Progressives try to have it both ways on Medicare for All - Semafor

Progressive Democrats are trying a tricky feat as their party takes power: endorsing Medicare for All while quietly pushing for smaller steps toward it.

Their dilemma began with the party’s remarkable midterm success. Democrats are united in attributing their electoral triumph in part to voter backlash against GOP healthcare moves — and this year, even purple-district candidates won while backing Medicare for All.

But now, the left is split on how to make it happen. Without a filibuster or veto-proof majority in Congress next year, Democrats are calibrating their expectations for change based on what can potentially pass through the maneuver known as reconciliation, which requires only a simple majority.

Some progressives are calling for a unified drive to lower the Medicare eligibility age, add guaranteed coverage up to age 19, and add dental and vision coverage. That could offer a middle ground for party leaders who are looking to stave off fights over bills likely to be vetoed by President Donald Trump.

Embracing a big step toward pure Medicare for All could also hand a victory to progressives who have long pushed for legislative action — if they can settle for something less than the litmus test they set up.

“It’s the perfect way for us to get ready for the next trifecta if we pass those three bills, and then if we mark up the entire Medicare for All bill,” said Rep. Pramila Jayapal, D-Wash., the lead sponsor of the House’s Medicare for All bill.

Others on the left may not be content with pushing off action on the marquee policy until later. An incoming cohort of progressives want to push their party to vote on the full government-run healthcare package now. Rep.-elect Melat Kiros, D-Colo., said the program was “one of our number one priorities.”

“I’ll never let perfect be the enemy of the good,” she added. “But if we’re not fighting like hell to actually get healthcare to every single American, then I don’t know what we’re doing here.”

Centrists wanted the party to work towards consensus — a tall order for Democrats. Quite a few in the caucus want the party to focus on the underlying drivers of healthcare costs before considering a system where taxpayers pay for all healthcare.

“I think we should talk more about cost and less about coverage,” said Rep. Jake Auchincloss, D-Mass.

Democratic leaders have said they would need to have a “family conversation” on their path forward; a working group led by Reps. Alexandria Ocasio-Cortez, D-N.Y., and Terri Sewell, D-Ala., laid out a menu of options that included Medicare for All alongside many other proposals.

“Are we messaging or are we getting something done?” said Rep. Adam Gray, D-Calif., a member of the moderate Blue Dogs. “We know that we have broad agreement that we want healthcare to be affordable, that we want it to be accessible … and that every American should have it, and so what are the solutions we can get agreement on to do that?”

Democrats across the ideological spectrum have coalesced around their healthcare agenda in the near term. After relentlessly campaigning on reversing GOP-enacted Medicaid cuts and restoring lapsed health care subsidies, Democrats plan to put those up for a vote.

They may even use the issues as leverage in the looming December government funding fight.

“I think everything should be on the table,” said Rep. Glenn Ivey, D-Md. “It’s important for us to make sure we listen to and respond to the message of the voters, and I think they want to really get relief.”

Rep. Kim Schrier, D-Wash., said that she wants both of those priorities to advance, but cautioned that “we still have the same president in the White House.”

Across the Capitol, Sen. Bernie Sanders, I-Vt., is pushing to use reconciliation to immediately advance his bill to lower the Medicare eligibility age to 55, add dental, vision and hearing coverage to the federal health insurance program for seniors, and ensure universal coverage for children through age 19.

Sanders already has one powerful ally: Sen. Ron Wyden, D-Ore., the expected chair of the Senate Finance Committee, said he wants “to push for the boldest, best bill possible.”

“I’m not taking anything off the table,” Wyden said, when asked about whether he supported using reconciliation to advance the legislation.

Other senators are already calling for a more moderate approach.

On Tuesday, Sen. Tammy Baldwin, D-Wis., introduced a bill that would lower the Medicare eligibility age to 50 and allow adults to buy into traditional Medicare or Medicare Advantage plans.

The legislation would allow adults eligible for Affordable Care Act cost-sharing subsidies and premium tax credits to continue to use such assistance to help make Medicare plans more affordable. But it would not give adults taxpayer-funded Medicare before they turn 65.

Democrats are going to eventually grapple with what exactly “Medicare for All” means to the disparate factions in their caucus.

While Republicans will be quick to paint any effort as a first step toward implementing a single-payer healthcare system that replaces private insurance, the truth is more complicated. The reality is that very few Democrats on the campaign trail explicitly called for the enactment of a single government-run insurance plan.

But with dozens of Democrats expected to launch presidential campaigns over the coming year, supporting universal healthcare coverage may quickly become, yet again, an up-or-down question for primary voters.