Bernie Sanders’ Medicare for All Act: Coverage, Costs, and Funding

The Bernie Sanders Medicare for All Act is single-payer legislation, most recently reintroduced as S.1506 on April 29, 2025, that would replace most private health insurance with one federally administered program covering every U.S. resident. The bill sits in the Senate Committee on Finance and has not been scheduled for a hearing, markup, or vote.¹ Sanders himself, while chairing the Senate HELP Committee in 2023, estimated the proposal would draw roughly 15 to 20 Senate votes and would not pass the House.²

Where the Bill Stands in Congress

Sanders introduced the current Senate version alongside a companion House bill led by Representatives Pramila Jayapal and Debbie Dingell. The Senate bill launched with 15 original cosponsors, with Senators Chris Van Hollen and Tina Smith added later, bringing the total to 17.³ The House version had 104 original cosponsors.⁴

The bill was read twice and referred to the Senate Committee on Finance. As of mid-2026, no hearings, markups, or floor votes have been scheduled.¹ Sanders has introduced some form of this legislation for more than a decade. His 2013 version drew zero cosponsors; his 2019 version drew 14, including four rivals for the 2020 Democratic presidential nomination.⁵ The current cosponsor total is the highest yet.

What the Bill Would Cover

The legislation would create a national health insurance program administered by the Department of Health and Human Services. Every U.S. resident would be enrolled automatically at birth or upon establishing residency.¹

The covered benefits are broad: hospital care, primary care, prescription drugs, mental health and substance abuse treatment, dental and vision services, home- and community-based long-term care, reproductive care including contraception and abortion, and gender-affirming care. Deductibles, coinsurance, copayments, and other out-of-pocket charges would be eliminated for covered services, with a narrow exception for certain prescription drug cost-sharing.¹ Under earlier versions of the bill, the HHS Secretary could require up to $200 per year in prescription drug copays, though not for anyone at or below 200% of the federal poverty level.⁶ HHS would be required to negotiate drug prices and establish a national formulary.

The transition would unfold over four years. In year one, people aged 18 or younger could enroll, while older adults could buy into a transitional plan or expanded Medicare coverage depending on age. By year four, full implementation would be required.¹

What Happens to Private Insurance

Private insurers and employers would be prohibited from offering coverage that duplicates the national program. They could sell only supplemental, non-duplicative plans, and the market for those plans would be narrow given how much the public benefit covers.¹ The Sanders bill does allow private insurance for patients who privately contract with providers outside the universal system, a carve-out the House version does not include.⁷

ACA exchanges and certain other federal health programs would terminate. The Veterans Health Administration, TRICARE, and the Indian Health Service would remain separate.¹ Existing Medicare, Medicaid, and CHIP would be absorbed into the new program for all covered benefits.

How It Differs From a Public Option

Medicare for All is often confused with more incremental proposals. A 2019 Kaiser Family Foundation survey found that 55% of Americans believed they could keep their existing private plans under “Medicare for All,” which is not what the bill does.⁸ The Sanders approach is full single-payer: one federal program replaces private insurance, employer coverage, Medicaid, existing Medicare, and CHIP.

Other proposals leave the current multi-payer structure in place:

A public option would add a government-run plan through ACA marketplaces alongside private insurance. People and employers keep their current coverage. Examples include the Medicare-X Choice Act and the Choose Medicare Act.⁹
A Medicare buy-in would let older adults not yet eligible for traditional Medicare, typically ages 50 to 64, purchase coverage through the existing program.⁹
Medicare for America is a hybrid that replaces marketplaces, individual insurance, Medicare, Medicaid, and CHIP, but allows employers to keep offering qualified group plans or pay 8% of payroll into the Medicare Trust Fund.⁶

Cost Estimates

The Committee for a Responsible Federal Budget estimated that Medicare for All would require between $25 trillion and $35 trillion in additional federal spending over a decade, with most external estimates clustering between $30 trillion and $40 trillion. CRFB’s own estimate of the Sanders plan was $29 trillion. Published estimates run from a low of $17 trillion (economist Gerald Friedman) to a high of $54 trillion (American Action Forum and others).¹⁰

The Penn Wharton Budget Model analyzed the 2019 Sanders bill and projected different economic effects depending on financing. Payroll-tax financing would reduce GDP by 7.3% and cost roughly 17 million full-time-equivalent jobs by 2030. Deficit financing would shrink GDP by 5.9%. A premium-based system would reduce GDP by 2.3%.¹⁰ Over a longer horizon, PWBM projected deficit financing would shrink the economy by 24% by 2060, while a modified plan that excluded long-term care and dental coverage and used premium financing could grow the economy by 12%.¹¹

CRFB found that taxes on high earners, corporations, and the financial sector together could cover only about 35% of the total cost. Broad-based taxes on workers and employers would be needed to fully fund the program.¹⁰

How Sanders Proposes to Pay for It

The bill itself does not include a financing mechanism. Sanders has published a separate options paper with ten-year revenue projections:

A 7.5% income-based employer premium, with businesses under $2 million in payroll exempt ($3.9 trillion).¹²
A 4% income-based household premium, with families of four earning under $29,000 exempt ($3.5 trillion).¹²
Eliminating tax breaks for employer-paid premiums, cafeteria plans, and medical expense deductions ($4.2 trillion).¹²
Higher marginal rates on income above $250,000, taxing capital gains as ordinary income, and capping deductions for high earners ($1.8 trillion).¹²
A 1% annual wealth tax on household net worth above $21 million ($1.3 trillion).¹²
Estate tax reform ($249 billion), a one-time offshore profits tax ($767 billion), closing business tax loopholes ($247 billion), a fee on large financial institutions ($117 billion), and repealing certain corporate accounting methods ($112 billion).¹²

Sanders’ outline also claims the system would save up to $500 billion per year in administrative costs and up to $113 billion per year through negotiated drug prices.¹²

Impact on Providers and Workers

The bill would pay all providers at Medicare rates, which are substantially lower than what private insurers pay. One analysis estimated an immediate payment reduction of more than 40% for hospitals and 30% for physicians treating privately insured patients, totaling roughly $5.3 trillion in cuts over ten years. By 2019, roughly 80% of hospitals were already losing money on Medicare patients, meaning extending those rates to all patients would deepen financial strain.¹³ Proponents counter that reduced overhead would offset some of the payment reductions: the bill targets administrative costs at roughly 2% of spending, compared to about 15% for private insurers.¹¹

Researchers at the University of Massachusetts’ Political Economy Research Institute estimated that 1.8 million jobs in private health insurance and billing administration would be eliminated: more than 800,000 at insurance companies and roughly 1 million administrative positions at healthcare providers. Median annual pay is about $55,000 for insurance workers and about $35,000 for provider administrative staff.¹⁴ Spread over the four-year phase-in, that displacement would raise the national annual layoff rate by about 2%.¹⁵

Both bills include transition provisions. The House version mandates that at least 1% of the program’s budget be spent over five years to assist displaced workers; the Senate version allows but does not require up to 1% for that purpose.¹⁴ Supporters also point to expected job creation, estimating that expanded coverage could generate demand for 2.3 million additional healthcare delivery workers, and converting even a fraction of unpaid long-term care hours into paid positions could offset insurance-sector losses.¹⁵

Who Opposes the Bill

The most organized industry opposition runs through the Partnership for America’s Health Care Future, a coalition founded in 2018. Members include the Federation of American Hospitals, AHIP, the Blue Cross Blue Shield Association, PhRMA, and the American Hospital Association. The healthcare industry spent nearly $568 million on lobbying in 2018 alone.¹⁶ The Partnership groups Medicare for All, public options, and Medicare buy-in proposals together as threats to patient choice and cites a $32 trillion price tag drawn from Mercatus Center and Urban Institute estimates.¹⁷

In a 2019 Urban Institute survey of Medicare for All opponents, 81.2% cited higher federal taxes as important to their opposition, 73.6% cited loss of current coverage (over 155 million Americans have employer-sponsored insurance), nearly 83% worried it might be harder to get a provider appointment, and 77% feared reduced medical innovation.¹⁸

Centrist Democrats have also expressed skepticism. Senator Amy Klobuchar called the proposal “pie in the sky” during the 2020 primary. Former President Barack Obama, former Senate Majority Leader Harry Reid, and then-House Speaker Nancy Pelosi voiced caution about pursuing a full overhaul rather than defending and improving the ACA.¹⁶

Who Supports It

National Nurses United, which represents more than 225,000 registered nurses, has been the most visible organizational backer. As of 2026, NNU and over 335 organizations signed an open letter calling for the bill’s passage. Signatories include the United Auto Workers, the American Postal Workers Union, the Association of Flight Attendants-CWA, Actors’ Equity Association, MoveOn, Indivisible, the NAACP, the Democratic Socialists of America, and Physicians for a National Health Program.¹⁹ The 2021 House version attracted endorsements from roughly 300 organizations, including the National Education Association, SEIU, and several state AFL-CIO councils.²⁰

Public Opinion

Polling depends heavily on how the question is framed. A November 2025 Data for Progress survey of likely voters found 65% support when the policy was described as a “national health insurance program that would cover all Americans and replace most private health insurance plans.” Support held at 63% when respondents were told it would “eliminate most private insurance plans and replace premiums with higher taxes, while guaranteeing health coverage for everyone and eliminating most out-of-pocket costs.” After hearing both supporting and opposing arguments, 58% still supported the idea. The partisan split was wide: 78% of Democrats supported the initial framing, compared to 49% of Republicans, with independents at 71%.²¹

A December 2025 Pew Research Center survey found 66% of Americans believe the federal government has a responsibility to ensure all people have healthcare coverage. Among those who hold that view, opinions split between a single government program (35% of all adults) and a mix of government and private programs (31%). Support for government responsibility ran at 90% among Democrats and 41% among Republicans, with a notable income gap among Republicans: 60% of lower-income Republicans agreed the government bears responsibility, compared to 28% of upper-income Republicans.²²

1
Congress.gov. S.1506 All Information
2
KFF Health News. Bernie Sanders, Senate HELP Committee Chair, Medicare for All, Big Pharma
3
Congress.gov. S.1506 Cosponsors
4
Office of Sen. Bernie Sanders. Sanders, Jayapal, Dingell and Hundreds of Health Care Workers Introduce Medicare for All
5
Time. Medicare for All History
6
Kaiser Family Foundation. Side-by-Side Comparison of Medicare-for-All and Public Plan Proposals
7
Kaiser Family Foundation. What’s the Role of Private Health Insurance Today and Under Medicare-for-All
8
Milbank Quarterly. Navigating the Shifting Terrain of US Health Care Reform
9
Physicians for a National Health Program. Medicare for All Versus Public Plan Buy-In Proposals
10
Committee for a Responsible Federal Budget. Choices for Financing Medicare for All
11
Wharton School, University of Pennsylvania. 6 Things to Know About Sen. Bernie Sanders’ Medicare for All Proposal
12
Office of Sen. Bernie Sanders. Options to Finance Medicare for All
13
Manhattan Institute. How Much Would Medicare for All Cut Doctor and Hospital Reimbursements
14
Politico. Medicare for All Jobs
15
Economic Policy Institute. Medicare for All Would Help the Labor Market
16
Politico. Medicare for All Lobbying
17
Partnership for America’s Health Care Future. America’s Health Care Future
18
Urban Institute. What Explains Support or Opposition to Medicare for All
19
National Nurses United. National Nurses United and 325+ Organizations Call for Passage of Medicare for All
20
Office of Rep. Pramila Jayapal. Medicare for All Act of 2021 Endorsements
21
Data for Progress. Medicare for All Is Popular Even When Put Up Against Attacks
22
Pew Research Center. Most Americans Say Government Has a Responsibility to Ensure Health Care Coverage