Medicare for All may be progressives’ rallying cry. But it’s Medicare for More that’s likely to wind up becoming reality.
Several likely 2020 Democratic presidential candidates are pushing plans for something short of universal health care, a move already creating friction within the party’s empowered left wing, which has panned any attempt to water down the progressive dream of a single-payer system.
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One idea gaining support is allowing some demographic groups to buy into Medicare earlier than age 65, while still incrementally building on Obamacare coverage gains.
“It’s easy to say ‘Medicare for All’ and make a good speech, but see no action,” said Sen. Sherrod Brown (D-Ohio), a potential 2020 candidate whose own bill would give retiring police and firefighters access to Medicare before 65. “I want to see action.”
It’s a pathway Brown and many in the party establishment have gravitated toward in recent months — one that balances the desire to make a Trump-era lurch leftward with memories of the political blowback Democrats endured for a decade after their last revamp of the nation’s health system.
So the Democrats, with their eyes on 2020, have introduced at least eight plans for expanding health coverage beyond Obamacare’s gains. They range from modest Medicare reforms to more ambitious restructurings that would extend government-run care to millions of new patients — an array of options that fall short of campaign trail promises for full Medicare for All.
That spectrum includes Sen. Debbie Stabenow (D-Mich.)’s bill allowing patients to buy into Medicare starting at age 55 and Tim Kaine (D-Va.) and Michael Bennet (D-Co.)’s plan to create a Medicare-style public option to compete with private insurers on up to bigger revamps, like Sens. Jeff Merkley (D-Ore.) and Chris Murphy (D-Conn.)’s expansion Medicare eligibility to nearly all Americans. Sen. Brian Schatz (D-Hawaii) would let everyone purchase Medicaid. Those options have been characterized by supporters as more practical alternatives to the completely government-run system popularized by Sen. Bernie Sanders (I-Vt.) and Rep. Pramila Jayapal (D-Wash.).
The wrangling has been largely obscured by the new House Democratic majority’s decision to spend its first months in power focused on efforts to strengthen Obamacare — a position endorsed by the closely aligned outside group Protect Our Care. But members acknowledge it’s only a matter of time until the focus shifts to 2020 and questions about how fast and how far to move beyond the Affordable Care Act.
“If we could make the leap straight to Medicare for All, I would love for us to do that,” Merkley said. “But it’s important to lay out a route about how we get to that vision. If you tell people the only choice they have is Medicare, that could produce a lot of folks being concerned about, ‘Wait a minute, I like my health care and you’re telling me I have to leave it.’”
The more incremental approach is nonetheless frustrating for some progressives buoyed by the November elections and House leaders’ commitment to hold the first-ever hearings on Medicare for All.
They believe their party should seize on grassroots enthusiasm for single-payer health care that’s injected the once-fringe concept into the Democratic mainstream, not run away from it.
“It’s not out of reach. It’s not impossible,” Jayapal said. “It just needs the political will here in Congress.”
But Democratic leaders prefer a drawn-out, lower-key debate over the myriad health plans. House Democrats are wary of moving away from the Obamacare-centric message that aided members across the board in 2018, and fearful of making life harder for members facing tough re-election fights in 2020.
A health care messaging guide developed for congressional Democrats by Protect Our Care urges the party to keep its focus on priorities that are proven winners: hammering Republicans over Obamacare “sabotage,” and lowering health care costs and boosting consumer protections within the current law. The group is advising Democrats to leave the bigger fights over universal health care for further “down the road.”
Corporate lobbies across the health sector, meanwhile, are already lining up to fight any move toward Medicare for All. And Republicans are eager to move the conversation beyond Obamacare and their efforts to gut pre-existing condition protections, believing a battle over a brand new health system will allow the GOP to regain its political footing in swing districts.
“The speaker gets this,” said one centrist House Democrat. “She’s not going to have people walk the plank for the sake of it because we’ve gotta satisfy some of our vocal friends on the far left.”
Add to that concerns about boxing in any eventual 2020 candidate, and House Democratic leaders have already privately ruled out allowing a House floor vote on any coverage expansion plan this Congress, a senior Democratic aide told POLITICO.
Potential 2020 contenders such as Sens. Cory Booker (D-N.J.), Kamala Harris (D-Calif.) and Kirsten Gillibrand (D-N.Y.) are also moving cautiously, embracing Medicare for All legislation authored by Sanders, who made the issue a defining feature of his 2016 presidential bid, while also signing onto less ambitious expansion bills. Others, like former Vice President Joe Biden, have yet to weigh in on what they would support.
But they’ll be tested by the party’s liberal wing in the coming months with Jayapal‘s Medicare for All bill, set to closely align House progressives with Sanders’ proposal and kick off a fresh push for single-payer inside and outside the Capitol.
The National Nurses Union is planning a nationwide grassroots campaign in February drumming up support for universal health care. And in the House, Jayapal’s bill will eventually receive hearings from committees led respectively by single-payer supporters Jim McGovern (D-Mass.) and John Yarmuth (D-Ky.).
Yarmuth, the chairman of the House Budget Committee, has also asked the Congressional Budget Office to evaluate the fiscal impact of a national single payer model – another first for the Medicare-for-All movement.
The Ways and Means Committee is planning a hearing this spring to examine the various Medicare expansion bills Democrats have proposed, said Rep. Brian Higgins (D-N.Y.), a committee member who has his own Medicare buy-in proposal. Jayapal, meanwhile, is pressing for a Medicare for All hearing in front of the Energy and Commerce Committee — though Chairman Frank Pallone (D-N.J.) has yet to commit.
Energy and Commerce health subcommittee Chairwoman Anna Eshoo (D-Calif.) on Wednesday appeared to promise her own hearing on the various Medicare bills. But she later walked that back, telling POLITICO it would only happen if the subcommittee completes its lengthy agenda and has “spare time” left over.
Progressives concede that a Medicare-for-All vote this year is a long shot — it would likely need support from both of those major committees and leadership — but expressed hope some kind of expansion bill might get consideration as a way to set the bar for 2020.
“We want a floor vote soon because we want it to be part of the presidential conversation, so certainly before the Iowa caucuses,” said Rep. Ro Khanna (D-Calif.).
Several Medicare for All backers in the House, including Khanna, have signed on to alternate bills that would more incrementally expand Medicare for certain slices of the population, or would simply create a public option that would compete for enrollees alongside private insurance plans.
Reps. Rosa DeLauro (D-Conn.) and Jan Schakowsky (D-Ill.) are pushing a plan similar to Merkley’s in the Senate, which would give all Americans the opportunity to buy a Medicare plan — but not force them into one. And Higgins late last year got Speaker Nancy Pelosi to pledge a “good-faith effort” to get a floor vote for his bill, which would allow patients to purchase Medicare starting at age 50 — a plan he called a bridge to an eventual Medicare for All system.
“You get in the majority, there’s no sense in having political pull unless you use it,” he said.
But the rest of the Democratic conference will take some convincing.
With no shot of enacting any coverage expansion bill while Republicans control the Senate, they say there’s little value in pushing anything right away. Rather, the party establishment is urging progressives to bide their time and use the next two years to perfect a plan the entire party can get behind come 2020.
“We have to work hard so we’re not starting from scratch in January 2021, but instead building on a foundation of lots of hearings, lots of experts, lots of debate,” Merkley said. “We have the worst, the most complicated, and the most stressful and the most expensive health care delivery system in the world. We need to do better.”
Heather Caygle contributed to this report.