The Washington PostDemocracy Dies in Darkness

Bernie Sanders’s claim that he would expand, not dismantle, the Affordable Care Act

(Jonathan Newton/The Washington Post)

“This is just old-fashioned political gimmickry. I helped write the Affordable Care Act. So I don’t want somebody suggesting I’m trying to dismantle legislation that I helped write.”

— Sen. Bernie Sanders (I-Vt.), interview with Des Moines Register, Nov. 16, 2015

During the most recent Democratic presidential debate, former secretary of state Hillary Clinton criticized Sanders for sponsoring a health-care bill that would have eliminated federal health-care programs, including the Affordable Care Act, and handed over health care to the states to administer.

Sanders did not directly dispute her claim but said the bill would have expanded, not eliminated, Medicare. Later, in an interview with the Des Moines Register, Sanders fought back against the idea that his bill would have dismantled the ACA, a.k.a. Obamacare.

So what exactly was his bill about?

The Facts

When Congress was debating Obamacare in 2009, Sanders proposed an amendment to create what he called a “Medicare-for-all-type-single-payer system.” The American Health Security Act of 2009 proposed a national health insurance system, administered by states and following guidelines set on a federal level. Rep. Jim McDermott (D-Wash.) introduced a companion bill in the House.

Sanders proposed to set up a new health-care system that would have eliminated all existing federal health insurance, including Medicare and Medicaid, and would repeal state exchanges as set up through ACA, according to a Congressional Research Service analysis of the bill.

It would have created the American Health Security Trust Fund, which would have diverted premium assistance credits under ACA to the new single-payer program. A national standards board would come up with eligibility, enrollment and benefits policies and guidelines — and take the place of the Centers for Medicare and Medicaid Services.

Sanders withdrew the 2009 bill after Sen. Tom Coburn (R-Okla.) initiated a procedural move requiring the Senate clerk to read all 767 pages of the amendment — which would have taken eight to 10 hours — and, thereby, halt the Senate health-care debate.

Then, Sanders turned his attention to inserting a community health center provision into ACA. The clinics served as an alternative to his preferred single-payer system, according to an article in the Intercept that details his role in the ACA debate: “Community health centers accept anyone regardless of health, insurance status or ability to pay. They are founded and managed by a board composed of patients and local residents, so each center is customized to fit the needs of a community. No two health centers are alike.”

This provision vastly increased health-care access for low-income and underserved communities, increasing the number of patients who receive primary and dental care, mental health counseling and low-cost prescription drugs. It also funded new centers and improvements to existing centers.

Sanders’s push for the centers helped win support from some Democratic lawmakers who believed that the bill was too weak and who were from rural states that relied on health centers, according to the Intercept. Sanders then voted in support of the ACA.

He continued to call for single-payer health insurance, riding on the momentum of the debate over the ACA. He said states should take the lead on creating single-payer insurance programs.

“I would point out that as someone who supported the health-care reform bill of last year, that after health-care reform is passed, after it is implemented, we are still going to be looking at 23 million Americans without any health insurance at all,” Sanders said in a joint news conference with McDermott announcing their reintroduction of the bill in 2011. He continued: “I think that health-care reform is a step forward. We have got to go a lot further.”

Sanders introduced his single-payer bill again in 2011 and 2013. It never went to a vote. Those versions still included language to replace existing federal health-care programs with the national health insurance system that he proposed.

But Warren Gunnels, Sanders’s senior policy adviser, said the 2013 plan would have combined and expanded the major federal health insurance programs to cover all Americans of every age, including those who have Medicare coverage.

“The 2013 plan would expand on current Medicare coverage, fully covering such expenses as prescription drugs, eyeglasses and hearing aids, and eliminating the need for supplemental coverage such as Medigap plans,” Gunnels said. The 2013 plan also would have a list of minimum requirements that “go above and beyond” ACA’s “essential health benefits,” he said.

“At a time when Republicans plan to truly repeal Medicare through privatization, vouchers and raising the age of eligibility, it is absurd to claim Senator Sanders wants to ‘repeal’ a program by finally guaranteeing health insurance to all Americans as a right,” Gunnels said.

In his major speech on democratic socialism on Thursday, this is how Sanders described his Medicare-for-all proposal:

“Health care should be a right of all people, not a privilege. This is not a radical idea…. That is why I believe in a Medicare-for-all, single-payer health-care system. Yes. The Affordable Care Act, which I helped write and voted for, is a step forward for this country. But we must build on it and go further.
Medicare for all would not only guarantee health care for all people, not only save middle-class families and our entire nation significant sums of money, it would radically improve the lives of all Americans and bring about significant improvements in our economy.
People who get sick will not have to worry about paying a deductible or making a co-payment. They could go to the doctor when they should, and not end up in the emergency room. Business owners will not have to spend enormous amounts of time worrying about how they are going to provide health care for their employees. Workers will not have to be trapped in jobs they do not like simply because their employers are offering them decent health insurance plans.
Instead, they will be able to pursue the jobs and work they love, which could be an enormous boon for the economy. And, by the way, moving to a Medicare-for-all program will end the disgrace of Americans paying, by far, the highest prices in the world for prescription drugs.”

David Himmelstein, co-founder of Physicians for a National Health Program, an advocacy group for single-payer national health insurance, said Sanders “would certainly say we don’t want to repeal ACA and not replace it with something better. What’s needed is to replace the ACA with much better coverage for people.” The group has supported Sanders’s proposals.

“I guess you could say it rolls back [Obamacare]. It eliminates the exchanges. It eliminates the exchanges because it replaces them with something much better,” said Himmelstein, a public health professor at the City University of New York and visiting lecturer at Harvard Medical School.

The Pinocchio Test

Sanders has said repeatedly that he wants to build on the health-care system created under the Affordable Care Act and to expand it to provide health insurance regardless of income or age. It’s clear that the provision in his bill to “repeal” ACA state exchanges was not just for the sake of repealing the law, in the way critics who oppose passage of ACA use the term “repeal.”

But the language of his legislation — all three times he introduced it — clearly stated that existing federal programs would be replaced with a new program that he sought to create. It wouldn’t simply increase current levels of coverage but would create a whole new health insurance system with new quality-control methods, a new standards board, and more.

We wavered between Two and Three Pinocchios. Sanders makes it sound as if he would tack on some additional provisions or coverage to ACA — when, in reality, his new single-payer health system would replace the ACA and all other existing federal coverage. He employs political wordsmithing by calling the criticism of his bill “old-fashioned political gimmickry.” However, he did “help write” ACA by pushing for an alternative (community health centers) to his single-payer system, making an important contribution to help get the law passed. So that tipped his rating to Two Pinocchios.

Two Pinocchios

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