-record — much quicker than their not-eyeing-2020 colleagues who can afford to be more judicious and deliberate.”
  2. As a way to move the healthcare debate away from the Affordable Care Act. From interviews with health policy experts and Democratic lawmakers, The Atlantic determined that single-payer proposals are an effort to change the terms of the national debate over healthcare: “Part of the appeal of single payer among liberal lawmakers is that many Democrats want to advance a health-policy agenda that goes beyond defending the ACA, a law that congressional Republicans have relentlessly attacked for nearly a decade, and which even Democrats agree has its flaws. Now that former President Obama is out of the White House, the party is less duty bound to act as though Obamacare is as good as it gets.”
  3. As a response to what these Senators see as grassroots support for such a bill. Sen. Richard Blumenthal (D-Conn.) told Vox that in town hall events this summer, the most popular idea was for a single-payer system. He said, “People literally erupted, every time. There is powerful, absolutely extraordinary momentum behind this idea.”

The proposal of Medicare for All has also been supported by the following organizations, according to The Intercept:

  • Our Revolution
  • Social Security Works
  • National Nurses United
  • Progressive Campaign Change Committee
  • Democracy for America
  • Labor Campaign for Single Payer
  • LULAC
  • Working Families Party
  • MoveOn
  • AllOfUs
  • Demand Progress
  • Health Care Now
  • Progressive Democrats of America
  • CREDO
  • Public Citizen
  • Latinos for Healthcare Equality
  • Americans for Democratic Action
  • AIDS Healthcare Foundation
  • DailyKos
  • Food & Water Watch
  • Friends of the Earth
  • 350.org
  • International Association of Machinists and Aerospace Workers
  • American Sustainable Business Council

Which Democrats are not supporting Medicare for All and why?

The bill has no support from Republican senators, who cite an increase in taxes and an expansion of the federal government as reasons for opposition. America’s Health Insurance Plans, a lobbying group for health insurance companies, also opposes the bill, with a spokesperson telling The New York Times, “Whether it’s called single-payer or Medicare for all, government-controlled health care cannot work. It will eliminate choice, undermine quality, put a chill on medical innovation and place an even heavier burden on hard-working taxpayers.”

The following Democratic senators have commented publicly in opposition to this particular bill. All are up for re-election next year, and only Tim Kaine is running in a state won by Hillary Clinton (D) in last year’s presidential election:

  • Claire McCaskill (Mo.) has come out against the bill. In an August town hall, she said she opposed the bill because of cost, saying it would be “irresponsible of us to expand the program that is driving the debt the most in a way that is unsustainable financially for this country.” The Cook Political Report currently rates McCaskill’s race as a toss-up.
  • Jon Tester (Mont.) has come out in support of making changes to the Affordable Care Act rather than changing the system entirely. He said, “I support fixing what we got because I think that’s more likely to happen.” The Cook Political Report currently rates Tester’s race as Likely Democratic.
  • Tim Kaine (Va.) has said he prefers a system in which consumers have options for healthcare but does support a government-run program as one option. The Cook Political Report currently rates Kaine’s race as Likely Democratic.
  • Debbie Stabenow (Mich.) will not support Sanders’ bill, choosing to focus on her own plan of reducing the age for Medicare from 64 to 55. She said she’s focused on making changes to the Affordable Care Act and on changing the Medicare enrollment age because “I think there is some bipartisan interest in that.” The Cook Political Report currently rates Stabenow’s race as Likely Democratic.

Tester was one of four Democrats to vote against a single-payer system when it was put up as an amendment in voting on the repeal and replacement of the Affordable Care Act. The other Democratic “no” votes were Heidi Heitkamp (N.D.), Joe Manchin (W.Va.), and Joe Donnelly (Ind.). These three are also up for re-election in 2018: the Cook Political Report rates Heitkamp’s race as Likely Democratic while Manchin and Donnelly’s races are called toss-ups. Rather than vote for or against the amendment, 43 others in the Democratic caucus voted “present.”

Which Democrats up for re-election in 2018 have neither supported nor opposed this specific bill?

The following Democratic senators up for re-election in 2018 have not commented publicly on Sanders’ bill at this point:

In addition, Democratic leadership has not signed on to support this legislation, with Senate Minority Leader Chuck Schumer (N.Y.) and House Minority Leader Nancy Pelosi (Calif.) both declining to endorse forms of single-payer healthcare in their chambers.

See also

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President Donald Trump's policies (first term)
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Domestic policy
Economic affairs and regulations
Foreign affairs and national security
Trump's second term overviews


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