In recent months, political candidates across the country have voiced support for exploring Medicare for All (M4A). In new research for the American Action Forum’s Center for Health and Economy (H&E), Stephen Parente updates an earlier assessment of a M4A plan (“the Plan”) introduced in 2019 by then-presidential candidate Kamala Harris. This update comes on the heels of a widely publicized Yale School of Public Health analysis which estimated that a single-payer system could save the country roughly $1 trillion and prevent 114,000 excess deaths per year; this paper explains that this estimate rests on considerably more optimistic assumptions than the H&E model supports.

Key findings:

• Coverage under the Plan reaches effectively universal levels almost immediately: The ranks of the uninsured fall from 13 million in 2027, the first year of implementation, and to zero from 2028 onward, as the individual market, employer-sponsored insurance, and Medicaid are fully absorbed into the new federal program.
• Total insured population grows from 332 million in 2027 to 358 million by 2036, tracking total U.S. population growth — which now reflects undocumented and other illegal entrants who begin receiving coverage in 2026 — as essentially all net growth occurs in the new “Other Public Insurance” category that replaces private and Medicaid coverage.
• Medical productivity is projected to fall as the newly insured population enters the system and network-based cost controls disappear: The Medical Productivity Index declines 14 percent in 2027 relative to the current-law baseline, worsening to a 22-percent decline by 2036.
• Provider access improves as cost sharing is eliminated and coverage becomes universal: The Provider Access Index rises 12 percent in 2027 and climbs to a 19-percent improvement by 2036, assuming provider supply keeps pace with demand.
• Absent new revenue, the coverage provisions of the Plan carry a net budgetary cost of $2.5 trillion in 2027, rising to roughly $5.9 trillion annually by 2036, for a cumulative net cost of $47.4 trillion over the 2027–2036 period.
• Layering in the pay-fors identified in Senator Bernie Sanders’ M4A financing framework — which Harris pointed to as a viable option — still leaves a shortfall: For 2028, $1.7 trillion in new revenue offsets only part of the $4.1 trillion coverage cost, leaving a net budgetary gap of $2.4 trillion for that year alone and $19.0 trillion cumulatively from 2028–2036.

Read the analysis.