Bernie Sanders: Medicare for All means more taxes, better coverage

FLORENCE, S.C. — Health care was the focus of Democratic presidential hopeful Bernie Sanders' second day of campaigning in the critical early-voting state of South Carolina, where lack of Medicaid expansion has left thousands unable to obtain health coverage.

The Vermont senator visited Florence on Friday for a town hall meeting on "Medicare for All ." His signature proposal, relaunched in the Senate earlier this year, would replace job-based and individual private health insurance with a government-run plan that guarantees coverage for all with no premiums, deductibles and only minimal copays for certain services.

"While this health care system is not working for working families, it is working for one group of people," Sanders told a crowd gathered in the afternoon sun at an outdoor amphitheater. "The function of a rational health care system is not to make billions for insurance companies and drug companies. It is to provide health care to every man woman and child as a human right."

Health care and how to reform the nation's system is a critical debate among the candidates vying for the Democratic nomination. It's under intense focus in states like South Carolina, home to the first-in-the-South 2020 primary, which is among the Republican-led states that turned down Medicaid expansion under the Affordable Care Act.

As a result of that decision, according to healthinsurance.org, a health insurance industry watchdog, about 92,000 South Carolinians are in the "coverage gap," without access to insurance. This group of mostly low-income residents doesn't qualify for subsidies on the exchange and is heavily reliant on emergency rooms and community clinics for care.

The lack of expansion has also had institutional ramifications, leading to the closures of hospitals in rural areas, tasked with serving a wide-reaching population and heavily reliant on Medicaid funds. According to the Sheps Center for Health Services Research at the University of North Carolina, 113 rural hospitals have closed since January 2010. Four of those facilities were in South Carolina.

While the overall notion of "Medicare for All" remains popular, some recent polling has shown softening support for the single-payer system, with hesitation at the idea of relinquishing private coverage altogether. Under Sanders' legislation, it would be unlawful for insurers or employers to offer coverage for benefits provided by the new government-run plan.

Nationwide, 55% of Democrats and independent voters who lean Democratic said in a poll last month they'd prefer building on President Barack Obama's Affordable Care Act instead of replacing it with Medicare for All. The survey by the nonpartisan Kaiser Family Foundation found that 39% would prefer Medicare for All. Majorities of liberals and moderates concurred.

Sanders' legislation does not specify new revenues, instead providing a separate list of "options" that include higher taxes on the wealthy, corporations and employers while promising the middle class will be better off.

"You're going to be paying more in taxes," Sanders said Friday to a man asking how he'd benefit from Medicare for All if his employer currently pays for most of his premiums. "But at the end of the day, you're going to be paying less for health care than you are right now. It will be comprehensive."

Sanders tallied up other personal expenses that would go away under his plan, including co-pays and medication costs over a $200-per-year cap. Sanders said he was also working on a proposal to eliminate medical debt.

In early states including South Carolina, some voters continue to voice confusion as to exactly what various candidates in the vast Democratic field mean when they advocate for pieces of a "Medicare for All" plan. California Sen. Kamala Harris' new plan would preserve a role for private insurance. New Jersey Sen. Cory Booker is open to step-by-step approaches.

Others including former Vice President Joe Biden have been blunt in criticizing the government-run system envisioned by Sanders.

"I'd like to know what 'Medicare for All' means," retired educator Bobbie Harrison, 77, wondered at a recent event in Great Falls, South Carolina, featuring Biden's wife, Jill Biden. "What does Bernie mean?"

Harrison backed Sanders in 2016 but remains undecided as to whom she'll support in 2020.

"They need to fix the way they talk about it," Dan Plemons agreed on Friday, ahead of Sanders' town hall. The 38-year-old from the nearby city of Hartsville said he backed Sanders in 2016 and intends to do so this time, adding that he would be hard-pressed without a mixture of Medicaid and Medicare coverage.

Friday's town hall wrapped up two days of campaigning in South Carolina for Sanders. More than 900 people attended a town hall meeting on climate change on Thursday night in Myrtle Beach.