“Expanded & Improved Medicare For All Act”, H.R. 676

Sponsor: Rep. John Conyers, Jr., plus 40 Cosponsors (2/14/13)
113th Congress

To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.

The Library of Congress
Thomas (Select “Bill Number” and enter H.R. 676)

As of 2/15/13 the text of the legislation has not been received from the Government Printing Office, but a draft is available at this link:

Congressman John Conyers has reintroduced his bill for a single payer national health program: H.R. 676, “Expanded & Improved Medicare For All Act.” Some perspective is warranted.

Our government stewards are intensely involved in implementation of the Affordable Care Act (ACA), and thus tend to dismiss any consideration of single payer reform as being irrelevant in today’s political climate. Such an attitude is decidedly unwise.

We know that a decade from now 30 million people will still be without any health insurance, and tens of millions more may be exposed to excessive medical debt because of the inadequate coverage of the health plans – the standard silver plan having an actuarial value of only 70 percent. We also know that the ACA model of reform will not be capable of adequately controlling costs and will fail to provide much needed reform such as the reduction or elimination of profound administrative waste.

Many understandably do not want to wait the years it will take to see that ACA is a failure. They are turning to their states to try to achieve single payer reform. But state efforts not only face the “political feasibility” hurdle, they also face the federal gridlock of existing programs, laws and regulations that place barriers in the way of state reform.

For example, Vermont’s highly touted single payer legislation has not enabled adequate federal flexibility with Medicare, Medicaid, and employer self-insured (ERISA) funds. Although state activists talk about obtaining federal waivers to free up these funds, without comprehensive federal legislation, the existing waiver programs cannot possibly open the gates for state-level single payer. Considering the complexity of existing federal laws and regulations, the federal legislation required to enable state single payer systems likely would be as complex, if not more so, than enacting a national single payer program. The latter simply would displace our dysfunctional financing system, whereas the former would have to negotiate the the extremely complex maze that has been constructed over many decades, most recently compounded by ACA.

The California legislature has twice passed a bill that they labeled “single payer,” but only with the promise of the Republican governor that it would be vetoed. Now that California has a Democratic governor and a two-thirds super-majority in each house of the state legislature, with only one week left to file bills for the current two year session, no state legislator has been willing to sponsor the single payer bill. They insist that all attention must now be devoted to implementation of ACA.

This is why H.R. 676 is so important. Even if Congressional barriers succeed in blocking the legislation, the Expanded and Improved Medicare for All Act serves as a very important vehicle for education and advocacy. The bill was introduced two days ago with 37 cosponsors, and yesterday, 3 more were added. That is more than they began with in the last session of Congress. We should build on this.

State efforts should be encouraged, but with a dose of reality. We need to be working on a national movement – all of us, including the state activists. We can support each other in our state efforts, but all of us must pull all stops in support of the national efforts.

Perhaps around 2017 the picture will finally emerge that the fragmented and dysfunctional model of a multitude of private plans and public programs cannot be repaired, and that a public program such as single payer or a national health service will be essential. Until then, we must continue to spread the message that there is a model that will work. People need to know that, when ACA fails, there is a place to where we can turn.