While Congress hears about Medicare-for-All Barr targets the ACA
Ady Barkan, a high-profile health care activist who has ALS was embraced by Representative Ilhan Omar as he testified before the House Rules Committee at a hearing on a Medicare-for-All bill on Capitol Hill on Tuesday. | J. Scott Applewhite/AP

WASHINGTON—A panel of witnesses delved into the details of the U.S. medical “system” and its costs, availability, outcomes, prejudices and frequent insurer-mandated denial of care at Congress’s first-ever hearing on Medicare For All.

The historic six-hour-plus session of the House Rules Committee once again also exposed the partisan gap over health care. Panel Democrats discussed both HR1384, the Medicare For All bill and improving the nine-year-old Affordable Care Act. Republicans retorted HR1384 would cost too much and raise everybody’s taxes.

Going even further was the Justice Department yesterday which, under the direction of Attorney General William Barr, began suing in court to kill the Affordable Care Act all together on grounds that it is unconstitutional. If Barr and the Trump administration succeed, millions across the country will lose all the healthcare they currently have.

Single-payer government-run health care, which would be an advance over the ACA which has been known as Obamacare, has been a key cause of National Nurses United, the primary union for registered nurses in the U.S., and 20 other unions that have joined their crusade at various times. At its last convention, the AFL-CIO also endorsed single-payer government-run health care.

The problem is acute. As both witnesses and lawmakers repeated, 29 million people – 50 percent fewer than before passage of the Affordable Care Act – are still uninsured. Another 41 million are underinsured. And 52 million have pre-existing conditions which would lead insurers to deny them coverage.

The lawmakers and witnesses at the historic hearing did not realize that, as they were meeting, Medicare for All was becoming even more important than it was at the moment their hearing opened. That’s because Donald Trump’s Justice Department was busy filing a brief with the federal appeals court in New Orleans – one of the most conservative in the country – telling the judges to toss the entire ACA out as unconstitutional.

Doing that would yank coverage from pregnant women, from those 52 million people with pre-existing conditions, from millions of new Medicaid recipients and from people up to age 26 who can stay on their parents’ policies. All those protections and more are in the ACA.

Before the Justice Department’s latest stand against the entire ACA, the Trump administration took the position that only part of it should be void. But now Attorney General William Barr runs the department.

As a private lawyer, Barr tried to convince the Supreme Court several years ago to toss the entire law. He’s repeating that stand now, simultaneously serving as Trump’s lackey on the Mueller investigation and carrying water for the president in his drive to kill the ACA.

A day after the Medicare-for-All hearing Barr lied repeatedly to a Senate committee and about his role in subverting the Mueller report and a day after that he defied a House committee by refusing to show up for questioning.  The Mueller report cited multiple instances where Trump obstructed justice in dealing with investigating Russian manipulation of the 2016 election. But Barr, now dangerous to the rule of law, singlehandedly declared Trump not guilty. Many lawmakers, after that and after his leading the charge against healthcare for many millions of Americans, now consider the Attorney General the most dangerous man in the nation.

Medicare For All supporters cheered the historic nature of the congressional hearing, however. In a brief interview during a break in the committee hearing, NNU Co-President Jean Ross, RN, said “it’s momentous to get” – Medicare For All – “this far.”

“Medicare For All is the only thing” – legislative solution – “that will save money and support everybody” in the U.S., she added. NNU was not invited to testify but submitted comments for the record. So did Labor Campaign for Single Payer, which represents 15 unions.

While witnesses conceded taxes would rise to pay for Medicare for All, the GOP didn’t mention, the higher taxes would be far less than savings to workers and families from elimination of the insurers, their overhead, high premiums, deductibles and co-pays and their routine denial of payment for care.

“All these premiums, co-pays and deductibles would go away – the government would be paying” for care, said economist Dean Baker, who recently retired after 17 years of running the Center for Economic Policy and Research, a progressive think tank.

“There would be an increase in taxes,” he admitted. “How much more an individual would pay would depend on how you structure” the tax system to pay for single-payer government-run care, he added.

“But the question also is on how much we would save on administrative costs, on getting rid of the insurance industry, on negotiating the prices of prescription drugs” downward. “People would pay less in” the increased “taxes than they now pay for health care,” he added.

By contrast, the Republicans defended the insurance companies. “Private insurance would be completely banned, whether you like your health insurance or not,” said Rep. Tom Cole, R-Okla.

The insurers’ denial, several witnesses told lawmakers, drives up costs, by forcing people to postpone care for such things as cancer and appendicitis until they’re forced into high-cost emergency rooms. It also bankrupts consumers and kills people who postpone care until it’s too late.

“It becomes impossible to care for someone who has to weigh one’s health versus one’s wallet,” said Dr. Farzon Nahvi, an emergency room physician from New York City and a member of Physicians for a National Health Program. And “41% of Americans have skipped ER visits because of the cost, while 45% live in fear of bankruptcy due to medical bills.”

He told of several patients he had to treat – including one who died because her insurer refused to pay for initial care for stomach pains. By the time the pain worsened and she appeared in Nahvi’s ER, she had incurable stomach cancer.

Another patient, a young woman with appendicitis, discussed treatments with him, including intravenous medicine, antibody injections “and possibly surgery.” She had insurance, but her insurer denied payment. She tried drinking cranberry juice from the hospital cafeteria, having read that would help.

“Then she decided to leave. ‘Thanks, doctor, I appreciate what you do, but I have to take my chances,’ she said.”

“I had a niece who died at age 48 from colon cancer because she couldn’t get the screening for it,” added Dr. Doris Browne, a retired military oncologist and former president of the National Medical Association, an African-American doctors’ group, told Rep. Jamie Raskin, D-Md. The insurer turned down the niece’s claim for screening because the woman was too young under its standards.

Single-payer government-run national health care would eliminate those worries, Nahvi, Browne and other pro-single-payer witnesses said.

“The insurance companies’ financial model is to not pay health care,” responded Raskin, himself a colon cancer survivor – but only because he had good health insurance as a Maryland state legislator before coming to Congress.

Some of the witnesses, and at least one panel Democrat, suggested improving and expanding the ACA would solve the problem. And Baker said improving the ACA could be a bridge in the transition to single-payer government-run health care, especially since health care spending now accounts for more than one-sixth of the U.S. economy.

Dr. Nahvi and the other pro-single-payer witnesses dismissed stopping with ACA improvements alone. “Just expanding the ACA wouldn’t solve” the nation’s health care system woes, he said. “All three patients I mentioned had private insurance – and it didn’t pay for them.”

When they ran the House, the Republicans tried unsuccessfully, at least 62 times, to repeal the ACA.

None voted for it when President  Obama and House Speaker Nancy Pelosi, D-Calif., pushed it through in 2009-10 – after then-Gov. Mitt Romney, R-Mass., and the Democratic-run Massachusetts legislature enacted their own statewide version.

The GOP had two other complaints. Cole mentioned Medicare for All would cover reproductive choice, including abortion rights, but he didn’t push it. Rep. Debbie Lesko, R-Ariz., pounded away that “most people in the U.S. are not going to be in favor of paying for free health care for illegal immigrants.” The ACA bans care for undocumented people.

Lesko also pointed out “the Senate is still Republican and you still have a Republican president and I’d like to work on something that has a chance to pass.”


Mark Gruenberg
Mark Gruenberg

Mark Gruenberg is head of the Washington, D.C., bureau of People's World. He is also the editor of Press Associates Inc. (PAI), a union news service in Washington, D.C. that he has headed since 1999. Previously, he worked as Washington correspondent for the Ottaway News Service, as Port Jervis bureau chief for the Middletown, NY Times Herald Record, and as a researcher and writer for Congressional Quarterly. Mark obtained his BA in public policy from the University of Chicago and worked as the University of Chicago correspondent for the Chicago Daily News.