The Consequences of “Medicaid for All”: Alani Bankhead’s Plan to Reshape Healthcare
The Consequences of “Medicaid for All”: Alani Bankhead’s Plan to Reshape Healthcare
Type: Research
Key findings
- Unlike supporters of traditional Medicare for All, Bankhead has not released a detailed plan explaining whether her proposal would eliminate private insurance, replace employer-sponsored coverage, establish federal Medicaid reimbursement rates, or simply expand eligibility for the existing Medicaid program.
- CBO has estimated that illustrative single-payer systems could increase federal healthcare subsidies by roughly $1.5 trillion to $3 trillion in 2030 alone, depending on the design.
- A 2025 Chartis analysis found that 57% of Montana’s rural hospitals were operating with negative margins, six were vulnerable to closure, and the statewide median rural-hospital operating margin was negative 1.2%.
- A University of Montana workforce report found that rural and frontier counties continue to struggle with shortages of nurses and other healthcare workers.
- Bankhead promises universal coverage, stronger rural healthcare and no apparent major new tax burden. She has not shown that all three can coexist.
Full report
## Executive Summary Alani Bankhead, the Democratic nominee for U.S. Senate in Montana, has made universal government-funded healthcare part of her affordability agenda, calling for “Medicaid for All” and proposing to finance it by redirecting what she describes as “use-lose” military spending. Unlike supporters of traditional Medicare for All, Bankhead has not released a detailed plan explaining whether her proposal would eliminate private insurance, replace employer-sponsored coverage, establish federal Medicaid reimbursement rates, or simply expand eligibility for the existing Medicaid program. Those details matter. If Bankhead intends “Medicaid for All” as a national single-payer system, it would represent a massive shift of healthcare spending to the federal government. CBO has estimated that illustrative single-payer systems could increase federal healthcare subsidies by roughly $1.5 trillion to $3 trillion in 2030 alone, depending on the design. The proposal could be especially disruptive in Montana, where rural hospitals already operate on thin margins and healthcare workers are in short supply. Expanding coverage could reduce the uninsured population, but placing substantially more patients into a government-run system would also make federal reimbursement policy increasingly important to the survival of Montana hospitals and clinics. Bankhead has not explained how she would reconcile those competing pressures. ## The Financing Reality: Military Savings Would Not Come Close Bankhead says her “Medicaid for All” proposal would be “paid for by use-lose military funds.” There is evidence of waste and poor financial management at the Pentagon. But eliminating waste is not the same as financing universal healthcare. CBO has estimated that single-payer systems could increase federal healthcare subsidies by trillions of dollars annually. A separate Mercatus Center analysis of Sen. Bernie Sanders’ Medicare for All plan estimated it would increase federal spending by roughly $32.6 trillion over its first decade. Even aggressive reductions in unnecessary military spending would not come close to covering a healthcare program of that scale. Bankhead has not proposed trillions of dollars in new taxes or explained what happens when the military savings she identifies fall short. The remaining cost would have to be covered through some combination of payroll taxes, income taxes, borrowing, lower provider payments or spending cuts elsewhere. For Montana families, eliminating private insurance premiums would not make healthcare free. It would change how they pay for it. ## What Bankhead’s Plan Could Mean for Montana Hospitals The biggest unresolved question is what Bankhead means by “Medicaid for All.” Medicaid is not Medicare. Medicaid reimbursement rates are often lower than commercial insurance rates and are a persistent concern for hospitals and physicians. That is particularly important in Montana. A 2025 Chartis analysis found that 57% of Montana’s rural hospitals were operating with negative margins, six were vulnerable to closure, and the statewide median rural-hospital operating margin was negative 1.2%. If Bankhead’s plan significantly expanded Medicaid-style reimbursement, rural hospitals could face even greater financial pressure unless the federal government substantially increased payment rates. But higher reimbursement would make the program considerably more expensive. That creates a fundamental tension in Bankhead’s proposal: she promises universal government coverage while also pledging to protect rural healthcare, but she has not said what hospitals and doctors would actually be paid. ## Montana Already Has a Healthcare Workforce Problem Insurance coverage is only one part of healthcare access. A University of Montana workforce report found that rural and frontier counties continue to struggle with shortages of nurses and other healthcare workers. Montana healthcare employers averaged more than 1,700 job postings per month, while wages for many healthcare occupations remained below national averages. Universal coverage would not, by itself, create more doctors, nurses, specialists or hospital beds. In fact, expanding coverage can increase demand for medical services as people who previously delayed care begin seeking treatment. If reimbursement rates are also reduced to control costs, providers may have even less ability to expand capacity. That trade-off could be especially significant in rural Montana, where patients may already travel long distances for emergency care, maternity services or specialists. Bankhead promises broader coverage and stronger rural healthcare, but has not explained where the additional medical workforce would come from. ## What It Would Do Nationwide If Bankhead means a true single-payer system rather than a limited Medicaid expansion, her proposal would represent one of the largest reorganizations of the American healthcare system in modern history. Employer-sponsored insurance currently covers roughly 165 million Americans under age 65. Under a full single-payer system, much of that coverage could be replaced by government insurance, depending on how Bankhead designed the program. There could be benefits. Universal eligibility could sharply reduce the uninsured population, and a streamlined government system could reduce some administrative costs. But the savings depend heavily on Washington controlling healthcare prices. If the federal government pays hospitals and doctors enough to preserve existing revenues, taxpayer costs rise substantially. If Washington lowers reimbursement rates to make the system more affordable, providers absorb the financial hit. Bankhead has not said which side of that equation she would choose. ## The Risk of Reduced Access Supporters of government healthcare correctly argue that broader insurance coverage can improve access for people who cannot currently afford care. But insurance coverage does not guarantee that a doctor or hospital will be available. CBO has found that reducing cost sharing under single-payer systems would increase healthcare utilization. That additional demand must be absorbed by a healthcare workforce with limited capacity. Nationally, rural hospitals are already under pressure. Chartis found in 2026 that more than 40% of rural hospitals were operating in the red. Montana enters that equation from an even weaker position. A healthcare system that expands coverage without addressing provider supply risks replacing one access problem — affordability — with another: having insurance but fewer places to use it. ## Bankhead Has Not Provided the Details Bankhead has provided the slogan — “Medicaid for All” — and a proposed funding source — military “use-lose” spending. She has not explained: - Whether private health insurance would remain. - Whether employer-sponsored insurance would continue. - Whether Medicare beneficiaries would stay in the existing program. - What reimbursement rates hospitals and doctors would receive. - How much the program would cost. - What taxes would finance the gap after military savings. - How Montana’s rural hospitals would be protected. - How the state would address increased demand amid healthcare-worker shortages. Without those answers, “Medicaid for All” remains more of a campaign promise than a complete healthcare proposal. ## Bottom Line Alani Bankhead is campaigning on universal healthcare financed through military savings. The promise is simple. The economics are not. A national government healthcare system could expand coverage and reduce some premiums and out-of-pocket costs. But existing single-payer analyses put the additional federal cost in the trillions of dollars, far beyond plausible savings from Pentagon waste. For Montana, the risks are particularly significant. More than half of the state’s rural hospitals were operating with negative margins in Chartis’ 2025 analysis, while rural communities continue to struggle with healthcare-worker shortages. Bankhead promises universal coverage, stronger rural healthcare and no apparent major new tax burden. She has not shown that all three can coexist. Until she explains who pays, what providers receive, what happens to private insurance and how rural Montana hospitals remain open, “Medicaid for All” leaves voters with a sweeping promise — and most of the difficult questions unanswered.