Congress

‘Medicare-for-all’ is no longer purely theoretical. Democrats are coming to terms with that

Support wobbles as Pramila Jayapal introduces new bill in the House

While there are fewer total co-sponsors than last year, the number of original co-sponsors for her universal health care bill is higher, Pramila Jayapal noted. (Tom Williams/CQ Roll Call file photo)

The single-payer “Medicare-for-all” bill that House Democrats are releasing Wednesday seems like it should stand a good chance of attracting more support than last year. After all, the House Democratic caucus ballooned this year and health care concerns were a key factor in the party’s electoral success.

But Rep. Pramila Jayapal of Washington, who will introduce the bill, said 107 House Democrats are initially supporting the measure. That number is fewer than the 124 Democrats who had formally backed an earlier version of the measure by the end of the last Congress.

Last year, a record 62 percent of Democrats backed the House single-payer “Medicare-for-all” bill. Roughly 46 percent of House Democrats have so far signed onto the measure to be unveiled Wednesday.

The downturn in support reflects in part the risks for any politician that proposes dramatic change and uncertainty in a system that is central to Americans’ well-being. It underscores the political calculations Democrats face now that the party controls the House and hopes to capture the White House in the 2020 presidential election. And as the party gains power, its ideas will be taken more seriously.

“The situation is much different,” said Budget Committee Chairman John Yarmuth of Kentucky, who has long backed a single-payer bill. “First of all, we’re in the majority, so it takes on a little bit more consequence when you do that.”

Some lawmakers who backed the bill in past years may have done so to show their support for universal health care coverage, Yarmuth said. Last year’s bill lacked some specific details, too, so lawmakers may have more to weigh as they analyze this year’s version, which would nearly eliminate private insurance and increase taxes. More Democrats could come on board later.

But while some new members ran on a “Medicare-for-all” platform, a majority of those who flipped their seats from red to blue focused on strengthening the 2010 health care law and protecting coverage for people with pre-existing medical conditions. Only a little over a quarter of this year’s Democratic freshmen so far plan to support the bill.

“Clearly, there is a caution by members who want to see how this issue plays out in their district,” said Robert Blendon, a health policy and political science professor at Harvard University.

Recent polls show that the public appears more interested in a plan that would allow people to maintain their current insurance plan, Blendon noted. That could make members more likely to back a plan that would expand health care coverage but be a less drastic change than a single-payer plan that would eliminate private insurance.

Support for the bill

Jayapal said she never aimed for last year’s number and had hoped for 100 colleagues to join the measure, an effort she is leading with Rep. Debbie Dingell of Michigan. Although there are fewer co-sponsors than last year, Jayapal noted that the number of original co-sponsors is higher than the one at the start of the last congressional session and said she expects more lawmakers will join the effort in the coming weeks.

“This is a significantly different bill,” she told reporters. “We’re thrilled that we have more than doubled the number of original co-sponsors that are on this bill” compared to last session’s bill.

Mark Peterson, a political science professor at the University of California Los Angeles, said support for single-payer type plans has slowly grown in recent decades, but an important indicator would be whether supporters span the ideological spectrum within the Democratic Party. If more centrists were to join the bill, that would be a more clear sign of a shift.

Still, support may be hindered by the fact that the measure will not be enacted soon. It’s not certain the House will vote on it, and Senate leaders are unlikely to bring it up for a vote. Instead, “Medicare-for-all” and what it represents has emerged as a key issue in the 2020 Democratic primary.

“The important symbolism of how it’s risen is how many Democratic presidential candidates are at least signing on thematically, even if it’s only because they support universal coverage, but that’s where you have to start,” Peterson said.

Rep. Tulsi Gabbard of Hawaii, who is running for the presidential nomination, and Reps. Eric Swalwell of California and Tim Ryan of Ohio, who both say they are considering bids, are all co-sponsors.

The bill’s backers so far come from the left wing of the caucus, including Reps. Alexandria Ocasio-Cortez of New York and Ayanna Pressley of Massachusetts. Rep. Robert C. Scott of Virginia, who chairs the House Education and Labor Committee that would have some jurisdiction over the bill, is also a co-sponsor.

Others are more surprising. Rep. Ann Kirkpatrick of Arizona said during the primary in her swing district last year she would not support a single-payer plan without identifying ways to fund it, but signed on to the bill. Massachusetts Rep. Joseph P. Kennedy III supports it for the first time.

“Those of us who sign our name to this bill must be willing to have a frank discussion with the American people about these difficult and complex issues,” Kennedy said on Facebook, adding that he’d held off on previous versions because they did not repeal an annual amendment that limits federal funding for abortion or cover long-term care. He also worried it would force the closure of regional hospitals.

Jayapal said she spoke with many freshmen and said some co-sponsors included people who are not members of the House Progressive Caucus, which she co-chairs. She said she’s explained the bill to lawmakers who haven’t yet hired a health care staffer in an effort to win them over. She cited co-sponsors like Reps. Josh Harder of California and Susan Wild of Pennsylvania, whose districts were previously represented by Republicans, to show support from more than just progressives.

Legislative details

The bill is a more expansive version of a single-payer bill previously introduced in the House and a similar measure proposed in 2017 by Sen. Bernard Sanders.

It would establish a single-payer, government-run health care system that would entitle all U.S. residents to a wide range of services, including primary and preventive care, hospitalization, prescription drugs, maternal care, and mental health care. Unlike the current Medicare program, it would cover vision and dental care as well as long-term care.

Enrollees would pay no premiums, co-pays or deductibles. The bill would prohibit duplicative coverage, which Jayapal staffers say would eliminate most private insurance. Supplemental insurance would be allowed, although a Jayapal aide did not envision a large market for such plans, which might cover treatments like cosmetic services.

The Health and Human Services secretary would set a national health budget to cover operating costs, capital expenditures, and administrative costs. To assist workers affected by the overhaul, 1 percent of that budget for the first five years would support assistance like wage replacement or job training.

It would also change how doctors and hospitals are paid. Institutional providers like hospitals or skilled nursing facilities would be paid through a global budget, so that hospitals would receive a quarterly lump sum to cover items and services. Individual providers would be paid based on a national fee schedule set by the HHS secretary. The bill would bar providers from using those funds for activities like marketing, increasing their profits or political activity. Providers would submit applications for capital expenditures.

The bill envisions a two-year transition, faster than a four-year plan in Sanders’ bill.

The measure will not include a cost estimate or a way to pay for the plan, although Jayapal said she’ll release some possible options to finance the plan. Sanders offered similar ideas for his plan in 2017.

Instead, Jayapal said she hopes to use hearings on “Medicare-for-all” in the Rules and Budget committees later this year to flip the conversation.

“It is not about can we afford it,” she said. “It is about: can we afford not to do this?”

From the archives: Sanders, Warren and Democrats unveil Medicare-for-all bill

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