The Democratic takeover of the House leaves members facing a crossroads over how far left they will go on healthcare.
Minority Leader Nancy Pelosi of California and other top Democrats have said they plan to focus on fixing Obamacare and on lowering the cost of prescription drugs, but the majority of rank-and-file House Democrats support the Medicare for All Act, a bill that would overhaul the healthcare system by rolling every person in the U.S. into Medicare.
Though the bill does not have a shot at advancing through Congress, given that the Senate is under Republican control, holding hearings or even votes on the bill could help signal to the public that the party intends to seek a fully government-funded healthcare system should Democrats take the White House and Senate in 2020.
At the helm of the “Medicare for all” movement in the House is Rep. Pramila Jayapal, co-chair of the Medicare for All Caucus who is also set to be the lead sponsor of the Medicare for All Act. One of her aides acknowledged there were detractors to single payer, but said the new House makeup could help draw attention to the policy, often referred to as single-payer healthcare.
“We are going to continue to have hearings and use it as an opportunity to educate members, staff, and the public about what ‘Medicare for all’ means,” the aide said.
Democrats making a bid for leadership slots are divided on the issue. Rep. Diana DeGette, D-Colo., is running for the No. 3 leadership spot as Democratic whip against Rep. James Clyburn, D-S.C., and both are co-sponsors of the bill. Rep. David Cicilline, D-R.I., running for assistant majority leader, has signed his name to the legislation, counter to those running against him. Candidates for Democratic Caucus Chair, Reps. Barbara Lee, D-Calif., and Hakeem Jeffries, D.N.Y., also are co-sponsors.
But those at the highest levels have not signed on to the bill, including Pelosi and Democratic Whip Steny Hoyer of Maryland.
Pelosi, who is running for speaker and shepherded Obamacare to passage almost a decade ago, stressed in a press conference after the election that her party would be focused on tackling drug prices and keeping in place rules that insurers must cover people with pre-existing illnesses.
Hoyer, who is running for majority leader, echoed similar sentiments.
“We are focused on strengthening the Affordable Care Act and defending against Republicans’ attacks on our healthcare system, including protections for people with pre-existing conditions,” Hoyer said in a statement provided to the Washington Examiner, referring to the formal name of Obamacare. “We will be working with the committees of jurisdiction, holding hearings, and following regular order to accomplish those objectives.”
Pelosi’s office did not respond to a request for comment, but this summer she cautioned that healthcare proposals would need to be evaluated for affordability and access, adding, “It’s all on the table.” In September, she said single-payer was not a litmus test for Democrats.
Rather than pursue an overhaul of the healthcare system, Democrats may prefer to commit hearings and votes to setting up Republicans for tough decisions on drug prices, a policy priority for the Trump administration, or for demonstrating their support for protecting people with pre-existing illnesses. Such a vote is already expected early next year.
National Nurses United, an organization that has appeared alongside Sen. Bernie Sanders, I-Vt., as he introduced his single-payer proposals over the years, said it hoped Democrats would go further.
“We will encourage anyone running to not only signal their support for this bill, but actually show some leadership to want to get it passed into law,” said Ken Zinn, the group’s political director.
Despite a lack of buy-in from leadership, a large number of Democratic House members have backed single-payer healthcare. The Medicare for All Caucus, formed in July, had 66 founding members, and before the election, 123 Democratic representatives were supporting the Medicare for All Act.
These numbers are set to change under the new Congress, and certain members that drew substantial media attention are coming into office vowing to pursue such a healthcare system, including Alexandria Ocasio-Cortez of New York, Ilhan Omar of Minnesota, and Rashida Tlaib of Michigan.
“They have been very great leaders on it, and we expect them to come in and put a lot of energy into the campaign,” Zinn said.
Several rumored 2020 presidential hopefuls also are behind single payer, including Sens. Elizabeth Warren of Massachusetts, Cory Booker of New Jersey, Kamala Harris of California, and Kirsten Gillibrand of New York. Taking action in the House helps to signal to voters where Democrats stand and how the legislative branch will work with a future executive supportive of its causes.
“Generally speaking there are all these things in place that are going to push the conversation forward,” Jayapal’s aide said. “It’s not going to stagnate. There is real energy behind this issue.”
Medicare currently has about 55 million enrollees, which include people 65 and older as well as people who are disabled. The “Medicare for all” plan would move all people in the U.S. from private health insurance, Medicaid, and being uninsured to being covered by the Medicare program.
The policy has gained more support from the public in recent years, polls show, though favorability drops off when respondents are asked about related trade-offs, such as higher taxes. And it wasn’t a winning cause for all candidates. Rep. Beto O’Rourke, D-Texas, a vocal single-payer proponent, failed during the midterms to unseat Sen. Ted Cruz, R-Texas.
The proposal will face backlash from the medical industry, including hospitals, and from Republicans. The Trump administration has signaled it will continue to attack Democrats politically over the Medicare for All Act. Seema Verma, the Administrator at the Centers for Medicare and Medicaid Services, has said that “Medicare for All” would end up translating to “Medicare for None.”
Rather than single-payer, Pelosi has long backed the creation of a public option to compete against private health insurers. Other Democrats, including in the Senate, have embraced this option.
Jayapal’s aide said it was possible to work on other policies, including prescription drug pricing, as steps toward single payer, but an incremental approach was shunned by National Nurses United.
“It’s a great opportunity to push Congress to take up ‘Medicare for all’ as the only serious solution to the ongoing healthcare crisis,” Zinn said of the House makeup. “The current crisis is a systemic crisis. It’s not fixable by a patch here and a patch there.”
Editor’s note: Story updated to show correct number of Medicare enrollees.
