As Trumpcare Crumbles, Single-Payer Builds Momentum At State Level

A key reason the Republican effort to repeal and replace the Affordable Care Act has collapsed is fear among conservative U.S. senators that the GOP replacement being rejected would keep much of Obamacare in place.

Take the comments of U.S. Senator Jerry Moran of Kansas, a conservative Republican, who said Senate Majority Leader Mitch McConnell’s Better Care Reconciliation Act “failed to repeal the ACA or address healthcare’s rising costs.”

“We should not put our stamp of approval on bad policy,” Moran said in outlining his opposition to the GOP Senate replacement last week. “If we leave the federal government in control of everyday healthcare decisions, it is more likely that our healthcare system will devolve into a single-payer system, which would require a massive federal spending increase.”

Republicans may have good reason to fear single-payer because it gained unprecedented momentum across the country during state legislative sessions that just ended.

In California, the state Senate overwhelmingly approved a single-payer bill before momentum stalled in the Assembly while a “Medicaid-for-All” bill in Nevada made it to Republican Gov. Brian Sandoval’s desk before it was vetoed. Sandoval, though, supports the ACA’s Medicaid expansion and the state’s Democratic U.S. Senator Catherine Cortez Masto signaled support for some sort of public option to improve ACA.

Meanwhile, doctors once opposed to single-payer are now endorsing it as a simpler approach.

Take physicians in Chicago’s Cook County and surrounding suburban counties where support for single-payer is at an all-time high, according to a recent survey by the Chicago Medical Society.

Nearly 67% of Chicago-area doctors have a “generally favorable” view of “single-payer financing healthcare system,” like Medicare for All, the Chicago Medical Society said. Chicago’s Cook County politically is dominated by Democrats, but the adjacent and collar counties lean Republican, and the survey included more than 1,000 physicians.

“I don’t think I’ve ever heard a doctor complain about Medicare regulations,” Chicago Medical Society President Dr. Clarence Brown told the Chicago Sun-Times last month. “They’re simple. They’re easy to understand. It’s easy to get an answer if you have a question.”

It’s unclear how any single-payer plan would be implemented in the U.S., but both Medicare and Medicaid are increasingly benefits managed by private insurance companies. And “Medicare for All” is gaining momentum among seniors and politicians from both parties as having the government pay an insurance company to manage benefits.

An executive from UnitedHealth Group last week predicted that it’s only a matter of time before 50% of all U.S. seniors eligible for Medicare enroll in Medicare Advantage plans, which are embraced by Republicans and Democrats. Medicare Advantage has enrolled nearly 36% of U.S. Medicare beneficiaries in plans sold by UnitedHealth and other carriers including Aetna , Anthem , Cigna , Humana and Blue Cross and Blue Shield plans.

Aetna CEO Mark Bertolini grabbed headlines two months ago when reports surfaced that he wants “a debate” on what single-payer may look like should it become U.S. health policy.