‘Medicare for all’ opens up Dem divide

The embrace of “Medicare for all” legislation by top 2020 Democratic presidential candidates has opened up a rift in the party. 

Democrats highlighted health care in the 2018 midterm elections and reclaimed the House majority by picking up 40 seats. But their message was focused on protecting ObamaCare, not implementing a single-payer system — which is favored by progressives. Some on the left maintain that backing Medicare for all legislation is a must for anyone who wants to secure the Democratic presidential nomination in 2020. 

{mosads}Sen. Kamala Harris (D-Calif.) this week attracted headlines when she told a CNN town hall she wants to eliminate private insurance in an effort to move fully toward Medicare for all. 

Former Starbucks CEO Howard Schultz, a one-time Democrat who may run for president as an independent, labeled Harris’s call to eradicate private insurance companies “not American.” Former New York City Mike Bloomberg, who is considering a 2020 run in the Democratic primary, said eliminating private insurers would “bankrupt” the country. 

While other White House hopefuls agree with Harris, top Democrats in Congress — including Speaker Nancy Pelosi (Calif.) — are urging caution. Leadership wants to shore up ObamaCare, and other Democrats support incremental alternatives to Medicare for all.

“I think we want to move toward a universal health care system, but we’re nowhere near it, because look at how long it’s taken us to start the process of straightening the ACA [Affordable Care Act] out,” said Rep. Bill Pascrell (D-N.J.), a senior member of the House Ways and Means Committee. “We only have a certain amount of the day, and we only have a certain amount of energy. We’re not super people. So let’s make the ACA better. We should concentrate on that now that we are the majority.”

But the support from the surging left could put pressure on moderates and Democratic leadership in Congress, setting up a showdown over what was once considered a fringe policy proposal.

“I do think there would be an intellectual [disconnect] if the entire Democratic field is running on Medicare for all, or at least a lot of the stars are, and we don’t take action here in the House,” liberal Rep. Ro Khanna (D-Calif.) said in an interview.

Rep. Pramila Jayapal (D-Wash.), co-chairwoman of the Congressional Progressive Caucus (CPC), told The Hill she plans to introduce her Medicare for all legislation during the second week of February. 

She has commitments from the Budget and Rules Committees to hold hearings on various Medicare expansion proposals. But Jayapal lacks commitments from the key committees with health care jurisdiction — Energy and Commerce and Ways and Means. 

{mossecondads}In the previous Congress, the leading Medicare for all bill attracted a record 124 co-sponsors in the House. Despite its momentum, it doesn’t have the votes to pass on the House floor and would be dead on arrival in the Republican-controlled Senate.

Regardless, Jayapal and CPC co-chairman Rep. Mark Pocan (D-Wis.) want to turn up the pressure. The goal is to convince other members that “their constituents want this; they should also support their constituents,” Pocan said, acknowledging supporters need to spend more time educating the American public about what exactly “Medicare for all” means. 

Republicans have pounced on Democrats’ division, highlighting former President Obama’s promise in the lead-up to the passage of the ACA that if people liked their health care plan they could keep it. Now, Republicans are warning that if single-payer passes, people will not be able to keep their private plans.

Political analysts say Democrats will need to have a major debate about how to pay for a single-payer system, whether it’s Medicare for all or something else. Medicare for all has been estimated to cost $32 trillion over 10 years in federal spending, but proponents say it would lead to a reduction in overall health care spending. 

Vermont was the first state to try to implement single-payer, but it failed in 2014 because the state couldn’t figure out how to pay for it. 

Even Democrats who support universal health care are far from united on the issue of Medicare for all and eliminating private insurance. There are eight separate proposals from Democratic lawmakers that would push health care toward single-payer, either in a complete change to Medicare for all or some incremental shift, such as allowing 50-year-olds to buy into Medicare.  

Rep. Brian Higgins (D-N.Y.) is the lead sponsor of a bill to allow anyone aged 50 to 64 to buy into Medicare, a version of a proposal first floated by former President Clinton in the 1990s. Higgins said his bill could be a bridge to Medicare for all.

All the different proposals “push us toward the same goal, but there’s a reality that has to be taken into consideration and that is that an attempt to fundamentally change a $3 trillion industry is going to take some time. We better be careful,” Higgins told The Hill. 

Harris’s spokeswoman said she supports many proposals to expand access to health care, but her preference is Medicare for all. 

Eliminating private and employer-sponsored health plans is a key part of Sen. Bernie Sanders’s (I-Vt.) Medicare for All bill, which is co-sponsored by announced presidential candidates Elizabeth Warren (D-Mass.), Kirsten Gillibrand (D-N.Y.) and Harris. Sen. Cory Booker (D-N.J.), who is considering a presidential run, also supports it. Former Rep. Beto O’Rourke (D-Texas), another possible 2020 candidate who fell short last year in his Senate bid, did not co-sponsor the House single-payer bill but has said he backs the Sanders measure.

Sen. Amy Klobuchar (D-Minn.), who is mulling a 2020 bid, prefers starting with a Medicare buy-in.

“I would suggest you start with age 55, by the way, instead of doing it so drastically in just a few years and changing our entire insurance system where over half of Americans get private insurance,” she said on CNN on Tuesday.

Recent polling finds that there are wide swings in support and opposition to the idea of Medicare for all, depending on how the question is asked. When people are told that Medicare for all would “guarantee health insurance as a right for all Americans,” support shoots up to 71 percent. But when people are told that the proposal would “require most Americans to pay more in taxes,” support plummets to 37 percent.