Pelosi on single-payer health care: ‘How do you pay for that?’

Speaker Nancy Pelosi (D-Calif.) expresses some skepticism about single-payer health insurance in a new interview, asking how the trillions of dollars in new spending would be paid for.

“That is, administratively, the simplest thing to do, but to convert to it? Thirty trillion dollars. Now, how do you pay for that?” Pelosi said of single-payer in an interview with Rolling Stone.

The roughly $30 trillion price tag over ten years of single-payer health insurance, sometimes referred to as “Medicare for all,” has been one of the leading criticisms of the proposal.

Over 100 House Democrats this week introduced a single-payer bill. But Pelosi, while supporting hearings on the legislation, has not given her support to the bill itself.

She faces a balancing act given that many more-centrist House Democrats think single-payer goes too far, and instead want to focus on improving the Affordable Care Act (ACA) and perhaps adding the option for government-run insurance.

Pelosi did not dismiss the idea of single-payer out of hand in the Rolling Stone interview, which was conducted in January but published this week.

“So I said, ‘Look, just put them all on the table, and let’s have the discussion, and let people see what it is. But know what it is that you’re talking about,’” Pelosi said.

But she touted her signature achievement, the ACA, and said she did not want to dismantle it, which moving to a single-payer system would do.

“All I want is the goal of every American having access to health care,” Pelosi said. “You don’t get there by dismantling the Affordable Care Act.”

Rep. Pramila Jayapal (D-Wash.), who is the main sponsor of the single-payer legislation with Rep. Debbie Dingell (D-Mich.), struck a very different tune than Pelosi on the issue of paying for the legislation when speaking to reporters earlier this week.

Jayapal said there is much less scrutiny of how to pay for military spending or tax cuts, but “all of a sudden” when the measure is about providing health care for all, people ask how to pay for it. Jayapal’s bill does not spell out how it would be paid for.

Jayapal, though, has so far been publicly appreciative of Pelosi’s stance on her bill, thanking her for supporting hearings on it.

Pelosi instead touted smaller improvements to the Affordable Care Act, such as restoring funding known as reinsurance, which helps bring down premiums, and getting more states to accept the expansion of Medicaid.

Pelosi noted that she supported a government-run “public option,” a smaller step than full-scale single-payer, that would be sold alongside private insurance on the ACA marketplaces. But she noted that the idea could not get through the Senate in 2009 and 2010 when ACA bill was passed.

House Democratic leaders have already started moving smaller bills through committee aimed at shoring up the ACA, through actions such as restoring funding for outreach to sign people up, funding which was slashed by President Trump.

As different Democrats jockey over where to go next, Pelosi told Rolling Stone, “This is a very interesting debate.”