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Mainstream Medicare-for-All Proposals Just Got a Lot More Inclusive

The Sanders/Jayapal M4A plans now include supports for disabilities. That's a huge deal.
Democratic presidential candidate Senator Bernie Sanders speaks during a rally at the Iowa State Fairgrounds on March 9th, 2019, in Des Moines, Iowa.

Democratic presidential candidate Senator Bernie Sanders speaks during a rally at the Iowa State Fairgrounds on March 9th, 2019, in Des Moines, Iowa.

Medicare for All is not just a catchy title. Over the last few years, the idea of expanding the popular program, which currently provides health care for almost 60 million Americans, has shifted from a fringe progressive dream to what feels like a path to real universal coverage in America. But until now, the proposals advanced in the senate by Senator Bernie Sanders (and co-sponsored by all his Democratic rivals for president) and in the House of Representatives by Representative Pramila Jayapal left out one big piece of the puzzle: long-term supports and services (LTSS) for disabled Americans.

Last week, that changed. After meetings with a team of experts arranged by Ady Barkan, an organizer with the Center for Popular Democracy Action, Sanders and Jayapal have agreed to add these needed supports into their bill. Medicare for All just got a lot more inclusive.

While Medicare is a remarkably successful program, it has gaps in coverage that would need to be filled before it could fully replace employer-based or other forms of health care. LTSS include assistance with daily activities, such as eating, bathing, dressing, laundry, and taking medications. These are the types of supports that allow a person to go to school, work, choose where to live, stay out of nursing homes, and generally maximize independence and agency. LTSS aren't cheap, but they are cost-effective, and most of all they are ethically necessary as part of any health justice-based proposal for universal health care.

Barkan, who has ALS, has been a national leader in pushing for an approach to universal health care that centers the needs of disabled Americans. And, according to him, Jayapal and Sanders have been making sure that patients are helping to draft the legislation.

"This year, disability rights advocates have urged both Sanders and Jayapal to ensure that the Medicare for All bill includes coverage for long-term care," Barkan writes in an email. Right now, he explains, LTSS are covered through Medicaid, which means that "disabled people need to impoverish themselves and family in order to qualify for Medicaid and home- or community-based care." Moreover, access to Medicaid is unequally distributed around the country, with generally poorer access in GOP-controlled states.

"So many people are currently forced to choose between leaving their home for a facility, living in poverty, and going without needed care. In the richest country in the history of the world, we must do better," Barkan writes.

Including LTSS at the core of mainstream Medicare-for-All proposals seems to be becoming standard. These critical programs now appear in "Medicare Extra for All," a plan developed by the Center for American Progress; they're included in legislation proposed this January by Democratic Representatives Rosa DeLauro of Connecticut and Jan Schakowsky of Illinois; and now they're built into the Jayapal and Sanders plans. Such details matter, not just in what gets passed, but also in how we envision what's possible going forward.