What is the difference between S-1804 (the Sanders bill) and HR-676 (Expanded & Improved Medicare for All)?


HR-676 is widely considered the gold standard of single payer legislation. As an organization, we have encouraged senators to cosponsor a Senate companion bill to HR-676. S-1804, while containing some improvements, falls short in the following ways:

  • Barriers to Long-Term Care: In Sen. Sanders’ plan, long-term care would be administered by the states only for low-income individuals, similar to Medicaid today. Long-term care should be provided to all as part of a national health plan. Nearly 10 million Americans need help with the basic tasks of living or help to maintain their independence. More than 80 percent of those who need care live in their communities, not in nursing homes, and nearly 40 percent of them are under age 65. 

  • Copays for some non-generic prescription drugs: Sen. Sanders’ bill requires patient copays on some non-generic prescription drugs. Research shows that copays of any kind discourage patients from seeking needed medical care, increasing sickness and long-term costs. Experience in other nations prove that they are not needed for cost control.

  • Delayed implementation: Delays add to implementation costs and allow opposition to prevent full implementation.

  • Allows investor-oned facilities to operate. For-profit health care facilities and agencies provide lower-quality care at higher costs than non-profits, resulting in both higher mortality rates and greater payments compared to not-for-profit providers. The bill also lacks global and capital budgets, which will allow for-profit facilities to drain the system.

  • Keeps complex payment schemes that increase paperwork, decrease time with patients and punish doctors who treat people in poverty.