WASHINGTON — As dozens of Democratic lawmakers unveiled their Medicare for All bill on a cold, late February day, 16 million Americans turned their eyes to Capitol Hill. Unfortunately for those Dems, the eyes were aimed a few hundred feet away at Donald Trump’s former lawyer Michael Cohen testifying before the House.
Being on the losing end of a big news day may be a fitting start for the bill. While universal health care has become perhaps the most energizing cause in progressive grassroots circles, party leadership in Congress is focusing elsewhere. The biggest short-term barrier to Medicare for All getting a floor vote isn’t Republicans, it’s convincing their own side to take it up.
After passing the Affordable Care Act in 2010, Democrats were hammered at the ballot box for years until disastrous Republican attempts to repeal or otherwise kill Obamacare finally flipped the switch. Even Republicans concede health reform cost them control of the House last year. Many Democrats, particularly those in swing states and districts, do not want to risk throwing that advantage away by spooking middle-of-the-road voters with ambitious reforms, several Democratic politicians and staff told BuzzFeed News.
“I don’t think [Medicare for All] plays that well. Health care in general plays well but people are concerned with it. They want options, I’ll put it that way,” said Alabama Sen. Doug Jones.
Asked about Democrats’ priorities for this Congress, a spokesperson for House Speaker Nancy Pelosi listed preexisting condition protections, repairing ACA sabotage, and improving the law. Focusing on fixing Obamacare allows Democrats to use tried-and-true messages about protecting people with preexisting conditions and Trump “sabotaging” the marketplaces (which has the benefit of being true).
It is in fact Republicans who are pushing to advance M4A in the House. They’ve sent a letter to Energy and Commerce Committee chair Frank Pallone asking him to hold hearings on the bill. Republicans in swing districts are cheering them on. “I hope my friends on the other side of the aisle do try to make this their signature issue,” said Republican Rep. Will Hurd of Texas’s very swingy 23rd District.
But Pallone, a Democrat, is more ambivalent. His committee has held hearings on 14 different bills to improve the current health care system, and that focus isn’t about to change.
“We’re going to look at all the different options,” he said. “We’ll be looking at Medicare for All, Medicare buy-in, public option, you know, a number of issues. But the main thing is to focus on stabilizing the Affordable Care Act.” (The M4A bill will be studied in the House Rules Committee, but going through Energy and Commerce is the route health care legislation would take to get to the House floor for a vote.)
The Democrats flipped 41 House seats last year, but only seven of those new members signed on to the Medicare for All bill. Some staffers speculate that Pelosi will want to avoid an M4A vote in the House to protect these vulnerable politicians from a politically tricky vote.
Medicare for All is a risky sell. Polling shows a majority of people support the idea, and it becomes wildly popular when they hear arguments about eliminating premiums and guaranteeing health care as a right for all Americans. But the same polling also shows that attitudes swing dramatically when people hear negative arguments. When people hear arguments that M4A will threaten existing Medicare, raise taxes, or lead to delays for some treatments, it becomes deeply unpopular.
In other words, the Medicare for All debate will in large part come down to who can yell their message the loudest. Any movement toward universal health care would be barraged with attacks from industry groups that stand to lose billions of dollars. “You are going to see probably hundreds of millions of dollars flowing against this bill,” said sponsor Rep. Pramila Jayapal at the bill’s unveiling.
If anything, that could be a massive understatement. Last year the dialysis industry in California spent $110 million to kill a state ballot initiative that would have capped its profits. That’s one industry in one state. Universal health care would threaten the profits of insurers, doctors, drug manufacturers, hospitals, and more or less every powerful health lobby. If you do some back-of-the-envelope extrapolation of the California campaign to the whole health industry, you get a number in the tens of billions of dollars. There’s no historical comparison for what a media blitz that size would look like. With that much money you could fund both sides of a presidential election campaign several times over.
Democratic leadership wants to avoid being the target of a massive ad campaign and so far they have. There is little sign of the health industry mobilizing in panic. The industry spent $556 million on lobbying last year, which is a huge number but not far out of line with the $516 million per year in lobbying it has averaged over the past decade.
A slew of powerful industry groups have joined to fund the Partnership for America’s Health Care Future to promote free market policy ideas. The organization says it has “significant six-figure” funding and has produced a couple videos — not exactly a sign of an industry in existential crisis.
The executive director of Partnership for America’s Health Care Future is Lauren Crawford Shaver, formerly director of expansion state programs for the 2016 Hillary Clinton presidential campaign, and before that an Obama administration official.
“To be honest, I’m not,” she said when asked if she is worried about the Medicare for All bill advancing. “I think the will of that caucus does not actually want this.”
The bill gathered 106 cosponsors, which is short of the 124 cosponsors for a Medicare for All bill from the previous Congress when there were fewer elected Democrats. But Jayapal said her bill is in fact pacing well ahead of the previous M4A bill, which debuted with half as many sponsors.
She said she expects the hearings at the House Rules Committee to build momentum, which will eventually lead to the Energy and Commerce Committee taking it up — a key step in getting to a floor vote. “I believe we’ll get those hearings,” she said.
Even if they never get their floor vote during the 116th Congress, the 2020 presidential election could be the coming0out party for universal health care. High-profile presidential candidates Bernie Sanders, Elizabeth Warren, Kamala Harris, Cory Booker, and Kirsten Gillibrand have all adopted a universal health care platform. And aside from being a rallying cry on the left, universal coverage has grown to be surprisingly popular among Republicans.
Proponents are digging in for the long game. Medicare for All Caucus cochair Debbie Dingell said arguments against universal health care now are the same ones lodged against the passage of Social Security, Medicare, and the Children’s Health Insurance Program. She insisted that even if there is no vote on the M4A bill anytime soon, it is much more than just a messaging bill.
“We will travel the country, we will meet with every single stakeholder,” said Dingell. “You know, hard things don’t happen overnight.”
Rep. Pramila Jayapal's name was misspelled in an earlier version of this post.