Medicare for All Act: Coverage, Cost, and Opposition

The Medicare for All Act is a bill in the 119th Congress that would replace private health insurance, employer plans, Medicaid, CHIP, and the current Medicare program with a single federal insurance system covering every U.S. resident, with no premiums, deductibles, or copayments for covered care. Representative Pramila Jayapal, Senator Bernie Sanders, and Representative Debbie Dingell introduced the current version on April 29, 2025. It has been referred to committee in both chambers and has not moved since.¹²

What the Bill Would Cover

The plan would guarantee a broad benefit package to every resident: hospital care, primary and preventive services, prescription drugs, mental health and substance use treatment, reproductive care including abortion, gender-affirming care, dental, vision, hearing, and long-term services and supports. Patients could see any qualified provider. There are no networks in the bill.³

Cost-sharing is stripped out. The bill prohibits deductibles, copayments, coinsurance, and balance billing for covered services, and enrollees pay no premiums.³

Providers would be paid differently depending on type. Hospitals and other institutional providers would receive global budgets. Individual physicians and practitioners would continue on a fee-for-service basis. All providers would have to accept the program’s payment as payment in full and would be barred from receiving bonuses tied to how much or how little care patients use. The bill creates a Universal Medicare Trust Fund, directs the Secretary of Health and Human Services to set a national health budget, and establishes offices focused on health equity and primary care.³

What Happens to Private Insurance

Once the new program takes effect, private insurers would be prohibited from selling coverage that duplicates its benefits, and employers could not offer duplicative plans.³ Medicaid, CHIP, and the existing Medicare program would be absorbed and replaced, consolidated into a single national system with uniform eligibility and benefits.⁴

The rollout is phased. General benefits would begin two years after enactment. Accelerated coverage kicks in one year after enactment for people under 19 and over 55.³

Where the Bill Stands

The House version is H.R. 3069 and the Senate companion is S. 1506. H.R. 3069 was referred to seven committees, including Energy and Commerce, Ways and Means, and the Judiciary. As of mid-2026, no hearings have been scheduled, and the bill remains at the referral stage.¹²

The House bill drew 104 original cosponsors. The Senate version attracted 16, including Elizabeth Warren, Cory Booker, Kirsten Gillibrand, and Adam Schiff. That is the largest base of explicit congressional support the proposal has ever had.⁵⁶

How Much It Would Cost

The price tag is the most contested part of the debate. Independent estimates vary widely depending on assumptions about provider payment rates, administrative savings, and how much more care people would use once cost barriers disappear.

The Committee for a Responsible Federal Budget put the increase in federal spending at $25 trillion to $35 trillion over ten years. The Urban Institute estimated $32 trillion to $38 trillion. Economist Gerald Friedman came in at $17 trillion. The Center for Health and Economy projected $54 trillion.⁷

A 2019 RAND Corporation analysis of the Jayapal bill found that total national health spending would rise modestly, between 1.8% and 9.8% depending on supply assumptions, but federal spending would climb by roughly 200% as Washington absorbed costs currently paid by employers, households, and states. Private-sector health spending would drop by an estimated 81%. RAND also estimated administrative costs would fall from about $581 billion to $422 billion, a 27% reduction.⁸

The Congressional Budget Office analyzed five hypothetical single-payer configurations in 2020. The option most similar to current legislative proposals, including long-term care, would add roughly $3 trillion in new federal costs in 2030 alone. CBO assumed administrative overhead of 1.5% to 1.6% under a single-payer system, well below private-insurer rates.⁹

Who Would Pay

The bill itself does not specify a financing mechanism. To illustrate what covering a $30 trillion ten-year cost would require through a single tool, CRFB modeled a 32% payroll tax, a 25% income surtax, a 42% value-added tax, or roughly doubling all individual and corporate income tax rates. Taxing only high earners and corporations, the group estimated, would raise about 35% of what is needed.⁷ Economist Gabriel Zucman has argued that if employer premiums were redirected as wages and replaced with a 6% income tax, many workers would come out ahead on take-home pay.¹⁰

The Arguments For and Against

Supporters argue that the plan would achieve genuinely universal coverage that does not depend on a person’s job, income, marital status, or state. It would end provider networks, eliminate medical debt from cost-sharing, and reduce the administrative work providers do dealing with dozens of insurers, each with its own billing rules, denials, and prior-authorization requirements.¹¹ A single payer would also have leverage to negotiate drug prices and set system-wide cost controls, tools that are fragmented in the current multi-payer system. The United States spends far more per capita on health care than peer nations with universal systems, often with comparable or worse outcomes.¹⁰

Opponents raise three main concerns. The first is taxes. The Heritage Foundation, citing estimates by Kenneth Thorpe of Emory University, argued that a payroll tax of roughly 20% would be needed and that 71% to 73% of Americans would end up with less disposable income.¹²

The second is disruption. More than 180 million Americans have employer-sponsored coverage, and polling shows support for single-payer drops sharply when respondents learn it would eliminate those plans.¹¹

The third is provider payment. The American Hospital Association has argued that Medicare and Medicaid already reimburse below the cost of care and that extending those rates to everyone would threaten hospital viability, especially in rural areas. An AHA-cited study found that reimbursing at Medicare rates could put as many as 55% of rural hospitals at risk of closure.¹³¹⁴ Opponents also cite waiting times abroad: 39% of Canadian patients and 19% of British patients waited more than two months to see a specialist in 2018, compared with 6% of Americans.¹²

Who Is Fighting the Bill

The most organized opposition comes from the Partnership for America’s Health Care Future, launched in June 2018 by the Federation of American Hospitals, America’s Health Insurance Plans, the Blue Cross Blue Shield Association, and the Pharmaceutical Research and Manufacturers of America. The coalition has grown to more than 120 member organizations, including the American Hospital Association and the biotech trade group BIO.¹⁵

Coalition member organizations spent $143 million on federal lobbying in 2018, and the broader health care industry spent $568 million that year.¹⁶¹⁵ A peer-reviewed study found the Partnership ran over 1,600 unique ads on Meta platforms between 2018 and 2021, generating more than 32 million impressions, and characterized its strategy as conflating single-payer, public option, and Medicare buy-in proposals as a single “government takeover.”¹⁷ The American Medical Association was a founding member of the coalition but departed in August 2019, reportedly seeking a more affirmative strategy focused on what the industry supports.

How It Differs From a Public Option

“Medicare for All” and “public option” often get used interchangeably in political shorthand, but they describe different systems. The Medicare for All Act is single-payer: it replaces private insurance. A public option, by contrast, creates a government-run plan that competes alongside private insurers rather than replacing them. Under a public option, people with employer coverage could keep it, and private plans continue in the individual market.

The public option polls substantially higher than full single-payer, with surveys showing more than two-thirds of Americans supportive, including about two in five Republicans.¹⁸ Single-payer advocates such as Public Citizen counter that leaving private insurance in place allows insurers to attract healthier enrollees, weakening the public plan’s finances.¹⁹

The Longer Arc

The idea of extending Medicare to everyone is older than most current debates suggest. In 1970, Republican Senator Jacob Javits introduced a proposal to do exactly that, which the New York Times described as “Medicare for All.” Senator Ted Kennedy followed the next year with a national health insurance plan financed by payroll taxes. The modern legislative lineage runs through Representative John Conyers, who introduced the Expanded and Improved Medicare For All Act (H.R. 676) in 2003 and reintroduced it every session until his 2017 resignation. Sanders’s own Medicare for All Act picked up zero cosponsors when he first introduced it in 2013; by 2019 it had 14 Senate cosponsors.²⁰¹¹

1
GovInfo. Medicare for All Act, H.R. 3069
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Congress.gov. S.1506 Medicare for All Act
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Congress.gov. H.R. 3069, Medicare for All Act Full Text
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Kaiser Family Foundation. How Will Medicare for All Proposals Affect Medicaid
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Office of Rep. Pramila Jayapal. Jayapal, Sanders, Dingell Introduce Medicare for All
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Office of Rep. Debbie Dingell. Dingell, Jayapal, Sanders Introduce Medicare for All Act
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Committee for a Responsible Federal Budget. Choices for Financing Medicare for All
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RAND Corporation. Estimating the Cost of a Single-Payer Plan
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Mercatus Center. Understanding CBO’s Medicare for All Cost Estimates
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UCSF Global Health Sciences. What the Evidence Says About Medicare for All
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Urban Institute. Pros and Cons of a Single-Payer Plan
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Heritage Foundation. Single-Payer Not the Solution to America’s Health Care Problems
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American Hospital Association. AHA Topics – Medicare for All
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American Hospital Association. AHA Comments on Medicare for All
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Politico. The Effort to Kill Medicare for All
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OpenSecrets. Big Pharma, Insurers, Hospitals Team Up to Kill Medicare for All
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National Library of Medicine. Analysis of PAHCF Advertising Campaigns
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Center for American Progress. Four Myths About the Public Option
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Public Citizen. Why Medicare for All, Not a Public Option, Is the Best Solution
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TIME. The History of Medicare for All