In theory, if a state wanted to create a "Medicare for All" system, it could take on such a challenge. Under the existing Affordable Care Act, states can apply for something called a 1332 waiver, which would, if granted, allow them make the transition from the existing ACA system to more of a single-payer model.
But in California yesterday, the head of the Trump administration's Centers for Medicare & Medicaid Services said while she supports state flexibility, she won't support Medicare for All waivers. Modern Healthcare reported:
CMS Administrator Seema Verma pumped the brakes Wednesday on growing political momentum to launch a Medicare for all program."We have all heard the drumbeat for what advocates of a government-run—socialized—healthcare system call 'Medicare for All,' " Verma said in a speech Wednesday at the Commonwealth Club of California. "By choosing a socialized system, you are giving the government complete control over the decisions pertaining to your care, or whether you receive care at all."
Explaining why she would reject any such waiver applications, Verma added, "In essence, Medicare for all would become Medicare for none."
Putting aside, at least for now, the larger debate about the merits of a Medicare-for-All approach, there are a couple of important problems with Verma's comments. The first is whether she actually has the authority to veto state plans she doesn't like.
Under the ACA, states seeking 1332 waivers have to meet an extensive list of requirements. If a state were to come up with a Medicare-for-All plan that met each of those requirements, I'm not at all sure how Verma could effectively respond, "No, I just don't think this is going to work out."
The second is the application of Verma's stated principles.
Look at her quote from yesterday again: "By choosing a socialized system, you are giving the government complete control over the decisions pertaining to your care, or whether you receive care at all."
In practical terms, this sounds an awful lot like the head of the Centers for Medicare & Medicaid Services condemning not just "Medicare for All," but also Medicare itself.