WASHINGTON (AP) — Congressional budget experts said Wednesday that moving to a government-run health care system like “Medicare for All” could be complicated and potentially disruptive for Americans.

The report from the nonpartisan Congressional Budget Office was a high-level look at the pros and cons of changing the current mix of public and private health care financing to a system paid for entirely by the government. It did not include cost estimates of Sen. Bernie Sanders’ Medicare for All legislation or its House counterpart, but raised dozens of issues lawmakers would confront.

“Policymakers would need to consider how quickly people with private insurance would switch their coverage to a new public plan, what would happen to workers in the health insurance industry if private insurance was banned or its role was limited, and how quickly provider payment rates under the single-payer system would be phased in from current levels,” the report said.

One unintended consequence could be increased wait times and reduced access to care if there are not enough medical providers to meet an expected increased demand for services as some 29 million currently uninsured people get coverage and as deductibles and co-payments are reduced or eliminated for everyone else.

“An expansion of insurance coverage under a single-payer system would increase the demand for care and put pressure on the available supply of care,” the report said.

Sanders, I-Vt., pushed back, telling reporters that what’s really disruptive is that millions of Americans remain uninsured while others can’t afford high co-pays and drug prices. “That is disruptive,” said Sanders. “What is not disruptive is expanding Medicare, which is a very popular and cost-effective program to guarantee health care for every man, woman and child.”

The Democratic presidential candidate’s single-payer proposal is coloring the nomination fight and is likely to be a significant theme in the 2020 elections. President Donald Trump derides it as “socialism.”

Employers now cover more than 160 million people, roughly half the U.S. population. Medicare covers seniors and disabled people. Medicaid covers low-income people and many nursing home residents. Other government programs serve children or military veterans.

Proponents of Medicare for All say the complexity of the U.S. system wastes billions in administrative costs and enables hospitals and drugmakers to charge much higher prices than providers get in other economically advanced countries. Critics acknowledge the U.S. has a serious cost problem, but they point out that patients don’t usually have to wait for treatment and that new drugs are generally available much more rapidly than in other countries.

While a government-run system could improve the overall health profile of the U.S., pressure on providers to curb costs could reduce the quality of care by “by causing providers to supply less care to patients covered by the public plan.”

Other potentially difficult choices flagged in the report included:

Within the health care industry, groups including hospitals, insurers, drugmakers and doctors have formed a coalition to battle a government-run system. Major employers are likely allies.

Polls show that Americans are open to single-payer, but it’s far from a clamor. Support is concentrated mostly among Democrats.

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