With the Democrats Keeping the Senate, Forget about Rolling Back the Government Takeover of Health Care

E lections have consequences. Republicans’ failure to capture the U.S. Senate means that the Senate Committee on Health, Education, Labor, and Pensions — known as the HELP committee — will be chaired by Senator Bernie Sanders (I., Vt.).

Sanders will replace Patty Murray (D., Wash.), who, by the standards of today’s Democratic Party, is relatively moderate in her views and temperament. “Moderate” is not in Sanders’s lexicon.

Lest we forget, Sanders is the senator who introduced the Medicare for All Act of 2017 that would have created a monopoly government health insurer to set all prices paid to health-care providers. Every American would be forced to participate with mandatory premiums set through tax policy. People who disliked the government’s plan would have no option to buy alternative insurance since the proposal banned private insurance for the comprehensive services covered by the program. Thankfully, that bill went nowhere.

But Sanders remains committed to a government takeover of the U.S. health-care sector that will limit Americans’ health-care choices. In May, he introduced the Medicare for All Act of 2022, which includes the identical prohibitions found in the earlier bill making it unlawful for a private insurer to sell health insurance or for a private employer to offer health insurance to its employees and their dependents.

Medicare for All would not simply expand Medicare. It would be a completely different system that would eliminate the private insurance elements, choice, and competition seen in the current system, even within government health insurance.

Currently, for example, Americans can elect Medicare Advantage, the privately run alternative to traditional, fee-for-service Medicare, that generally provides comprehensive insurance coverage. It has steadily grown in popularity since being introduced in 2007 and now covers nearly half of Medicare beneficiaries. Advantage plans compete against other advantage plans and traditional Medicare, providing enrollees a choice of what benefits and costs best suit their needs.

People who elect to stay in traditional Medicare automatically get Part A, which covers inpatient hospital expenses without paying a premium. They decide whether they want to pay for Part B, which covers physician expenses, and whether they want to purchase a supplemental policy to cover the 20 percent coinsurance for each Part B–covered service.

Medicare beneficiaries also get to decide whether they want prescription-drug coverage. Three quarters of them have chosen to enroll in Part D, a voluntary, outpatient, prescription-drug benefit provided through private plans that contract with the federal government. The average enrollee gets to choose among 23 private, standalone plans if he or she is in traditional Medicare or 31 Medicare Advantage drug plans.

Under Medicare for All, Americans would have no choice but to accept the government insurance or pay out of pocket — an option available only to the wealthiest. And, while health providers would not be government employees, the elimination of private insurance would obligate providers to receive their income and instructions from the federal health-insurance monopoly.

For Sanders, lack of patient and provider choice is a feature, not a bug. Never mind that single-payer systems have delivered lower quality health care as measured by wait times, patient-survival rates, and rates of health care innovation. Sixty-one percent of Americans wait less than a month for recommended surgery. In Canada and the United Kingdom, often cited as single-payer models, the comparable figures were 34.8 percent and 43.4 percent. The percentage of Americans who can see a specialist within four weeks of referral was 69.9. The figures for Canada and the U.K. were 38.0 and 48.6 percent, respectively. All-cause mortality rates for people over 75 and cancer-survival rates are better in the U.S. than in the European Union. And the U.S. generates a disproportionate share of the world’s medical innovation, giving Americans earlier access to life-saving therapies.

Sanders’s expansive vision of government-knows-best health care is unlikely to be completely realized now that Republicans have secured a House majority. But he will thwart efforts to reverse the slow-motion government takeover promoted by the Obama and Biden administrations.

Medicaid now covers more than one in four Americans. Enrollment jumped under the Affordable Care Act’s Medicaid expansion but then stabilized and even declined a little in 2018 and 2019. Expansion resumed due to pandemic-era programs that prohibit states from removing ineligible recipients from the Medicaid rolls while a public-health emergency is in effect. Medicaid enrollment grew by an estimated 19 million (more than 26 percent) between February 2020 and July 2022, and the Biden administration has just indicated that it will extend the public-health emergency for the twelfth time — despite the president’s acknowledgment that the pandemic is over — continuing the expansion of Medicaid to cover those who aren’t even eligible.

With political control split between the two houses, Congress will be unlikely to end the now defunct emergency and start the process of removing the more than 16 million otherwise ineligible beneficiaries from the Medicaid rolls.

Congress will also be unlikely to advance legislation making privately provided, more-affordable plans available. Association Health Plans, for example, allow small businesses to band together and offer health insurance as a large group that is exempt from many of the ACA’s onerous and costly rules that apply in the individual and small-group markets.

A 2018 Trump administration rule eased requirements for small businesses and self-employed individuals, known as working-owners, to band together into associations to benefit from the less burdensome regulation and economies of scale that large employers receive when offering health insurance. The Congressional Budget Office projected these new AHPs would offer coverage that is similar to comprehensive employment-based coverage at lower premium cost than fully regulated small-group and individual plans, and they would cover over 4 million people by 2023, half a million of whom were previously uninsured.

The initial response to the rule was positive, with many new AHPs launched by regional chambers of commerce offering plans with generous benefits and premiums lower than those in the ACA marketplaces. Unfortunately, a federal district court struck down the rule in 2019. The Trump administration appealed. The rule remains in limbo three years later as the Biden administration, claiming the matter “remains under consideration,” has neither moved the appeal forward nor issued an alternative rule.

H.R. 4547, the Association Health Plan Act of 2021, introduced by Representative Tim Walberg (R., Mich.), would circumvent the Biden administration by creating a statutory basis for these new AHPs. Unsurprisingly, it did not advance with a Democratic majority in the House. But even if it advances in the new Republican-controlled House, it will die in the Sanders-led HELP committee in the Democratic-controlled Senate.

The failure of the “red wave” to materialize means that an old-fashioned socialist will have the whip hand over health care for the next two years. Another election failure in 2024 could mean permanent negative consequences for American patients.