At Thursday night’s Democratic presidential debate, Sen. Kirsten Gillibrand gave a misleading description of the “Medicare for all” proposal that she says she helped to write – implying that it calls for a voluntary buy-in rather than mandatory government coverage.

Gillibrand cosponsors Sen. Bernie Sanders’ Medicare for All Act of 2019, and describes herself as the author of the section dealing with the transition from the status quo to single payer. That bill does provide for an optional buy-in during a four-year transition period, but it would work differently than she described during the debate.

Here is what she said on stage in Miami:

In 2005, when I ran for Congress in a 2-1 Republican district, I actually ran on Medicare for All, and I won that 2-1 Republican district twice. And the way I formulated it was simple: Anyone who doesn’t have access to insurance they like, they could buy it in [at] a percentage of income they could afford. So, that’s what we put into the transition period for our Medicare for All plan. … The quickest way you get there is you create competition with the insurers. God bless the insurers if they want to compete; they can certainly try. But they’d never put people over their profits, and I doubt they ever will. So what will happen is people will choose Medicare. You will transition. We would get to Medicare for All. And then your step to single payer is so short. I would make it an earned benefit just like Social Security, so that you buy in your whole life. It is always there for you and it’s permanent and it’s universal.

This account differs from the bill language in important ways.

• The buy-in would not be available to anyone who wants it. Applicants would have to be at least 55 years old in the first transition year, 45 in the second and 35 in the third. 
• Buy-in premiums would not be based on a percentage of income, but on the program’s average projected cost per recipient. The net cost would be reduced for many enrollees through tax credits similar to those offered under the Affordable Care Act.
• The buy-in period would be limited to three years. At the beginning of the fourth year, Americans would no longer “choose” to buy the federal plan. Enrollment would be automatic and universal.
• Even if private insurers successfully competed with the federal plan, they would be effectively banned and put out of business at the end of the third year.

These inconsistencies raise doubts about where Gillibrand stands on a central issue for Democrats in the 2020 race – the role of private and employer-based insurance in the nation’s health-care system. Her debate statement implied that it would continue to be an option, but the legislation she touts says otherwise.

Another thorny issue is how much what she calls an “earned benefit” would ultimately cost for taxpayers. Gillibrand initially claimed the price tag would be just 4 percent of income, then clarified that employers would also have to contribute a similar amount. As discussed in previous posts, neither rate would come close to raising enough revenue for a single-payer system.