Medicare for All Act

Floor Speech

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Ms. JAYAPAL. Madam Speaker, let me say how pleased I am to be with Ms. Tlaib today, leading the Special Order hour, and, Madam Speaker, how pleased I am to see you at the podium.

This is a fantastic group of individuals who have joined us here in Congress, and I couldn't be prouder to serve with both of you and with others who are here as well.

The topic of this Special Order hour is so important. It has been important to me, of course, but also to Members of Congress in general and to communities across the country, and that is the topic of healthcare.

I wanted to break this down a little bit, in terms of where we are on this issue for people who are watching, because this is one of the beauties of the Special Order hour, that we get to talk about the issues that matter; we get to explain things; and we get to put forward our proposals and our ideas.

I am so proud to say that, on February 27, I and my colleague, Representative Debbie Dingell, introduced the Medicare for All Act of 2019, and we had 107 original cosponsors. Those are the folks who sign on right as it is getting introduced.

Of course, a bill gets introduced, and we always add people on after that. But this is 107 original cosponsors for this act that would build upon, improve, and expand Medicare so that it covers every single person in this country--universal healthcare, the idea that healthcare is a right and not a privilege.

Let me start by saying that we Democrats are absolutely united around the need to shore up the Affordable Care Act. There is no question that there is work to do immediately on some of the things that were done to take away access to those with preexisting conditions, to strip away the benefits of the Affordable Care Act. We are 100 percent united around continuing to do that.

However, we have to have a bold vision that addresses the healthcare crisis in this country that leaves 30 million people uninsured and 40 million people underinsured, without access to healthcare.

We have to understand, in doing that, in the United States today, we spend, depending on what estimate you look at, about $32 trillion to $39 trillion on healthcare costs over 10 years. That is going up to about $50 trillion over the next 10 years on healthcare. That is about 18\1/2\ percent of GDP.

If you look at every other major industrialized country in the world, what you see is that they provide healthcare, comprehensive care, to everybody in their country, and they do it at about half the cost, or less, of what the United States spends.

You might think that you could look at costs of healthcare in this country and you could say: Well, America has the best healthcare system in the world, and that is why we spend so much. We have the best healthcare outcomes.

Well, let's talk about that for a second. In the United States, we spend 18\1/2\ percent of our GDP on healthcare costs, yet we have the worst health outcomes of any peer country in the world.

Today in the United States, we have the highest maternal mortality rate. We know what that is; that is moms dying in childbirth.

We have the highest infant mortality rate. That is kids dying at young ages.

We have the lowest life expectancy rate of any of our peer countries. In fact, we are the only industrialized country in the world where life expectancy is going down and not up.

So we don't even have good health outcomes to show for our healthcare system.

That is why Representative Dingell and I and our 105 additional cosponsors of the bill, and Representative Tlaib and many others who are part of this effort, have introduced the improved Medicare for All Act of 2019.

What this bill does is it offers, first of all, comprehensive coverage to everyone in the country. We say that that includes primary care; it includes vision, dental, hearing; it includes mental health and substance abuse; it includes long-term services and supports, maternal healthcare, and more.

Everybody in the country will have access to healthcare when you get sick, not when you need an emergency room, not when you simply can't take your illness anymore, but when you actually get sick.

This bill is the first time that we will actually have long-term care supports and services included in this coverage. This is very, very important because it covers seniors, obviously, our elderly, as they get toward the end of their life, and it includes people with disabilities who have, traditionally, been left out of this entire sphere.

What we do is we say that, instead of the current system where you have to get so poor that you have to be on Medicaid--you have to have a low level of income, be on Medicaid--if you want long-term supports and services, and the automatic default is institutional care instead of home care, we flip that on its head and we say you get to stay at home with the people you love. You get to be in your home as you are dealing with these incredible challenges that you may have.

Our bill says no premiums, copays, and deductibles. We don't want you to have to think about that as you go to the doctor.

This is very important, because you will hear this is a government takeover of healthcare. That is what opponents of my bill are already trying to tell you.

I want you to hear this really clearly, if you are listening: We use the same network of doctors and hospitals that is already here.

In fact, I bet, if we had a roomful here and I were to ask people how many of you have been told, or have a family member or a relative who has been told, that you can't go to a certain hospital or doctor because it is out of network, or you only get a certain coverage if you go, I bet everybody would raise their hands. I see people raising their hands right now. Good for you. I feel like I have an audience here.

What our plan says is that you can go to any doctor or hospital. The government isn't taking over those services. It is not going to be a different government service. It is just the same as what you have right now.

The only thing that changes is, instead of having to argue with five insurance companies--because maybe you have Medicare and you have Medicare Advantage; maybe you don't have anything at all; maybe you have a combination of things put together. Instead of having to argue with five insurance companies, you get to just say: This is a government insurance program. This is covered by one insurance program, a single payer.

If you have heard that statement, that is what that means. This is the way that almost every industrialized country in the world does it.

I think that we have to think about what the problem is here, why have we not been able to do this. We have, increasingly, seen our healthcare system, unfortunately, being moved more and more to a for- profit system that puts those profits over patients.

If you look at, for example, the cost of pharmaceutical drugs in our country today, it is so much more expensive to get insulin treatment or cancer treatments or even an MRI in the United States. I have clients and constituents who drive to Canada, who go to other places, because they can't afford the drugs here, and they can buy the exact same thing across the border for significantly cheaper.

We are having a crisis, Madam Speaker, where people are going to bed at night thinking about how they are going to pay their rent and pay for their cancer treatment, how they are going to afford to get the insulin treatments that they want. People are foreclosing on homes.

In fact, two-thirds of all the bankruptcies today in the United States are due to medical issues, medical costs. GoFundMe has become one of the most popular insurance plans around, where people are just banking on the goodness of people to take care of their healthcare costs. That is simply not acceptable.

If we want to take on this question of universal healthcare coverage, which, by the way, Teddy Roosevelt talked about in 1910, Harry Truman in 1945, President Johnson--this is not a radical idea. It is actually something that has been tried and tested.

But here in the United States, the idea that we could provide universal healthcare for everybody, make sure that people get the healthcare access that they need, this is the time for it. Seventy percent of the American people actually agree with us. You might hear that that support goes down if you say some other things, but let's be really clear that the fearmongering out there is driven by for-profit industries that, unfortunately, have a lot to lose if a plan like this were to pass, because we would actually make sure that we are not only providing universal coverage but that we also have cost containment built into our system.

That is what my bill does. We build in cost containment measures so that we can actually bring down the overall cost of healthcare in this country to what is standard in other countries around the world.

This is incredibly important to us, and as we think about who gains and who loses in this, I believe that it is actually a win-win for everybody who is concerned about putting patients over profits.

It is a win-win for doctors who have been trained to take care of patients but, instead, spend 25 to 30 percent of their time dealing with insurance companies and trying to do all the paperwork that needs to be there, trying to argue for a patient of theirs to be able to get the care they need.

It is a win for hospitals that want to make sure that they know what kind of budgets they are going to have and that they can work within that. We have something built into our plan called global budgeting, which is actually the standard in other countries but is being tested in Maryland to great effect, where hospitals get an overall amount of money, and they get a global budget. We have that built in as well.

It is a win for patients. This is the thing that is so important to emphasize again and again.

Actually, before I get to the patients, let me say it is also a win for our businesses, particularly our small- and medium-sized businesses. I have a lot of business owners who might disagree with me on a few other issues, many of them are across the aisle--they are Republicans; they are independents. They come up to me and they say: Representative, I don't agree with you on this or this or this, but please, can you get the Medicare for All bill passed, because we cannot, as small businesses and even medium-sized businesses and, by the way, even large-sized businesses, deal with the growing cost of these insurance premiums that we are paying that are really just going to line the pockets of top CEOs.

The CEO of UnitedHealth took home $82 million, even as people are not able to afford treatments and are dying. The other CEOs have taken in $52 million, $29 million.

We have to make sure that the balance of something like healthcare, which is an essential, I believe, a common good in this country, that we are able to provide that to people.

There are lots of other places where markets can work, but in this marketplace where you need to make sure that healthcare is provided to everybody regardless of whether you are rich or poor, regardless of where you live, regardless of the color of your skin, this is where the government comes in to try to help make sure that that is actually possible.

This is a really important bill for us, and I am absolutely honored to have so many of my colleagues who are so smart on these issues, not only in liberal districts like mine but also in frontline districts, places that were held by Republicans for a very long time.

My Democratic colleagues flipped those districts, and they ran on this issue. They ran on this issue, and they won on this issue, because they know, and their constituents know, that it is time to take profit out of this system and make sure that it once again gets focused on the healthcare of people.

We also have an incredible coalition of labor unions that have come on board for the first time ever. Our teachers are on board, our machinists, our steelworkers. We have so many different unions that are on board this time.

Our disability rights community is on board.

Our women's organizations are on board, because for the first time, we make sure that everybody gets the care they need, whether they are a woman or a man, and we make sure that people have control over their reproductive choices.

We are absolutely thrilled about this.

I want to be clear about one thing, as I turn this back over to my incredible colleague from Michigan. This is not a messaging bill. I want to be clear about that.

For the first time in the House of Representatives, this bill is over 120 pages long. It is a detailed analysis and layout of exactly how this would work. It ensures that everybody gets healthcare. It keeps the existing system of delivery that we have. We are not changing the system of delivery.

It does not in any way say that insurance companies can't continue to operate. They just can't provide the same benefits that we are providing through the government insurance plan. That is actually the way Medicare works right now.

You can't provide the same benefits because we don't want a two- tiered system.

Now, if they want to provide benefits outside of what we provide, they are welcome to do so. That is how Medicare Advantage originally came in to being. Medicare Advantage plans, the benefits that are offered under those, would be included in our plan, so we wouldn't need those plans. But insurance companies are free to continue to innovate as they need to; and we have built in 1 percent of the cost of the bill for the first 5 years actually goes to a fund that ensures transition and appropriate support for workers in the insurance industries who may actually end up having to lose their jobs or to eventually transition into this new system that we have.

We will, for the first time, thanks to Speaker Pelosi's support, and others' support, we will have hearings on this bill. And whether you agree or you disagree with the premise, what I would ask is that you understand how critical it is to address and finally get to universal healthcare in this country.

This is a debate that should have been had on the House floor and in our committees a long time ago. We are finally going to have that with a number of different committees; and I am looking forward to continuing to help lead with all of my colleagues on ensuring that healthcare is a right and not a privilege; that you don't have to be wealthy to get basic healthcare; and that we improve the ultimate competitiveness of our businesses, our families, our communities, and the health, the basic health, the right to live with dignity and respect for all of our people.

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