Research Desk: How much would single-payer cost?

justin84 asks:

Did the CBO ever get around to scoring HR 676?

I remember that was promised back in 2009, but it's hard to tell if anything ever came of it.

Did any other reputable organizations estimate how much HR 676 would cost, if the CBO passed on it?

H.R. 676, better known as the "Expanded and Improved Medicare for All Act" or "United States National Health Care Act," was first introduced by Rep. John Conyers Jr. (D-Mich.) in 2003, and has been introduced in every Congress since. As its first name implies, it creates a single-payer health-care system by enrolling all Americans in Medicare. This would be financed through administrative savings, negotiating down prices with providers and drug manufacturers, and a few new taxes, including a payroll tax, an income tax surcharge for high earners, and a financial transactions tax. Hospitals would have to go nonprofit, and private insurers would be banned from providing coverage similar to Medicare's.

The bill got some attention last Congress, when single-payer advocates presented it as their alternative to bills coming from the House and Senate leadership, and the Congressional Budget Office looked set to score the bill. This was because then-Rep. Anthony Weiner got the House leadership to commit to giving H.R. 676 a floor vote. The CBO is required to score bills that are reported out of committee in either chamber, so such a vote would have required it to score H.R. 676. But because Nancy Pelosi and other House leaders thought a single-payer vote would hurt the chances of passing the main health reform bill, they rebuffed Weiner and the floor vote didn’t come, H.R. 676 never made it out of committee, and thus the CBO was not required to score it. It sometimes provides estimates for bills that have not made it out of committee, but in this case, it did not.

But that doesn’t mean there aren’t data on the budgetary impact of greatly expanding publicly-provided health care. In 2007 and 2009, Rep. Pete Stark (D-Calif.) introduced the “AmeriCare Health Care Act,” which would automatically enroll Americans in a Medicare-like public plan at birth and allow employers to choose between covering their employees or paying into the public plan to cover them.

The plan would be financed through these employee contributions as well as premiums and state contributions equal to their previous spending on Medicaid and S-CHIP, which would be rolled into the public plan. Unlike H.R. 676, the AmeriCare bill doesn’t force providers to go nonprofit, and, importantly, it maintains a role for private insurers. People are free to opt out of the public plan and keep their employer-based health plan if they wish. This means it’s not a single-payer plan, but it’s the closest thing for which we have reliable numbers.

Those numbers come courtesy of the Commonwealth Fund, which commissioned the Lewin Group to take a look at AmeriCare and a few other health-care proposals in 2009. The resulting study predicts that, because of a public plan’s lower provider reimbursement rates and administrative costs, as well as its ability to negotiate down drug prices, enacting the bill would have resulted in $58.1 billion less annual health spending in 2010. It would increase the federal deficit by $188.5 billion a year, and employers would pay $61.5 billion more annually, but state and local governments would save $83.6 billion, and households a whopping $224.5 billion.

The AmeriCare bill would cover all the uninsured, leaving 85 percent of all Americans enrolled in the public plan, 10 percent in Medicare, and only 2.1 percent in employer plans.

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