Medicare for All, Explained: What It Would Actually Change

Medicare for All is the name Congress uses for legislation that would scrap private health insurance, Medicare, and Medicaid as they exist today and replace them with a single federal insurance program covering every U.S. resident, with no premiums, deductibles, or copayments for almost all covered care. The current versions, both titled the Medicare for All Act, were introduced on April 29, 2025: H.R. 3069 in the House, led by Rep. Pramila Jayapal, and S. 1506 in the Senate, led by Bernie Sanders. Neither has become law. This is what their text actually says.

What the bill would establish

Section 101 of both bills creates the Medicare for All Program, a national health insurance program administered by the Secretary of Health and Human Services. Section 102 makes every U.S. resident entitled to its benefits, and Section 103 lets an enrollee see any qualified provider. Section 107 makes it unlawful for a private insurer to sell coverage that duplicates what the program covers, or for an employer to offer duplicate benefits, once the program takes effect. Supplemental insurance for services the program doesn’t cover stays legal, including additional benefits an employer chooses to offer on top of it.

Section 201’s list of covered services runs long: hospital and outpatient care, primary and preventive care, prescription drugs and medical devices, mental health and substance-use treatment, laboratory and diagnostic services, reproductive care including abortion, maternity and newborn care, gender-affirming care, dental, vision, and hearing care, rehabilitation, emergency services, and home- and community-based long-term care, among others. Section 202 bans deductibles, coinsurance, and copayments for covered care outright. The Senate bill writes in one exception: the Secretary may charge up to $200 a year per person for prescription drugs, adjusted for inflation, and even that is waived for households at or below 250 percent of the federal poverty line. The House bill bars cost-sharing without the exception.

When it would start

Neither version takes effect the day it might pass. The House bill phases benefits in over two years from enactment, with people under 19 or 55 and older enrolled after one year. The Senate bill runs longer: full coverage begins on January 1 of the fourth calendar year after enactment, though its own transition title adds nearer-term changes to existing Medicare, including expanded dental, vision, and hearing coverage and a lower buy-in age, while that longer phase-in plays out.

What it would cost

The most detailed federal answer sits in a Congressional Budget Office working paper from December 2020, which modeled five illustrative single-payer designs, each built on Medicare’s existing fee-for-service structure and differing mainly in how generous the benefits and payment rates were. CBO projected that by 2030, federal subsidies for health care would rise somewhere between $1.5 trillion and $3.0 trillion above what current law already spends, depending on which design was chosen. National health spending overall, not just the federal share, could move either direction: from a $0.7 trillion decrease to a $0.3 trillion increase, again depending on design. In every version CBO modeled, demand for care grew faster than the supply of it, producing more unmet demand than under current law, meaning delays and forgone care, in the scenarios where prices and cost-sharing dropped the most.

That figure comes from a federal budget office modeling illustrative options, not from a score of either bill currently before Congress, and it isn’t the same number produced by researchers outside government.

How it would be paid for

Title VII of both bills creates a trust fund, called the Universal Medicare Trust Fund in the House bill and the Medicare for All Trust Fund in the Senate version. The text funds it by redirecting money the federal government already spends on health care, Medicare, Medicaid, the Federal Employees Health Benefits Program, and several smaller programs, into the trust fund instead of their current accounts, plus any net increase in federal revenue that results from two other sections of the bill: the ban on duplicate employer health benefits and the sunset of the Affordable Care Act’s insurance exchanges. Neither bill’s text specifies a broader tax increase; no new income bracket, payroll tax, or wealth tax appears in the legislation itself. Financing beyond redirected spending would depend on a separate bill Congress hasn’t written yet.

What outside researchers have found

A team led by Yale epidemiologist Alison Galvani published an analysis in The Lancet in February 2020 that put a single-payer system’s annual savings at roughly $450 billion, with about 68,000 fewer deaths a year, largely from extending coverage to people who currently go without it. The same team posted a follow-up preprint in 2026, not yet peer-reviewed, using 2024 spending and coverage data, that produced a larger number: nearly $1.04 trillion in annual savings, close to a fifth of national health spending, and 114,174 lives saved a year, with roughly 63,000 of that from extending coverage to people who currently lack it and the remainder from reversing coverage losses attributed to policy changes made since 2025. Even the study’s more conservative assumptions still produced at least $663 billion in savings. Neither figure is CBO’s; they come from a separate research group using a different method, and the range between the two Yale figures shows how much the answer moves with the assumptions.

Where things stand now

The U.S. spent an average of $14,775 per person on health care in 2024, according to the Peterson-KFF Health System Tracker’s analysis of federal spending data, almost $5,000 more per person than the next-highest country, Switzerland, and nearly double what comparable wealthy countries spend on average. The Census Bureau counted 27.1 million people, 8.0 percent of the population, uninsured at some point during 2024. The Commonwealth Fund’s most recent biennial survey found another 23 percent of insured working-age adults were underinsured: people with coverage all year whose out-of-pocket costs run high enough relative to their income that the insurance stops functioning as protection.

Who’s backing it

The AFL-CIO, the country’s largest labor federation, adopted a resolution at its 2017 convention in St. Louis, by unanimous vote, committing to “support legislation that guarantees health care as a human right through an improved Medicare for All.” National Nurses United, which has organized around the bill for years, was represented alongside Sanders and Jayapal at the 2025 reintroduction. In June 2026, more than 325 organizations signed a public letter backing the bill; Public Citizen’s health care policy advocate spoke for the coalition, and the signers named in reporting on the letter include the United Auto Workers, the American Postal Workers Union, the International Federation of Professional and Technical Engineers, the Association of Flight Attendants-CWA, the United Electrical, Radio and Machine Workers of America, and Actors’ Equity. Medicare for All has also been a flagship policy of the American democratic socialist movement since Sanders’s 2016 campaign, though the current bills’ more than 100 cosponsors don’t all share that label.

What the bill would actually change

The bill’s own text is specific about the mechanism, whatever the debate over its effects: it takes Medicare’s existing fee-for-service payment system, extends eligibility to everyone, adds dental, vision, hearing, mental health, and long-term care to what it covers, and removes the deductibles and copayments attached to coverage today. What that change would cost or save the country depends on the model used and the design Congress would actually pass, neither of which is settled.