Rep. Nancy Pelosi, D-Calif. (Photo: Pelosi)
Speaker Nancy Pelosi is guiding House Democrats along a narrow path as she seeks to convince party progressives that the idea of providing Medicare for everyone in the U.S. is being taken seriously, while assuring moderates that the House won't move too far, too fast.
The House on Tuesday will gavel in the first-ever hearing on a sweeping Medicare for All proposal, an idea that's energized the Democratic left, which is pushing to make it a central part of the 2020 campaigns for the White House and Congress.
If private health insurers are one day put out of business by a government-run single payer health system, they may look back at Tuesday as the beginning of the end. Yet the bill coming before the House Rules Committee won't become law anytime soon and may never get a hearing in the committees that oversee Medicare.
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Rep. Pramila Jayapal of Washington State, sponsor of the legislation and a leader of the Democrats' progressive faction in the House, said she's playing the long game.
"This is first step but certainly not the last step," she said in an interview. "There is tremendous amount of attention coming to this issue because of the presidential candidates."
Sen. Bernie Sanders of Vermont, one of the leading contenders for the 2020 Democratic nomination has introduced his own Medicare for All bill in the Senate. Four of his Senate colleagues also seeking the Democratic nod, Kamala Harris, Cory Booker, Kirsten Gillibrand and Elizabeth Warren, have signed on as co-sponsors.
But some of the other candidates have stopped short of endorsing the replacement of private insurance plans with the government's Medicare program, which now covers those 65 and older. Former Vice President Joe Biden, Sanders' main competitor at this stage of the campaign, on Monday said he supported giving Americans an option to buy into a Medicare-based insurance plan.
In the House, Jayapal's bill has backing from 109 out of 235 House Democrats.
"From my read of the room, there isn't support for that proposal," said Rep. Ben McAdams, a freshman Democrat who represents a swing district in solidly Republican Utah. "I'm worried it causes more problems than it solves."
'Obamacare'
Pelosi and other House leaders are moving cautiously. They are promoting a bill to shore up the Affordable Care Act commercial health insurance rules and programs — "Obamacare" — and developing legislation to lower drug prices, while letting the debate on a more radical overhaul of the health system continue. The two committees with jurisdiction over Medicare haven't agreed to hold hearings and there is no push for a floor vote this year under discussion.
"Things are moving at a faster pace than some had anticipated and I think that's good," said Massachusetts Rep. Jim McGovern, the Rules Committee chairman and a supporter of the Medicare for All bill. "This is not being slow-walked, we are trying to ignite the discussion on this."
Some Democrats have said they prefer lowering the Medicare age to 55, allowing people to buy into the program or a public option to compete with traditional insurance. A group of liberals led by Connecticut's Rosa DeLauro and Illinois's Jan Schakowsky are introducing a bill that would allow traditional employer-based insurance to continue while enrolling the uninsured automatically in expanded versions of Medicare and Medicaid.
Quick Expansion
Jayapal's bill, H.R. 1384, is far more generous than that plan or the legislation proposed by Sanders.
It would expand Medicare to everyone over just two years and once in place would waive all co-pays, deductibles and premiums for the insured. Unlike Medicare now, it would cover long-term nursing home care. Private insurers would be banned from competing with the new Medicare for essential services but could offer new plans for elective procedures like plastic surgery, Jayapal said.
Jayapal and other supporters are focused on attracting more rank-and-file Democrats to the idea and addressing the qualms of their own leaders about embracing a concept that could cost tens of trillions of dollars while threatening the revenue of health providers and hospitals.
