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Single Payer


NABIP strongly opposes all forms of single-payer healthcare and is committed to promoting employer-sponsored health coverage and preserve Medicare, Medicaid, and other existing health programs.


  • There is no active legislation on this issue.


NABIP is committed to ensuring that every American has access to affordable, quality health coverage, and believe that the free market and public programs can bring down the cost of care and expand access to high-quality care for every American. Instead of considering single-payer healthcare proposals, Congress should focus on bringing costs down for everyone, no matter where they get their insurance. As a member of the Partnership for America's Health Care Future (PAHCF), NABIP works with a coalition of industry stakeholders to promote employer-sponsored health coverage and preserve Medicare, Medicaid, and other existing health programs. One pager on PAHCF mission and beliefs.


NABIP committed to preserving the private health insurance market amid growing concerns by consumers over increasing instability, premiums and cost-sharing, and decreasing choices. As frustrations with these conditions continue, it has led to a growing interest in some version of a single-payer healthcare system, either through incremental approaches such as a public option or Medicare or Medicaid buy-in, or a more sweeping federal takeover of the entire healthcare system to implement a single standardized government-run plan.

Legislation to implement a Medicare-for-All system has been introduced in both the House and Senate in past Congressional sessions. Representative Pramila Jayapal (D-WA) and 106 original co-sponsors introduced H.R. 1384 in February 2019 and Senator Bernie Sanders (I-VT) and 14 co-sponsors introduced S. 1129 in April. These proposals would force all Americans into government run plans within two-years (house) or four-years (senate) by expanding Medicare into a government insurance plan, gradually providing comprehensive health insurance coverage to all U.S. residents. The coverage would be available at the end of the first transition year for current Medicare enrollees, people over age 55 and those under 19, and to all Americans by the end of the second year. The plan would be based on an expanded form of Medicare coverage that would also include prescription drugs, dental and vision services, and long-term care, but without co-pays, premiums or deductibles.

Existing individual and employer-based coverage would be replaced by the plan, and it would be illegal for any private insurance to compete with the government run plan, although limited private coverage would be available for any services not covered by the plan. There would also be an exception for the Department of Veterans Affairs and the Indian Health Service to continue their existing coverage.

The Medicare-for-All legislation followed the introduction of Medicare buy-in legislation introduced in the House by Representatives Brian Higgins (D-NY) joined by 29 co-sponsors, and in the Senate by Senator Debbie Stabenow (D-MI) and 19 co-sponsors in 2019. That legislation would have allowed those aged 50-64 to buy into current Medicare coverage. Similarly, Senators Michael Bennet (D-CO) and Tim Kaine (D-VA) introduced S. 981, the Medicare-X Choice Act that would establish a public option plan parallel to Medicare coverage for all Americans to be able to buy-into, including those who already have employer-sponsored coverage. 

Leading proposals for a public option would make it available to consumers purchasing coverage through the state or federal marketplaces. The plan would comply with requirements related to other state or federal marketplace plans, and offer various level plan options. Premiums would be established according to state or federal marketplace rules. As a public plan it could have the power to dictate prices, provider networks, and provider reimbursements. It could also potentially indemnify itself for unexpected costs, allowing it to offer insurance at below-market costs.

One of our most serious concerns about the public option is its potential to further exacerbate the cost-shift that already drives up health care spending. Cost-shifting is a hidden tax on private payers that occurs when government payment rates are too low and providers shift costs to the privately insured to make up the difference. The public reimbursement rates result in these costs being shifted onto private insurers and plan enrollees, as a study by the actuarial firm Milliman found that annual healthcare spending for an average family of four was $1,788 higher than it would be if Medicare, Medicaid and private employers paid hospitals and physicians similar rates. A government-run plan reimbursing at the rates could result in a net $70 billion decrease in provider reimbursements with at least some of those costs shifted directly onto those already privately insured, while drawing consumers away from private coverage and leading to a potential death-spiral and the collapse of the private market.

NABIP strongly opposes these government-run insurance proposals, regardless if it is Medicare for All, Medicare buy-in, single-payer or a public option, given the consequences it would have for Americans who already have coverage, including the more than 180 million Americans who receive coverage through their employer.


  • Every American deserves access to affordable, quality health coverage. 
  • When the free market and public programs work together to bring down the cost of care, we can expand access to high-quality care for every American.
  • Far-reaching proposals like Medicare for all would create a one-size-fits-all system for health care. It would eliminate Medicare as we know it and kick 180 million Americans off their employer-sponsored insurance.
  • Medicare for all means that Americans will have less choice and control over their doctors, treatments, and coverage, while hardworking families will pay more taxes, have longer wait times, and reduced access to medical specialists and experts.
  • There are some reality checks we need to remember before jumping on board the Medicare for all bandwagon:
  • Medicare for all would kick people off their current coverage;
  • Medicare for all would be prohibitively expensive. Estimates put the number around $32 trillion with an average annual tax increase of $24,000 per household; and
    • Medicare for all would reduce the standards of quality and access Americans currently enjoy in their health care.
  • Personal health care decisions should be made by patients and their doctors — not bureaucrats. That’s why a better solution is to build on our existing system to fill in gaps in coverage for those who still cannot afford health insurance. We should improve what’s working and fix what’s broken — not start over.
  • A Kaiser Family Foundation poll found the majority of Democrats want Democratic lawmakers to focus on protecting the ACA rather than passing Medicare for all.
  • We can solve healthcare cost problems without creating a new program that disrupts existing coverage options for millions of Americans.