Testimony of National Nurses United Before the House Rules Committee Hearing on H.R. 1384: Medicare for All Act of 2019

National Nurses United (“NNU”), the largest union representing registered nurses (“RNs”) in the United States, submits this testimony in support of the Medicare for All Act of 2019, H.R. 1384.

With over 155,000 registered nurse members across the country, NNU proudly endorses the Medicare for All Act of 2019 and we urge the Committee to support H.R. 1384. NNU members, as registered nurses, care for people in their most difficult hours, when they are sick, injured, and dying. We witness the personal impacts of a flawed health care system in our hospitals and clinics every single day. Our primary responsibility is to protect the health and wellbeing of our patients by providing safe, therapeutic care at the bedside, but this is made increasingly difficult by our country’s broken health care system.

Under our current multi-payer system that is dominated by insurance, hospital, and pharmaceutical corporations, the basic health needs of tens of millions in the United States go unmet while health corporations soak-up billions of health care dollars. Today, the United States spends more money on health care than any other nation in the world, wasting hundreds of billions of dollars each year on unnecessary administrative costs, huge profit margins, and inefficiencies in our current system. The patchwork system of private for-profit insurers necessitates over $200 billion per year in administrative-related activities, and represents 20 to 30 percent of U.S. health care costs. Despite spending more money on health care than any other country, our county ranks at or near the bottom on many international health indicators, including on such critical barometers as average life expectancy, infant mortality, maternal mortality, and death from preventable diseases.

Too many Americans — as individuals, families, businesses, and taxpayers — have been driven past their breaking point as a result of soaring health insurance costs. Health insurers, as market-driven corporations, enrich themselves by imposing harsh limitation in coverage and through perpetually increasing insurance premiums, deductibles, and co-pays. Private insurers deny between 11 percent to 24 percent of all claims for care, and they restrict patient choice through narrow provider networks, limited drug formularies, and other barriers to care. More than 40 percent of all U.S. adults under the age of 65 forego needed medical care, and 30 percent fail to fill a prescription or take less than the recommended dose. One third of U.S. adults say that, in the past year, they have had to choose between paying for food, heating, housing, or health care. The inability to pay medical bills continues to be a leading cause of personal bankruptcy, with 66.5 percent due to medical debt and job loss due to illness. Of those whose illnesses led to bankruptcy, 75.7 percent had insurance at the onset of their illness.

Even though the Patient Protection and Affordable Care Act enacted important improvements that have enabled more Americans to enroll in health insurance, out-of-pocket health costs continue to increase and many remain severely underinsured. These reform efforts temper, but do not resolve the fundamental problems embedded in the market-driven system of health care delivery. The rate of uninsured U.S. adults has risen in the past four years to nearly 30 million. An estimated 41 million more are underinsured, meaning that they have insurance but cannot obtain the care they need because they cannot afford their co-payments or deductibles.

Moreover, the ever-rising cost of health care and its discriminatory characteristics contribute to the growing national chasm in wealth inequality and health disparities. Of those uninsured, 59 percent are people of color. African-Americans suffer higher death rates than whites at an earlier age due to heart disease, diabetes, cancer, HIV, and infant mortality, and African-American women are three to four times more likely than white women to die in childbirth. High costs and poor health outcomes persist because access to insurance is not the same as guaranteed health care for all. Our country must do better.

The Medicare for All Act of 2019 improves and expands the overwhelmingly successful and popular Medicare program, so that every person living in the United States has guaranteed access to health care. Medicare benefits would be improved so that all comprehensive health services are covered, including dental, vision, prescription drugs, women’s reproductive health, and long-term services and supports. It would require no out-of-pocket costs for patients for any services, and would give all patients the freedom to choose the doctors, hospitals and other providers they wish to see.

Importantly, “gatekeeper” obstacles to receiving care — like insurance pre-authorization requirements, lifetime or annual limits, or network restrictions — would be eliminated under the Medicare for All Act of 2019. Health care choices would be a decision between you and your doctor and would no longer be a decision made by insurance company administrators. Similarly, the benefits under the program would be completely portable across the United States. There would no longer be gaps in coverage if you change jobs or move. And our health care would no longer be subject to the unpredictable network changes or the ability of your employer to annually negotiate a health plan.

The Medicare for All program would create huge cost-savings for the country through a series of measures. It would simplify the health system and cut administrative costs significantly. By improving payment systems to hospitals and other providers and by reducing the costs of prescription drugs through leveraged negotiations as a single-payer, the Medicare for All program would save the country trillions of dollars while also guaranteeing improved, quality health care to every person living in the United States.

Medicare for All is the only solution to the health care crisis in our country. On behalf of National Nurses United, we urge the Committee to support the Medicare for All Act of 2019, H.R. 1384.

Sincerely,