On Wednesday, senators from across the political spectrum introduced two very different healthcare bills—one aiming to repeal and replace the Affordable Care Act, and another seeking to implement a single-payer system.
Neither, though, likely has a strong chance of passing.
First to be released was a bill (PDF) from Senators Bill Cassidy, R-La., Lindsey Graham, R-S.C., Dean Heller, R-Nev., and Ron Johnson, R-Wis.
As expected, the legislation would repeal the ACA and replace it with an annual block grant to states “to help individuals pay for healthcare,” per a statement from the senators. That grant funding would replace the money the federal government currently spends on the ACA’s two types of subsidies, Medicaid expansion and Basic Health Plans.
In addition, the bill repeals the ACA’s medical device tax and the law’s individual and employer mandates—all generally less popular provisions.
“Our bill takes money and power out of Washington and gives it back to patients and states,” Graham said in his statement. “It takes us off the path to single payer healthcare—which would be a disaster—and puts us on a path toward local control.”
Sen. Bernie Sanders, though, doesn’t quite share the same view.
The Vermont Independent unveiled his own bill (PDF) on Wednesday, which he indicated was co-sponsored by 16 other lawmakers and supported by “dozens of grassroots organizations all across America.”
True to its name, the “Medicare-for-all” legislation would establish a national health insurance program for all U.S. residents. The program would be rolled out over four years, starting with the automatic enrollment of those younger than 18. Many services would be covered without any cost-sharing requirements, and individuals would be issued universal Medicare cards.
“Today, we begin the long and difficult struggle to end the international disgrace of the United States—our great nation—being the only major country on earth not to guarantee healthcare to all of our people,” Sanders said during a Capitol Hill press conference.
He urged those listening to help him discontinue a system that “allows insurers and drug companies to make hundreds of billions of dollars each year” and that makes “healthcare industry CEOs extremely wealthy.”
With Republicans in control of both Congress and the White House, Sanders' bill has scant chance of passing anytime soon. But the fact that it's gained the support of so many Democrats is a sign that the party has moved considerably to the left on healthcare.
Cassidy's bill faces similarly long odds, as the budget reconciliation instructions that would allow Republicans to pass an ACA repeal and replacement bill with just a simple majority will expire Sept. 30. Given that previous attempts at repeal have failed and Congress is facing other pressing priorities, it is unlikely that proponents of the bill could gather enough votes to pass it with such a tight timeline.
Reactions roll in
Even before Sanders unveiled his single-payer legislation, the health insurance industry’s major trade group made its stance clear on the idea of eradicating private payers.
“Whether it’s called single-payer or Medicare For All, government-controlled health care cannot work,” David Merritt, executive vice president at America’s Health Insurance Plans, said in a statement.
"The most effective way to ensure affordable care and coverage is to strengthen the private market’s ability to serve the American people, whether it’s building upon private plans serving nearly 180 million people who get their coverage through their employer or the tens of millions who depend on private plans that partner with public programs,” he added.
The left-leaning group Progressive Change Campaign Committee, though, pointed to the support that the bill has gathered as proof that single-payer is going mainstream.
"When people as credible as Bernie Sanders, Elizabeth Warren, Kamala Harris, Cory Booker, and Kirsten Gillibrand call for Medicare-for-all, it's clear that's the future direction of the party," PCCC co-founder Adam Green said.
Republicans' latest ACA repeal and replacement plan, meanwhile, drew support from none other than President Donald Trump.
"I applaud the Senate for continuing to work toward a solution to relieve the disastrous Obamacare burden on the American people," he said in a statement. "As I have continued to say, inaction is not an option, and I sincerely hope that Senators Graham and Cassidy have found a way to address the Obamacare crisis."
However, the left-leaning Center for American Progress had withering words for the legislation.
“The Graham-Cassidy bill is one of the most devastating proposals put forth by congressional Republican leaders yet, threatening to overhaul the Medicaid program as we know it and leave millions uninsured,” Topher Spiro, the group’s vice president for health policy, said in a statement.
Even the conservative group Heritage Action for America was skeptical in a statement sent before the repeal/replacement bill was officially released.
“Based on what we know right now, Graham-Cassidy would make some improvements over the status quo but it would not actually deliver on the Republicans’ seven-year campaign promise to repeal and replace Obamacare,” said CEO Michael A. Needham. “Any reforms that maintain the law’s onerous federal regulations will ensure networks continue to narrow, premiums continue to rise and choice continues to decline.”