Medicare for All provides crucial life services that necessitate strong federal roles and involvement.

The United States is at a health care crossroads. We either move forward toward making health care a basic right for everyone, or fall backward, with coverage and care increasingly out of reach as politicians actively take it away, employers cut back and higher prices make it ever harder to afford.

Making Health Care a Right

Having the health care we need, no matter who we are and regardless of our circumstances in life, is fundamental to our well-being as individuals and as a nation. That is why the American labor movement has fought for more than a century to make quality health care a basic right in the United States. Our longstanding goal for achieving this is to move expeditiously toward a single-payer system, like Medicare for All, that provides universal coverage using a social insurance model, while retaining a role for workers’ health plans. Any such system must guarantee everyone can get the health services they need without exclusions or financial barriers to care, and with access to high-quality doctors, hospitals and other health care providers; not diminish the hard-fought benefits union members have won for themselves and all working people; include long-term care for all; retain the Department of Veterans Affairs health care system as the primary direct provider of fully integrated care to veterans; provide multiemployer and other worker health plans the opportunity to administer core health benefits and to provide supplemental benefits, each on a fully tax-advantaged basis; and keep a strong federal role without shifting costs to states.

We will support legislation that guarantees health care as a human right through an improved Medicare for All, which we will judge according to our core values. We look forward to working with the sponsors of single-payer plans to ensure the needs and concerns of working people and their unions are met.

To transition to an improved Medicare for all system, we should begin taking steps toward creating a single-payer system by lowering Medicare’s eligibility age from 65 to at least 55. This would extend health care provided on a single-payer basis to millions more Americans. Further, this could help preserve coverage for pre-65 retirees, whose current health benefits earned through work are increasingly at risk. We also should create a public health insurance option that builds on Medicare or Medicaid as an alternative to for-profit insurance companies.

Strengthening Worker Plans

Health benefits earned through work are the primary way Americans get health coverage, with nearly 178 million people enrolled. Preserving this coverage must be a priority, and it is imperative that Congress and President Trump take steps to strengthen it, as well as avoid unnecessary and harmful disruptions of it.

First, the misnamed 40% “Cadillac Tax” on high-cost health benefits earned on the job must be repealed immediately. It is based on the flawed assumption that health care cost growth is best controlled by making patients pay more, instead of directly targeting the major cost drivers in our system, such as rising pharmaceutical costs, use of new medical technologies and the pricing power of consolidating health providers. The threat of its implementation in 2020 already is inflicting real harm, as the tax creates an incentive for employers to cut benefits and shift costs onto workers and retirees through increased deductibles, copays and coinsurance. This is compounding long-term trends in which employers shift more and more costs onto working people through ever-higher out-of-pocket requirements; reforms that stop these trends and ensure affordability are critical. Congress also must reject proposals to limit the tax exclusion for workplace health benefits.

Second, the role that nonprofit, patient-centered worker plans play in providing quality, affordable coverage must be strengthened. Multiemployer plans, in particular, have long track records of providing portable, reliable, cost-effective coverage. Many of these plans cover working people who otherwise would be left out of typical employer plans, including those in industries where employment is highly mobile or part time; some are among our largest, most sophisticated and most innovative providers of health benefits in the United States.

Some federal health programs, such as Medicare and Medicaid, already recognize the critical value of worker plans, enabling them to play a role in providing stable coverage. The ACA, however, excluded worker plans from playing a direct role in providing coverage using the new federal premium tax credits and cost-sharing reduction payments available to for-profit insurance companies.

Future health reforms, whether through the expansion of Medicare or Medicaid, creation of a public option or improvements to the ACA, must include an explicit role for worker plans in expanding affordable health care as a competitor to for-profit insurance companies, particularly by using or building on direct federal funding for health coverage. In particular, workers’ nonprofit health plans must be given the opportunity to be part of the solution for the uninsured.

Proposals to weaken or repeal the ACA’s employer shared responsibility requirement also should be rejected. Instead, Congress should enact changes that strengthen it, preferably replacing it with a true pay-or-play requirement for all employers. This approach would solve many of the problems and complexities of the current rules, such as the difficulty of applying it to industries in which the standard workweek is not based on the number of hours. In the alternative, the existing rules should be tightened to apply to more employers, especially in the construction industry, where the vast majority of companies are small, and to assess a full penalty if coverage is not offered to workers averaging 20 or more hours per week, and a pro rata penalty for those who work fewer hours.

Making Drug Companies and Health Care Providers Accountable for Health Care Prices

We must take steps to control health care prices, which are now a serious threat to all Americans’ health care. To address the unchecked growth in pharmaceutical prices, we must empower the federal government to engage in binding arbitration with drug manufacturers on behalf of Medicare and all other payers when these corporations demand unreasonable prices; allow the government to reduce prices when taxpayers have helped fund the development of a drug; and curb corporate abuse of monopoly rights. Trade agreements that expand monopoly rights for drug companies should be rejected, and public investment in the development of new drug therapies should be leveraged to ensure medicines can be obtained for a fair price. The high and increasing prices charged by all health providers also must be checked, by setting fair rates for all health care payers and extending the application of quality measurement, value-based purchasing and payment reforms.