Lee Carter, a Democrat running for a Manassas-area seat in the House of Delegates, is leading a crop of House candidates pledging to push for a state-level, single-payer healthcare system if they reach Richmond.
Carter joined 15 other Democratic hopefuls in announcing the new initiative Oct. 2, which is aimed at radically reforming Virginia’s healthcare system to cover all of the state’s 8.4 million residents.
While Sen. Bernie Sanders, I-Vt., has made national headlines proposing a national “Medicare-for-all” system with the support of a bevy of prominent Democrats, individual states have yet to successfully build single-payer systems. Lawmakers in Vermont, California and New York have worked to move to government-run insurance systems, but so far those efforts have stalled.
Yet Carter said he believes the “instability in Washington, D.C.” surrounding healthcare policy — with Republicans pushing to repeal former President Barack Obama’s “Affordable Care Act,” and Democrats bickering over solutions to expand coverage — means that Virginia lawmakers should take matters into their own hands.
“The federal government is just not a reliable partner anymore,” said Carter, who is challenging Del. Jackson Miller, R-50th District, Nov. 7. “And we’re in a moment now where people are dissatisfied with the way healthcare is currently being run. This is about stating our goal so people know where we stand.”
Carter acknowledges that the proposal will be quite the uphill battle, as it requires a substantial reordering of the state’s economy, on top of the healthcare changes — his plan would build a “two-tiered system,” ensuring basic insurance access for all Virginians under a government system similar to Medicaid and leaving a private marketplace for people seeking more expensive elective procedures or clinic visits.
But Carter believes European countries similar in size to Virginia (like Austria) provide a blueprint for the state to follow, helping Virginia chart a path toward simultaneously providing universal coverage and cutting down on healthcare costs.
“On the world stage, there’s 95 years of precedent for this,” Carter said. “”Within the political class, this may be something new, but people are ready for it.”
Carter pointed to national polls showing support building for a national single-payer system as evidence that this proposal could find some traction in Virginia.
The challenge will be convincing the Republican-dominated General Assembly of the proposal’s merits — the GOP holds a 66-34 advantage in the House, presenting quite the tall order for Democrats looking to flip the chamber this November when all 100 seats will be on the ballot.
“We’ve always known that my opponent is a Bernie Sanders liberal who wants state-run single-payer healthcare, we just never thought he would admit it,” Miller, who doubles as the House majority whip, wrote in a statement. “This proposal demonstrates the clear choice voters have in this election.”
John Whitbeck, chairman of the Republican Party of Virginia, says he’s “shocked” that Carter and his fellow candidates would even propose such a policy. The plan calls for a $23-billion annual tax increase, a number Whitbeck expects will prove to be politically toxic in a “swing state” like Virginia.
“This is an October surprise in a good way for us,” Whitbeck said. “This is an outrageous proposal that’s been tried in other states and failed. And, frankly, I don’t think anybody in Virginia supports putting the government in charge of our healthcare.”
Carter argues that focusing merely on the tax increase is a bit misleading, as estimates suggest that Virginians spend about $41.6 billion on healthcare each year. By covering every legal resident and vastly shrinking the role of private insurers, he expects that any tax increase would be instantly offset by how much people would save when it came time to go to the doctor or the hospital.
“Our current health insurance system is incredibly inefficient,” Carter said. “This is saving money for our economy while giving everyone healthcare.”
But Whitbeck observes that Carter and company may have trouble even building consensus on single-payer within his own party.
Lt. Gov. Ralph Northam, the Democrat running to succeed Gov. Terry McAuliffe, said following a gubernatorial debate that he didn’t support Sanders’ “Medicare-for-all” proposal, and a campaign spokeswoman said he thinks Virginia “should be moving in the direction of healthcare coverage for all Americans through Medicaid expansion.”
“Instead of single payer, Northam thinks Virginia could design a public option that would create competition and help drive down costs,” spokeswoman Ofirah Yheskel said in a statement.
House Democratic leaders agree, choosing to put their energy behind more modest coverage expansions.
"Our immediate focus is on increasing access to affordable health care through Medicaid expansion, which would cover 400,000 Virginians — including veterans and working families — who have fallen through the cracks," Katie Baker, spokeswoman for the House Democratic Caucus, said in a statement.
Yet Carter feels that merely expanding Medicaid eligibility under the ACA doesn’t go far enough, as even that change would still leave thousands without coverage.
Rosemarie Day, a healthcare consultant who worked to set up the nation’s first health insurance exchange in Massachusetts under then-Gov. Mitt Romney, wonders if Virginia could manage a single-payer system politically, if lawmakers haven’t even been able to agree on a “relatively safer step” like Medicaid expansion. She thinks there is room for states to experiment with their own healthcare solutions, but she fears the process of moving to single-payer may prove too complex for Virginia to manage.
“You’re going to take millions of dollars out of employer-sponsored insurance that they’re kicking in and replacing them with taxpayer dollars,” Day said. “Maybe you contract with the feds to port over aspects of the Medicare program, but how do you suddenly disentangle all the contracts with providers and start new ones? There are so many things to unwind and replace with what a government entity would do. It would take years of work.”
Carter concedes that even the Democratic candidates he convinced to support this plan may disagree on exactly how to fund a single-payer system or how exactly it might work, but he feels certain that they’ll be “united” in pushing the proposal going forward.
“We’re going to keep building pressure until we have 51 votes in the House, 21 votes in the Senate and a governor who will sign it,” Carter said. “This is just the beginning.”
Democrat Elizabeth Guzman is not one of the candidates supporting the measure. She had been listed among the supporters in an earlier press release, but her campaign says that was due to an errant email from a staffer.