No, Joe Biden can’t give everyone Medicare for All with the Social Security Act

Welcome to Libby Montana sign
Photo credit: Jimmy Emerson, DVM, (CC BY-NC-ND 2.0)

First thing’s first: I am a staunch, active supporter of Medicare for All. I’ve hectored my junior senator about it. I’ve sat down with my Congressional representative Rosa DeLauro’s health care staffer about it. I’ve knocked doors, and made phone calls, and stapled up posters around my neighborhood. Don’t misinterpret what I’m about to say as being critical of Medicare for All. This is about disinformation and misapplying hope and energy to pipe dreams about “one weird trick” to achieve single-payer health care.

Section 1881a of the Social Security Act isn’t a magic bullet

According to some people on Twitter, Joe Biden can invoke Section 1881A of the Social Security Act to unilaterally bypass Congress and implement Medicare for All across the entire country. Sound too good to be true? Of course it is!

The argument

The logic for this case starts in Libby, Montana. As outlined in the blog Shadowproof in 2011, Libby was home to a mine that exposed many of its residents to illness-causing asbestos. Democratic Senator Max Baucus, to support the ailing community, worked a provision into the Affordable Care Act that would let residents of Libby apply for and receive Medicare coverage without many of the usual requirements (age, disability). This was codified into a broader law in the Social Security Act, under Section 1881A.

In a nutshell, if someone lives in an emergency area due to an environmental disaster — such as a mine exposing an entire town to asbestos — those affected can become eligible for Medicare benefits.

The COVID-19 pandemic, the argument goes, could or should qualify as such an emergency, making the entire country eligible for Medicare. (If only the President would act!)

Where it falls apart

Where to begin? First, let’s clarify what Medicare For All isn’t: It’s not everyone in the United States receiving Medicare as it currently exists. Medicare today is for people over 65 and the disabled. It covers a lot, but not everything. Parts of it charge a monthly premium, and supplementary private insurance is often needed to fill in gaps in coverage. It’s not a “single-payer” system. There are still lots of other payers — i.e. every single other private and public insurer in the country.

Medicare For All, however, would abolish the private insurance industry as we know it and establish a single public insurer — an expanded Medicare (so named because it’s already a popular universal program with built-in brand recognition). Everything would be covered with no premiums, co-pays, or deductibles. No need to enroll, much less qualify. It would be paid for by taking the money that is already spent on premiums and insurance company profits, and redirecting it (yes, via taxes) toward providing universal coverage.

Section 1881A would not do any of that. It would merely offer “eligibility for benefits” to “environmental exposure affected individual[s].” That is to say, it would offer eligibility for benefits to people “diagnosed with a medical condition caused by the exposure of the individual to a public health hazard to which an emergency declaration applies.” Not exactly universal health care, and certainly not a single-payer system!

In more plain language, here’s text from the Social Security Administration’s Libby, Montana portal:

If you’re diagnosed with an asbestos-related disease and you lived in Lincoln County, Montana for a total of at least six months during a period ending 10 years or more before the diagnosis, you’re eligible for Medicare coverage, including:

  • Free Medicare Part A (Hospital Insurance).
  • The ability to enroll in Medicare Part B (Medical Insurance) and Medicare Part D (Prescription Drug coverage) for a monthly premium.
  • Additional assistance through the Medicare Savings Program with your state (depending on your family’s income).

This is not Medicare For All. Even if the Biden Administration did declare the entire country eligible for Medicare benefits through Section 1881A thanks to COVID-19 — which it won’t, and probably couldn’t — it would represent, at best, a jimmy-rigged public option.


Look, I admire the passion and energy behind any and all calls for Medicare For All and single-payer health care in America. But channeling that energy into the bizarre and doomed quest to push one man instead of all of Congress is misguided. There is no “one weird trick” to win health care justice. There are no shortcuts. Pressure needs to be on Congress, behind the Medicare for All Act (or its eventual successors).

Learn more at the Medicare For All CT website (I sit on the organization’s board).