In a world without Roe, how would Medicare for All guarantee abortion access in states that outlaw it?

Image: Bernie Sanders
Bernie Sanders speaks during the Democratic primary debate at the Adrienne Arsht Center for the Performing Arts, on June 27, 2019, in Miami. Copyright Wilfredo Lee AP
By Adam Edelman with NBC News Politics
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Vermont Sen. Bernie Sanders seemed to make this claim during Thursday night's debate. Experts say he's wrong — but it's complicated.


MIAMI — Vermont Sen. Bernie Sanders, responding to a hypothetical question during Thursday night's Democratic debate, seemed to suggest that his "Medicare for All" health care plan would guarantee all women the right to an abortion even if Roe v. Wade is struck down.

Policy experts told NBC News Friday that this is wrong. It would not be possible for Sanders' health care plan — as it is written now — to ensure the right to abortion in states that decide to outlaw the procedure in a world where that landmark Supreme Court decision doesn't exist.

But, they said, the issue is a complicated one. Here's why.

What Sanders said

MSNBC's Rachel Maddow, one of the debate's moderators, asked Sanders: "What is your plan if Roe v. Wade is struck down while you're president?"

Sanders, after talking about appointing progressive judges to the high court, eventually responded by saying, "Medicare for All guarantees every woman in this country the right to have an abortion if she wants it."

His response raised an enormous theoretical question: Assuming Roe v. Wade is overturned, and Sanders' iteration of Medicare for All is in place, could women covered by the health care system still obtain an abortion in states that decide to outlaw the procedure?

Experts told NBC News that the answer would essentially be no, though there's more to the story.

Insurance versus access

If the Supreme Court were to strike down Roe v. Wade, the 1973 decision that effectively legalized abortion nationwide, states could make abortion illegal. In other words, they could deny the legal right to receive this procedure within their individual state borders.

Under Sanders' version of Medicare for All, women would have insurance that pays for the procedure. But experts on the issue told NBC News that it wouldn't matter. "Medicare for All" simply guarantees the insurance — not the procedure.

"Medicare for All could pay for abortions, but that's different than whether or not a person could get one," said Lawrence Gostin, a professor of global health law at the Georgetown University Law Center.

"It only solves the issue of payment, not the issue of access," he added.

Gostin added that, in the scenario Sanders was responding to, "a person who lives in a state where abortion is outlawed could travel to a state that still allows it," and use the insurance there.

"Which isn't really different than how things are now," he said, referring to the idea that some women are already traveling hundreds of miles to visit an abortion clinic due to restrictive laws in their home states.

Michelle Mello, a professor of law and health research and policy at Stanford University's School of Law and School of Medicine, agreed.

"The mere fact that a woman has insurance coverage available for abortion will not open a pathway for her to receive an abortion in a jurisdiction that has chosen to make it illegal," she told NBC News in an email.

"In order for Sanders' claim to make sense, the Medicare for All legislation would need to include a provision that prevents states from regulating abortion" or "asserting that Congress intends to pre-empt state law in that area," Mello added.

"I don't know whether Sanders envisions including such a provision, and I can't imagine it would have a shot in a Republican-controlled Senate," she said.

A spokesman for the Sanders' campaign, when asked to elaborate on Sanders' statement from the debate, explained to NBC News that the Supreme Court striking down Roe "could mean any number of any different things because the court would be re-writing precedent" and pointed to efforts to codify Roe v. Wade into law as a more viable way to preserve abortion rights.


"If the right to abortion was annihilated, period, the solution would be codifying Roe into federal law," the spokesman said, pointing out that Sanders has supported such efforts since 1993.

Sanders is a co-sponsor of the The Women's Health Protection Act, which would codify Roe v. Wade into federal law. His Senate colleagues and fellow 2020 candidates, Sens. Elizabeth Warren of Massachusetts, Kirsten Gillibrand of New York, Cory Booker of New Jersey, Amy Klobuchar of Minnesota, Kamala Harris of California and Michael Bennet of Colorado, have also signed on to the bill.

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