Today, Explained - Medicare for All fever

Episode Date: August 24, 2026

A new crop of Democrats is running on an old slogan: Medicare for All. Now might be the moment it finally catches on. This episode was produced by Peter Balonon-Rosen, edited by Jolie Myers, fact-checked by Gabriel Dunatov, engineered by Patrick Boyd and David Tatasciore, and hosted by Noel King. A protester holds a sign at a rally in New York calling on lawmakers to pass comprehensive healthcare for all, without exception. Photo by Erik McGregor/LightRocket via Getty Images. Listen to Today, Explained ad-free by becoming a Vox Member: vox.com/members. New Vox members get $20 off their membership right now. Transcript at ⁠vox.com/today-explained-podcast.⁠ Learn more about your ad choices. Visit podcastchoices.com/adchoices

In the spring of 1970, Republican Senator Jacob Javits of New York proposed a fix for America's health care system, which he said was uneven. And for many, particularly the poor, it is abysmally low, if not non-existent. His fix, expand Medicare, Medicare for all. This idea bounced around Congress for years. And then in 2016, Senator Bernie Sanders made it the cornerstone of his presidential campaign. Count me in as one of those people. who believes that health care is a right, not a privilege. Newshounds may recall Senator Sanders did not win the presidential election.

And for a time, Medicare for All was viewed as another improbable progressive fantasy. You stopped hearing much about it. Until this year, when a bunch of Democratic candidates seizing on frustration over the high cost of health care, started talking about it once again. On today, explained from Vox, is it Medicare for All's moment? I'm pretty confident talking into a mic. Hey, I'm doing it right now. But home projects, I second-guess everything.

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you get clarity and can hire the right pro with confidence. your next home project, try Thumbtack. They know homes. Hire the right pro today. Hear that? It's your money calling. It wants a promotion. Elevate your savings with the Scotia high interest savings account. Always earn high regular interest rates that grow the more you save and invest. Conditions apply. Visit scotiabank.com slash h-I-SA to learn more. Scotia Bank. You're richer than you think. This is a day. Today it's planned. This is a day. I'm Noelle King with Julie Appleby. She's a senior correspondent with KFF Health News. So, as this conversation about Medicare for All heats up, it's worth remembering that health care in the U.S. has long been a mess. 16 years ago, President Obama signed the Affordable Care Act into law trying to fix some things. Julie, what was the situation at the time that made it feel so necessary? What did the affordable care care?

Act aimed to do? You know, there was a lot going on. So we had a lot of people who were uninsured. We had premiums going up. Many times in the past, there had been some effort to do some kind of health reform, but nothing ever really passed. We had, you know, we had Medicare and Medicaid in the 60s, right, but no major legislation since then. So people had employer coverage, which like they do now, but there were a lot of people who were on their own and buying in what's called the individual market. The individual market was really tough. They could tell people, hey, you've got a health condition. We're not taking you. You could sign up for an individual plan. And later, if you did get some kind of health condition, they could go back through your medical records and see, hey, did they tell us about every single thing that had happened to them in the past five or ten years?

And if not, they could retroactively cancel your plan. And so, top line, what did the Affordable Care Act, which came to be called Obamacare because Obama passed it? Thanks, Obama. What did it do exactly? You know, it did a lot of things, right? So it allowed young people to stay on their parents' insurance plan up to age 26. And that was a really big deal and also a very popular provision in the Affordable Care Act. Health care plans are required to let young adults stay on their parents' plan until they're 26.

It created these subsidies to help people purchase coverage on the individual market. Tax credits that have given about... Eight in ten people who buy insurance on the new marketplaces, the choice of a health care plan that costs less than $100 a month. It pays for part of your premium. After you pay a certain percentage of your household income, the subsidies kick in, and it picks up the rest up to a certain income level. It did some other things like, okay, they can't tell you you have a preexisting condition, so we're not going to take you.

They've got to take you. Insurance companies, they can't deny somebody coverage or change them, simply because, they have a pre-existing condition like diabetes or asthma. It created sort of a benefit package that covers all these essential things like hospitalization and drug costs and maternity care, which might not have been in plans before that. They used to be able to charge women more than men. They can't do that anymore.

What was the conversation around passing the Affordable Care Act and remind us how and why it got so toxic and pitched? It was super polar. polarized kind of like what we have now, right? I mean, a lot of people really, yay, we have the Affordable Care Act. This will be the most important piece of social legislation since the Social Security Act passed in the 1930s. I'm going to give you my five top reasons why you should enroll in Marketplace Health Insurance, also known as the Affordable Care Act, also known as Obamacare. I received chemotherapy at Johns Hopkins, and the Affordable Care Act literally saved

my life. There was a lot of discussion around whether this is going to be too much government or or if it was just the right amount. And a lot of people thought, oh, no, this is terrible. It's going to destroy things. How did Obamacare destroy our health care system? You got an hour and a half? You got an hour and a half. Individual state exchanges, 28 medical excise taxes, not allowing health insurance to be bought across state lines. Hey, do you have that Obama care? Obama care. What's that? Obama care has to go. For the first, you know, four or five years or more of the Affordable Care Act, it was pretty evenly divided.

And when you looked at opinion polls between people who thought it was a good thing and people who didn't think it was a good thing. In more recent years, that has changed. And the favorability ratings have gone up for the Affordable Care Act. And now, majorities do favor the Affordable Care Act. I noticed, by the way, that since it's become popular, they don't call it Obamacare no more. Okay, okay, majority's favorite. Wow, if you had told me that 16 years ago, I would not have believed you. Here we are. And majority's favorite. And so how is the Affordable Care Act doing? Well, you know, so sort of used medical terminology. You know, is it on life support? No, it's actually doing fairly well. But you know what? There are some symptoms that there's some problems, right? Remember at the end of last year, there was all the discussion about these things called enhanced.

premium tax credits and whether they were going to be extended or not. Yes. House Democrats will fight to extend the Affordable Care Act tax credits. This fight is not over with just getting started. Government shut down over this, if you remember at the end of last year. Those were not extended. As a result, it costs more this year for most people in the plan. So those expired January 1st.

And overnight, the average payment, people are making jumped almost 60%. I need insurance, okay? Oh my God. This is not happening to me. At Marketplace pricing, qualifying for a subsidy, it was $170 a month, which I'm very thankful that that was so low. I'm aware of that that was low.

It is jumping to $1,000 a month. $1,000 a month for a single income family. And what we've seen is during open enrollment last year, we had about a million people fewer sign up. Wow. And that was about a 5% drop. Okay. So that was a 5% just in signups at the end of last year. And then since then this year, the first few months of the year, we've seen another about 3 million people drop off.

So some people, I think, are finding they can't afford it. And they are not paying their bills and they are getting dropped off. So a 3 million person drop off is pretty substantial. A lot of policy experts say, look, when you raise the price of something, demand goes down. And that's what's happening here. It's the prices people are dropping out. There's actually no effing way that I'm paying for health insurance. Insurance is absolutely assonine.

The cost of insurance is not reasonable. People are skipping health care not because they're irresponsible. They're skipping it because they can't afford to stay alive. But there's also a group of folks, many people, particularly conservatives and Republicans, who say, you know what? The numbers were inflated. There was all this improper enrollment. People were getting these zero premium plans. And so there was fraud.

There was improper enrollment. The subsidies were too generous or there were other factors that led to some fraudulent activity. And so these drop-offs just represent. People who were fraudulently rolled dropping out for one reason or another. Hi, I'm Robert F. Kennedy Jr., your HHS secretary. I'm joined today by my good friend and anti-fraud warriors, CMS administrator, Dr. Memad Oz. Health care fraud and corruption affect millions of Americans and maybe even you. The Obamacare marketplace is plagued by fraud.

If you're a fraudster, here's our advice to you. Do not walk away from us. Run, because we are going to find you. There's this real split right now between what What are the reasons for the drop-off? But most policy folks, most people who study the situation here say the main reason is people just aren't being able to afford it. Why is it so expensive? Why are health care costs so high?

You know, that's the $64,000 question, right? And if you get it right, you win. You're in charge. You win. That's been the question since I've been covering this debate. Look, it's not just Affordable Care Act costs. going up. Employer plans are going up. Everything's going up. Generally, health care costs go up faster than inflation, and that's driven by a lot of things, right? It's driven by drug costs. It's

driven by hospital costs. It's driven by labor costs. So all of those things going to the mix with the Affordable Care Act, but also this year, there's this additional factor of the subsidies went away. So insurers were looking at that saying, you know what, the subsidies are going down. We expect to have lower enrollments next year. The people most likely to stay enrolled, right, are the ones who have health problems because they don't want to take the risk of being uninsured. So their insurers were calculating that in when they set their premium rates for this year. We might have sicker people in our pool that we're going to have to cover. So that's part of what we've seen with costs in the Affordable Care Act. But look, everybody is seeing health inflation.

go up right now, and that's affecting premiums. All right, so here we are 16 years later, 16 years after the passage of the Affordable Care Act. Has it accomplished, did it accomplish what it set out to do? You know, you've got to look at that in a number of ways. So it aimed to expand coverage, right, and reduce uninsured. I think the answer there is yes. The number of uninsured have gone from that 13 or 14 percent. It dropped to as low as, like, you know, just under 8 percent a couple of years ago.

It's ticked up a little bit since then. So we have far fewer people who are uninsured. So yes to that. Did it control costs? That's a harder one to answer. And it's back to that $64,000 question. How do you do that? And costs have continued to go up.

Premiums are higher. Premiums are definitely higher than they were pre-ACA. To be fair, the plans are very different. They cover more. They're more generous. They're better coverage, but they are more expensive. The big question is, what is going to be put forward as an alternative? And how palatable will that be to both?

both consumers, lawmakers, the healthcare industry, it's going to be challenging. But I think we're going to hear certainly a lot more discussion this year. Whether or not we see actual proposals that could pass, I think that's a little more questionable. She's Julie Appleby. She's a senior correspondent with KFF Health News. When we come back, once upon a time, Medicare for All was a popular slogan on the left, but it never came close to being a reality. This midterm cycle, some Dems are reviving the idea and they sound serious.

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This product is not intended to diagnose, treat, cure, or prevent any disease. This is Today Explained. My name is Rachel Booth. I am a senior policy correspondent at Vox. Medicare for All, well, it's become really, a rallying cry for the progressive left. We're hearing voters talk about it a lot. Voters want action on health care.

92%. That's the share of American adults who say they've delayed or skipped medical care because they couldn't afford it. For five stitches, $3,800. Health care in general is horrible. Insurance is bad. It's like, we need to find something better. It's become a rallying cry for a lot of progressive candidates that have won key

primaries across the country. I'm Claire Valdez, and I'm running for Congress to make billionaires and corporations pay their fair share. So we can fund Medicare for All, good union jobs. What are your five main policy proposals? Medicare for All, Housing First, Universal Child Care. We show the world what people of Florida are all about. Most notably, it's become a really big part of Abdul Al-Sayed's campaign in Michigan. He has been a champion of Medicare for all for a long time.

Medicare for All is guaranteed health insurance for every single American. Guarantee every single person the health care they need and deserve. Medicare for All does that. Look, y'all, the answer to this is easy. Medicare for All. He, along with Bernie Sanders and IOC, has become sort of one of the leading figures elevating this and putting it into the conversation. What Medicare for All will do is save the average American substantial sums of money.

Substantial. Be much less expensive than your plan. We need Medicaid for all. for all right now. People ask me, what would Medicare for all feel like? But I think everyone is really talking about health care right now. It's ranked as one of the top, if not the top concerns for voters. And it's a really big part of the Democratic Socialist for America platform. When people say Medicare for all, obviously, this is something that we've been hearing for a long time. Also, as acknowledged earlier in this show, health care in the United States is very confusing and complicated. When people say Medicare for All, does everybody mean the same thing?

So there is a slogan, you know, Medicare for All, which most Americans hear as something like universal health care backed by the government. And then there is the Medicare for All Act, which is a real live federal bill. And that is a much more specific thing. Bernie Sanders, when he ran for president in 2016, he campaigned explicitly on guaranteeing Medicare for every American. In my view, we must move forward toward a Medicare for All single payer program. You know, he lost obviously. And once again, asking the financial support. But since 2017, he's been the lead Senate sponsor of the Medicare for All Act, which would replace most private health insurance with a single public plan,

and everyone would be covered under the same plan. It's interesting because Bernie and AOC, they've both endorsed El-Sayed. and he is known as a really big champion of Medicare for all, of single-payer health care, and the importance of that. But right now, if you look at his Senate campaign website, he is running right now on a vision of Medicare for all that does not advocate for eliminating employer or union health insurance. Oh. Which is basically essentially the same thing that Pete Buttigieg called for when he ran for president in 2019. Sort of a Medicare for all who wanted.

Medicare for all who want it means lower costs, everyone gets the coverage they need, and it leaves the choice with you. The left was really unsupportive of that. The position of the Sanders wing was just, if you allow for private insurance, then you shouldn't have the right to associate yourself with Medicare for all. But the left today is behind El-Sayed. And so it raises this question that maybe they're open to a different path going forward. But the fact that you have someone like El-Sayed running on Medicare for All, championing the issue, making it a huge issue, but also supporting a version that doesn't call for banning private insurance, that is new and that is pretty big. Universal health care is, it's very controversial in this country. But many other developed nations have it. And I think this leads Americans sometimes to question, why is that? What goes on here?

What is going on here that is not going on elsewhere? Yeah, so, I mean, Americans have actually supported the idea for a long time. Truman proposed national health insurance in 1945. And polls often show that most Americans support it, you know, depending how the question is worded. Americans really do hold broadly progressive views on health care. 64% of Americans told Gallup that it's the responsibility of the federal government to make sure all Americans have coverage. But what's killed it over the years has been Congress and campaigns from doctors and private insurers and disagreements from Democrats. I think that Americans really do believe that your ability to see a doctor shouldn't depend on if you can afford it.

Now, with respect to other countries, nearly all of them are universal in that they cover everybody, but most haven't gotten rid of private insurance. You know, France, Australia, Germany, they have universal coverage with a private, layer on top. I wonder if there is something different about this time that we're living in. I mean, is somebody who's been around for a while and seen the debate over Medicare for all go through many different iterations. In the U.S., we are rethinking a lot of things. Populism is ascendant on the left. Is it possible that now is the time for Medicare for all, that this time really is different? I think that there is real recognition from Americans and from people across, at least the Democratic Party, that there are untenable

components of our health care system that will get even worse if left undressed. There is growing appetite to take big new action because we know Americans are super concerned about affordability and cost of living. And people are really worried that they could slip and fall or get sick one day and then be in financial ruin. 27 is shaping up to be a really brutal year for health care. Cuts from the big, beautiful Bill Act from 2025, a lot of them start to take effect on January 1st. It splashes Medicaid by $930 billion over 10 years and as work requirements for adults that they enrolled. So the way that work requirements work, and we know this because some states have implemented work requirements in the past, and so we have data on this,

work requirements do not increase the number of people working. they never have when they've been done in the past. But what they do is they implement more paperwork and more barriers. And so what happens is a lot of people just don't navigate that system. So it lapses and they lose their health care. You know, millions of people on Medicaid are going to have to deal with a lot more paperwork just to prove that they're still eligible. And we know from states that have implemented work requirements in the past that a lot of people lose coverage.

So that is looming. We also know that insurers want to do substantial hikes on premiums, on top of the substantial hikes they already did this year. I think that you're right in recognizing that people are, I think, very open to the idea of doing something serious to fix the problems. People do want change and they are worried also about losing their health insurance if they get laid off from their job. So it's making people feel really nervous. Sometimes a politician will introduce a policy idea, not because they think they will get the policy pass, but because they think it's going to force a conversation about the issue.

You've been watching this for a long time, and you are seeing people on the left talk about Medicare for All in a way that 12 months ago they were not. Do you get the sense that this is about shaping the conversation around Medicare for All and health care? Or do you think this is about actually trying to get something done? I think people are serious and I think people do want to get something done. Huh? And I also think that the people who have been pushing Medicare for All have shaped a conversation. I think it's worked. You know, Bernie's bill has never gotten a vote, but the terms of his arguments have moved a lot of people.

We need a universal health care system in the United States of America, and that is Medicare for all. One way of trying to get health care to everybody, which Bernie's very big on, is you take the current Medicare program, you just eliminate the age limit, make it available to everybody, pay for it through. taxation. Interesting. However, I'm open to other models if they get everybody health care. That is good quality and affordable. A country that is supposed to be the greatest country where flags fly higher than any other country in a country where eagles fly upside down because it's too great to poop on. We still see people dying because the government's refused to get people health care. My ass. There is real recognition that high deductibles, high drug prices, all of these structural problems keep compounding.

And all of this is going to be happening just as the 2028 presidential primary picks up. And so I think we're going to see a lot of attention and focus rightly on health care. And I think there's a lot of expectation right now from lawmakers and 2028 contenders that this is going to be something that voters are going to want to hear candidates talk about.

And there's a feeling that, you know, Every 20 to 30 years, Congress kind of gets these big windows to take big action on health care. And in my reporting, people are thinking that one of those windows is potentially going to open up fairly soon. Vox's Rachel Booth. Peter Balin-on-Rosen produced today's show and Jolie Myers edited. Gabriel Dunedhov checked the facts. Our engineers are David Tadishore and Patrick Borg. I'm Noelle King, it's today explained.