Politics

On ‘Medicare-for-All,’ Democrats Tread Lightly

It polls well. But Dems say the proposal isn’t ready for floor action

Rep. Pramila Jayapal, D-Wash., founded the Medicare-for-All Caucus earlier this year. She pushed back on the idea that single-payer health care is unpopular in suburban parts of the country. (Bill Clark/CQ Roll Call)

Progressives in the House are calling for a vote on a single-payer “Medicare-for-all” bill in the next Congress, but the expected chairmen who will set the agenda for next year say they have other health priorities.

Still, the progressives’ push could earn more attention over the next two years as Democratic candidates begin vying to take on President Donald Trump in 2020. A handful of potential presidential candidates expected to declare interest have already co-sponsored “Medicare-for-all” legislation, an issue that was also a flashpoint in Democratic primaries over the past year.

Most Democrats say the proposal, which polls show enjoys significant public support, hasn’t been fully fleshed out and isn’t ready for floor consideration. The drawbacks, like a major tax increase, the type of changes that would be needed to the Medicare program and the reality that millions of Americans would lose their current coverage plan, could become politically dangerous, they say.

Democratic Rep. Frank Pallone Jr. of New Jersey, who is set to be chairman of the Energy and Commerce Committee, said last week he supports the concept, but doesn’t expect the votes to be there. Instead, Pallone said he wants to focus on shoring up the 2010 health care law and addressing prescription drug prices, including by allowing Medicare to negotiate drug prices.

“Our priority has to be stabilizing the Affordable Care Act, preventing the sabotage that the Trump administration has initiated,” he told reporters.

Democratic Rep. Pramila Jayapal, who founded the Medicare-for-All Caucus earlier this year and is chief among those calling for a vote on a single-payer measure, acknowledged those priorities are important and should be addressed, but said it was also the time to turn to a broader overhaul of the health system.

“We should continue to try to shore up health care as we have it, but we really have to be pushing to a complete transformation of our health care system and not just trying to do little fixes here or there because we’re still leaving out too many Americans who are literally cutting their pharmaceuticals into half because they can’t afford it, or getting off of health care because it’s not a choice to pay another $300 a month,” she said.

A bill has little chance of winning support from Senate Republicans and Trump, so some Democratic advisers are wary of highlighting an issue that divides the party and could open up lawmakers to outside attacks.

“Until they do a better job of selling this thing, I don’t want to see this become a litmus issue for 2020,” said Jim Manley, a Democratic operative who worked for then-Senate Majority Leader Harry Reid.

Moderates’ pushback

Moderates are feeling confident after a group of suburban district Democrats swept the party back into the majority for the first time since 2010.

Rep. Ron Kind, a Ways and Means Committee member, said most members who flipped seats in the election did not embrace the single-payer proposal, suggesting that it’s not the best path for Democrats to take if they want to notch up accomplishments.

“I don’t think [it] makes a lot of political sense,” the Wisconsin Democrat said.

Rep. Lloyd Doggett, a more progressive member of the party who could lead the Ways and Means Health Subcommittee next year, said it would be appropriate to learn more about the policy in the next session, but that plans for a vote were “premature.”

“We’ve not fully explored cost, transition, the effect of on people who have — such as many union workers — strong policies now,” the Texas Democrat said. “There’s so many aspects of it, so I wouldn’t envision that there would be any early vote.”

Manley said that while “Medicare-for-all” is polling well now, he would expect its favorability to drop as the idea is further hashed out. But taking a smaller step toward expanding federally financed insurance plans, such as instituting a public option which several newly-elected members have backed, may not be enough to satisfy those on the far left, he said.

Jayapal pushed back on the concept that the single-payer idea is unpopular in suburban parts of the country, noting recent polling that shows a majority of Americans support “Medicare-for-all.” She mentioned newly-elected Democrats from Orange County, California, like Katie Porter, Josh Harder and Harley Rouda, all of whom were backed by Jayapal’s recently-formed Medicare-for-all PAC.

“We have to change our notion of what wins in swing districts,” she said.

Progressive advocacy groups will be pressuring Democrats. Progressive Change Campaign Committee co-founder Adam Green said lawmakers should vote on a “Medicare-for-all” bill next year even if it would fail. The House could also hold votes on a public option plan or changes to the health law, he said.

“The advice we’ve given to House leadership is to beware of a lowest common denominator agenda,” he said, adding, “Let’s pass things that will pass the House but are almost certain to die in the Senate so there’s a bright North Star in the sky for 2020 voters signaling what Democrats would do if given more power.”

Presidential primary

Democrats are certain to talk about expanding coverage in some way over the next two years as the 2020 primary elections near. While some likely candidates back a government-run single-payer plan, others support smaller steps, like creating a public option or allowing adults between the ages of 55 and 65 to buy into Medicare.

David Kendall, senior fellow for health and fiscal policy at Third Way, a center-left think tank in Washington, said Democrats could face a challenge if a single-payer plan is seen as the “dominant position” for the party.

But if the debate is about “competing ideas about how to get to universal coverage and cost control, then I think it’ll be okay,” he said.

In the Senate, Democrats have offered at least six bills ranging from a Medicare buy-in proposal from Sen. Debbie Stabenow of Michigan to a “Medicare-for-all” single-payer plan from independent Sen. Bernie Sanders. Several senators seen as likely presidential candidates have either offered their own plan or signed on to one or more proposals.

Take Sen. Cory Booker, who is expected to enter the primary fray. He has co-sponsored six bills that would expand on the health law. Sen. Kamala Harris has signed on to five, while Sen. Kirsten Gillibrand co-sponsored four of the measures.

Trump and other Republicans have already begun attacking “Medicare-for-all,” warning of tax hikes and seniors losing their current Medicare coverage. If Democrats further push the proposal, it’s likely that health industry groups and other groups will strongly resist it, too.

The primary stretch could give Democratic candidates a chance to truly define what a “Medicare-for-all” policy means, a process that Congress could mirror.

“The whole fact that we’re speculating on what it means means it ain’t ripe for legislative action yet,” said Rep. Gerald E. Connolly of Virginia.

New Lame Duck, Same Lame Congress: Congressional Hits and Misses

Get breaking news alerts and more from Roll Call on your iPhone or your Android.