House Democratic leaders gave their liberal lawmakers what they wanted on health care. Now they’re fighting to keep “Medicare for All“ from devouring the party.
Progressives emboldened by this week’s bill rollout are vowing to turn up the pressure on fellow Democrats to back the single-payer blueprint and build momentum ahead of the 2020 election. That’s already creating headaches for top Democrats who fear the political blowback of the plan’s most liberal elements, including abortion funding and the elimination of most private health insurance.
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The leaders are trying instead to keep the chamber united behind popular but narrower proposals aimed at strengthening Obamacare and lowering drug prices. But Medicare for All has grabbed most of this week’s health care headlines and energized the party’s progressive base — leaving top Democrats to look for ways to avoid criticizing the bill publicly even as they express little enthusiasm.
“Everybody has the right to introduce a bill on any given issue,” said Rep. Hakeem Jeffries of New York, the Democratic caucus chair. “Our strategic focus remains on articulating our for-the-people agenda, centered on the concept of lowering health care costs.”
Rep. Anna Eshoo (D-Calif.), a close ally of Speaker Nancy Pelosi, brushed off the Medicare for All fanfare as simply evidence that the House “is a very big place — you’ve got 435 people and we all have ideas.”
“But there’s got to be a sense of order and priorities that have been out there in the campaign: Reducing drug prices, strengthen the ACA, all of that,” Eshoo added. “Those are consensus items because we not only campaigned on them, it was the No. 1 issue in every single congressional district.”
The leaders have long sought to avoid an intraparty clash on Medicare for All, first by committing in January to hold a pair of first-ever hearings on the proposal in an olive-branch offering to its rowdy left wing. But those hearings will be in two committees — Rules and Budget — that don’t have the power to send the bill to the floor.
Leadership will probably allow a third hearing in front of the more powerful Energy and Commerce Committee’s health subpanel, said Rep. Ben Ray Luján (D-N.M.), the fourth-ranking House Democrat.
But that appeasement strategy appears to have only further invigorated single-payer advocates inside and outside of Congress, who now want more concessions.
Liberal lawmakers are pressing for Medicare for All hearings in front of the full Energy and Commerce and Ways and Means committees — the chamber’s two main health care panels, both of which are helmed by lawmakers skeptical of the single-payer push.
Outside groups, meanwhile, are vowing to turn their fire on a range of Democrats whose support they view as essential to speeding the Medicare for All bill to a House vote over the next year.
“There will be growing pressure on Democratic leadership to urge their fairly out-of-touch Democrats, who did not really have to feel the dynamics of the 2018 election, to get with it and at least schedule hearings,” said Adam Green, a co-founder of the Progressive Change Campaign Committee, which maintains close ties to House progressives. “That is like, literally the least House Democrats can do … to keep peace in the land.”
Rank-and-file Democrats will have few places to hide, as supporters try to add enough co-sponsors to the legislation’s original 107 supporters to justify a floor vote. Reps. Colin Allred of Texas and Haley Stevens of Michigan — Democrats’ freshman class co-presidents — are among the early targets.
Rep. Pramila Jayapal of Washington state, a lead author of the bill, downplayed the prospect of a vote in the weeks leading up to the legislation’s release. But she told supporters Wednesday night she’s aiming for as many as 160 co-sponsors, and expressed greater confidence earlier this week about the odds of getting legislation to the floor this year.
“If I had to guess, I would say yes,” Jayapal said.
That’s touched off fresh anxieties among moderate Democrats fearful that the party’s leftward turn could cost them their swing-district seats — and the House majority.
“That’s one-fifth of our economy, so I don’t think we move there on a dime,” said Rep. Mikie Sherrill, a New Jersey freshman whose district went for Trump in 2016. “I want to know, any move we make, how it’s going to be paid for and how it’s going to be fair.”
One centrist Democrat prior to the bill’s introduction likened the prospect of voting on Medicare for All to the politically painful 2009 vote on cap-and-trade legislation that factored in Democrats losing the House the following year. Pelosi, the centrist member said, wouldn’t make vulnerable lawmakers walk the plank again.
Top Democrats feel the same way, with some dismissing the bill as a meaningless gesture that would divide the caucus and expose vulnerable swing-district members to a fresh wave of GOP attacks.
“I think there’s an electoral risk in trying to throw out bills that are $50 trillion,” said Budget Chair John Yarmuth of Kentucky. “I know that a lot of people want to move faster than we’re going to be moving, but they can get over it.”
And there’s little enthusiasm within the establishment for giving the bill more attention than necessary and risking raising thorny questions about legislation that would wipe out out employer-based health coverage amid a broader economic restructuring. That’s especially after Democrats retook the House on more modest promises to lower drug prices and strengthen the Affordable Care Act.
Meanwhile, House Republicans trying to recover from deep voter mistrust over their failed Obamacare repeal efforts are already trying to brand Medicare for All as the Democratic Party’s main health care vision.
“Now we know what’s available in the bill, and unfortunately it is perhaps even worse than we anticipated,” Energy and Commerce ranking member Greg Walden (R-Ore.) told reporters, pointing to the proposed elimination of private health insurance and the tax increases probably required to pay for the plan. “This is obviously a huge priority for them to have a full federal takeover of the system.”
Yet Democratic leaders remain wary of stifling a progressive wing that’s fueling voter enthusiasm and is made up of members with no qualms about speaking their minds.
“The worst thing that anyone could do — an outside group or leadership on the Hill — is to shut the conversation down entirely,” said Brad Woodhouse of Protect Our Care, the pro-Obamacare group that works closely with leadership on health care messaging. “The American people in the end, in elections, will make a judgment not about the differences within each party, but about the differences between each party.”
Top progressive leaders sought as well to prevent any rifts from bubbling up by showering praise on Democratic leadership following the bill’s introduction.
“She seems very happy with what we’re doing,” Mark Pocan (D-Wis.), a leader of the Congressional Progressive Caucus, said of Pelosi. “And we know maybe not everyone in the caucus is there yet, but the good news is it’s our job to show everyone that this is what people across the country want.”
Still, Democratic leaders took pains this week to downplay the bill’s significance, characterizing it as just another idea to add to the growing pile of ambitious Democratic health care proposals.
They’ve consciously tried to redirect the hype over single payer toward more the inclusive calls for “universal health care” that the party believes will play better in key districts.
“It’s a conversation about ideas, of what we can get done,” Lujan said. “Our larger goals, which are universal coverage, greater access to affordable quality care — that’s what we should be talking about.”
Moderate Democrats are mounting their own health care push too. Two hours after progressives introduced the Medicare for All bill, the centrist New Democrat Coalition rolled out a set of priorities backed by the group’s 101 House members. The aims are more modest, they allowed, but also more practical.
“There’s a lot of reality to come in terms of where the rubber hits the road — the practical, pragmatic approach to how we get from here to universal coverage,” said Rep. Ann Kuster (D-N.H.), a co-chair of the New Democrats’ health care task force. “There’s not a switch in Washington, D.C., where we go from here to there.”
Still, the leaders have yet to roll out major legislative packages either expanding Obamacare or slashing drug prices — delayed by internal policy debates and a resolve to methodically move bills through the House committees.
That’s frustrated some who hoped to make quicker progress on signature issues for Democrats this Congress, two individuals familiar with the discussions said, especially after a government shutdown consumed the opening weeks of the session. Others have countered that it’s imperative to get the policy right first if it’s going to have maximum political impact.
“We’re going to give our members the opportunity to say that they’re voting for strong legislation that would lower health costs, protect pre-existing conditions,” a senior Democratic aide said. “To have our own conversation about the things House Democrats are doing and the things Senate Republicans are standing in the way of.”
Medicare for All advocates are stepping into that vacuum in the meantime to build the case for their bill. Democratic leadership has given progressives plenty of leash to push single-payer health care into the mainstream, liberal lawmakers said, praising Pelosi in particular as a key ally. But the high-volume Medicare for All push in Congress is much closer now to the beginning than to the end.
“Some people are inherently afraid of everything,” Pocan said. “But the fact that every presidential candidate who’s running across the country — and has to run in red states and blue states — is talking about Medicare for All tells them that they can probably return the box of Depends they bought and be comfortable that this is an issue the public supports.”