Sen. Bernie Sanders (I-VT) and Rep. Pramila Jayapal (D-WA) on Tuesday announced that they and House colleagues would introduce Medicare for All legislation, marking the fifth time Sanders has put forward legislation to have the federal government pay for health services and ban private insurance.

In an editorial published in the Guardian on Tuesday, Sanders framed the bill’s reintroduction in terms of plans to reduce Medicaid spending through the budget reconciliation process. In the piece, Sanders said the reconciliation bill will “throw millions of Americans off the healthcare they have,” but added that Democrats can’t solely play defense.

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“Obviously, we must defeat that terrible legislation,” said Sanders, referencing the reconciliation bill. “But we must do much more. We cannot simply defend the status quo in healthcare.” 

Single-payer healthcare refers to having the government provide health insurance for all. Sanders’s Medicare for All legislation would have the federal government directly pay for all healthcare services, including dental, vision, and prescription drugs, among other services.

Sanders’s version of single-payer also prohibits a private health insurance market that would compete with government-funded care.

Although the text of the new bill is not yet available, Sanders said the new proposal is similar to prior iterations of the legislation in that it would provide “comprehensive healthcare coverage to all without out-of-pocket expenses” and “full freedom of choice regarding healthcare providers.” 

“No more insurance premiums, no more deductibles, no more co-payments, no more filling out endless forms and fighting with insurance companies,” Sanders said.

Sanders introduced a Medicare for All plan in 2017 during the heat of the first Trump administration’s attempt to repeal and replace Obamacare. Along with Jayapal in the House, Sanders reintroduced different versions of Medicare for All during the 2019, 2022, and 2023 sessions of Congress.

Sanders said on Tuesday that his plan “would save Americans $650 [billion] a year.”

However, the specifics of the plan matter a great deal when trying to estimate program costs.

In response to increased interest in Medicare for All, the Congressional Budget Office in May 2022 analyzed multiple single-payer health insurance scenarios based on the Medicare fee-for-service model.

The CBO estimated that a Medicare for All model would increase federal health subsidies from $1.5 trillion to $3 trillion, mainly depending on healthcare professionals’ reimbursement rates. 

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Their models also predicted that the scheme could either decrease national health expenditures by $700 billion or increase them by $300 billion, depending on the specifics of the program. 

However, regardless of program design, the CBO predicted that any single-payer system would lead to demand for healthcare services outpacing supply, leading to “increased congestion in the healthcare system, including delays and foregone care.”