Beto O’Rourke’s Health Care Proposal Is Not Medicare for All, but It Is Ambitious

DUBUQUE, IOWA - MARCH 16: Democratic presidential candidate Beto O'Rourke addresses a packed St. Patrick's Day party at the home of County Recorder John Murphy March 16, 2019 in Dubuque, Iowa. After losing a long-shot race for U.S. Senate to Ted Cruz (R-TX), the 46-year-old O'Rourke is making his first campaign swing through Iowa after jumping into a crowded Democratic field this week. (Photo by Chip Somodevilla/Getty Images)
Beto O’Rourke. Chip Somodevilla/Getty Images

Beto O’Rourke may not be feverishly churning out policy white papers like some of his presidential rivals, but over the last few days, the hand-wavy former representative from Texas has at least started clarifying his position on health care. And for a candidate who seems to be carving out space in the Democratic field as a relative moderate, it’s strikingly ambitious.

While campaigning in Iowa on Friday and over the weekend, O’Rourke backed away from his previous support for Bernie Sanders’ single-payer bill. The former Senate candidate told an audience that he was “no longer sure” it was “the fastest way” to achieve guaranteed, high-quality universal health care for all.” Instead, he talked up another piece of legislation currently kicking around Congress known as “Medicare for America.”

Introduced by a pair of progressive congresswomen, Reps. Rosa DeLauro and Jan Schakowsky, Medicare for America offers a sort of middle ground between a true, Sanders-style single-payer system—which would ban private comprehensive health coverage—and a more modest public insurance option. (It is extremely similar to a proposal crafted by the Center for American Progress, which I’ve described as “single-payer with American characteristics.”) The bill creates a new, revamped version of Medicare that would be open to all adults and children. It would automatically enroll newborns, the elderly, and the uninsured. It would also bar insurance companies from selling policies to individuals that duplicated the government’s coverage, meaning it would largely wipe out the nongroup market as we now know it. However—and this part is key—the bill would permit businesses to continue offering private insurance as a benefit, as long as it was as comprehensive as today’s gold plans. Companies would also have the option of purchasing Medicare for their employees by paying a tax equal to 8 percent of their annual payroll. Individual workers could opt for the government plan, as well.

One of the major political selling-points of Medicare for America is that it wouldn’t necessarily force workers off of the health plans they currently receive through their jobs, which many people still like, or at least are hesitant to give up. Polling suggests that support for Medicare for All drops drastically when voters are told that it would eliminate private insurance. While some people would have their current coverage disrupted under DeLauro and Schakowsky’s bill, it wouldn’t force everyone at once into a single program. And that could make it more popular. (The Kaiser Family Foundation has found that 73 percent of Americans back the idea of a national health plan if it would let them keep their current coverage).

That seems to be Beto’s wager.

“It responds to the fact that so many Americans have said, ‘I like my employer-based insurance. I want to keep it. I like the network I’m in. I like the doctor that I see,’ ” O’Rourke said of the bill, according to the Texas Tribune. “It complements what already exists with the need that we have for millions of Americans who do not have insurance and ensures that each of them can enroll in Medicare. It then suggests additional investments in that program so it becomes the program of choice and people who have private insurance migrate over to the Medicare system.”

Another advantage to Medicare for America is that it would be cheaper than single-payer, at least so far as the federal budget is concerned. There are no public cost-estimates for the bill yet. But it would almost certainly save Washington money compared to the Sanders approach, because it would not require immediately transitioning the entire employer-sponsored market onto a government health plan. The new version of Medicare also wouldn’t be free for everyone; families earning more than 200 percent of the poverty line would pay premiums—they would go up with income, but be capped at no more than 9.69 percent of a household’s earnings—as well as copays and deductibles. Of course, the Sanders bill wouldn’t exactly be free either; instead of paying “premiums,” households would simply pay taxes. To a certain extent, the difference there is semantic.

While Medicare for America is not a single-payer system, it could create the bones of one, and gradually transition the country in that direction over time as it automatically enrolled more individuals and more businesses chose to buy in. At the same time, by preserving private coverage, it could leave a pressure valve in place, giving voters another option in case the new system doesn’t work out quite as smoothly as its supporters hope (we all remember the rough early days of, after all). In the scheme of major Democratic health care plans, it’s arguably the second most far reaching after the Sanders bill; it would do more to fundamentally change the U.S. insurance system than the Medicare or Medicaid buy-ins that other candidates have talked about, which would basically graft a public option onto Obamacare’s framework. Medicare for America would be something genuinely different.

Now we’ll see if Beto sticks to it.