Democrats Split on Sanders' Medicare for All Plan

Democrats Split on Sanders' Medicare for All Plan
Alex McIntyre/The Herald-Times via AP
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High-profile Democrats are lining up behind Sen. Bernie SandersMedicare for All plan before its Wednesday release, leaving little doubt about where the base of the party stands on the issue of health coverage well ahead of what already figures to be a robust presidential primary. 

More than a quarter of Senate Democrats, including several thought to already be laying the groundwork for 2020 presidential bids, have signed on to co-sponsor the single-payer legislation, a concept Sanders championed in his unsuccessful campaign for the party’s nomination. 

Sanders’ plan calls for a federally run, federally funded health care program providing comprehensive coverage for Americans of all ages and incomes. 

“I’ll be fighting with Bernie,” said New York Sen. Kirsten Gillibrand in announcing her support on Tuesday, noting she added a provision to Sanders’ bill to allow individuals to buy into a public health insurance plan during the transition to single payer.  

But while backing the proposal may be good politics for Democrats in the next presidential primary, it could cause division in the more immediate 2018 midterm elections as Democrats seek to retain Senate seats in states won by President Trump and hope to compete for the House majority. The proposal also comes as some Senate Republicans make a last-ditch attempt to repeal the Affordable Care Act before the end of the month while a bipartisan group negotiates a potentially small package of changes to the current law. 

House Minority Leader Nancy Pelosi said Tuesday she was focused on “protecting the Affordable Care Act” rather than pushing for Medicare for all. Whip Steny Hoyer added: “We ought not to divert our attention from the immediate objective.” 

Democratic Senate Leader Chuck Schumer was non-committal about Sanders’ proposal on Tuesday. “There are many different bills out there,” he said. “We're looking at all of these.”

The vast majority of Democratic senators up for re-election next year have also shied away from backing Sanders’ bill. Only Tammy Baldwin of Wisconsin has signed on, endorsing the plan Tuesday and featuring the news on her campaign website. Republicans wasted no time going after her. “A $32 trillion socialist health care system is the last thing Wisconsinites want or need,” said National Republican Senatorial Committee Communications Director Katie Martin, citing an Urban Institute study estimating the costs.  

Republicans, stinging from their unsuccessful attempts to repeal and replace Obamacare after years of campaigning to do so, have already seized the opportunity to weaponize Democrats’ support for a single-payer system. Republicans concerned about voters’ frustration at their failed health care efforts plan to attack Democrats on single-payer to energize their base supporters.  “This idea is good for whipping up the far-left base – and bad for everyone else,” wrote Wyoming Sen. John Barrasso in an op-ed.

The pressure is already palpable. When Republicans put a single-payer amendment to the floor in July as a way to put Democrats on record, four red-state senators facing tough re-election bids next year voted against it: Joe Donnelly of Indiana, Heidi Heitkamp of North Dakota, Joe Manchin of West Virginia, and Jon Tester of Montana. Sanders and Democrats voted “present,” arguing that the amendment was a political stunt.

Sanders knows his proposal does not stand a chance of becoming law so long as Republicans control Congress, which helped garner support from Democratic lawmakers who face few political consequences in backing a bill that won’t become law in the near future. In addition to Gillibrand, co-signers now include Sens. Kamala Harris of California, Cory Booker of New Jersey, Jeff Merkley of Oregon, Brian Schatz of Hawaii, Sheldon Whitehouse of Rhode Island, and Ed Markey and Elizabeth Warren of Massachusetts. 

“It's clear that's the future direction of the party. This is how big ideas like expanding Social Security and debt-free college were moved into the mainstream,” said Adam Green, co-founder of the Progressive Change Campaign Committee. “The North Star gets put up, solid organizing is done, critical mass is built in Congress and on the campaign trail, and party consensus falls into place. It's happening now. Democrats are increasingly wrapping themselves in the flag of Medicare for All.”

A recent Pew survey found that 52 percent of Democrats say health insurance should be provided through a single insurance system run by the government, marking a 9 percent increase in support for such a program since January, and a 19-point increase since 2014. Support among liberal Democrats is higher, with 64 percent backing a single-payer program.

And in another sign of the changing politics, former Montana Sen. Max Baucus, an architect of the Affordable Care Act, said recently, “We’ve got to start looking at single-payer.” As chairman of the Finance Committee, Baucus was key in crafting health care plans in 2009, when Democrats had control, and saw single-payer as a non-starter in his quest to secure bipartisan support for legislation. But last week, Baucus said Congress should start hearings. “We’re getting there. It’s going to happen,” he said at an event at the Montana State University.  

"The growing momentum for Medicare for All is a remarkable turnaround for an idea that was deemed too radical to even debate eight years ago,” said Charles Chamberlain, executive director for Democracy for America, a group led by former presidential candidate Howard Dean.

But not all Democrats are ready to sign on to Sanders’ proposal. Connecticut Sen. Chris Murphy, a fierce defender of Obamacare and also considered a rising party star, is proposing a universal Medicare buy-in, legislation he sees as a bridge to universal coverage.

The plan would allow “individuals to make the choice for themselves as to whether they want to get into a single-payer system, and may in some ways be a quicker way to get to a single-payer system, and it might be a more politically viable option in the short term while Bernie and others build support for a single-payer bill sometime down the line,” Murphy told RealClearPolitics. Another senator, Hawaii’s Schatz, is proposing a buy-in program for Medicaid. 

Other than Baldwin, senators up for re-election have so far declined to sign onto Sanders’ bill. Debbie Stabenow of Michigan and Sherrod Brown of Ohio have proposals that would allow individuals 55 and up to buy into Medicare (the current age requirement is 65). Hillary Clinton campaigned on a similar “Medicaid for More” plan as an alternative to supporting a single-payer system.  

“This is the next major expansion,” Brown said of his proposal to open up Medicare. “I don’t fault anybody for going different places, but this is the most practical, sellable, sensible way to expand health insurance for people.”

Bob Casey of Pennsylvania argued for an implementation of a public option for Medicare, and said he would need to see the legislation and attend hearings before considering Sanders’ bill. Heitkamp said Tuesday she preferred making Obamacare work better; Manchin said his priority was fixing Obamacare, but that he would look at all options down the road. Tester was clear that he wasn’t backing Sanders’ bill. 

 “I support fixing what we’ve got because I think that’s more likely to happen,” he said. 

Caitlin Huey-Burns is a national political reporter for RealClearPolitics. She can be reached at Follow her on Twitter @CHueyBurnsRCP.

James Arkin is a congressional reporter for RealClearPolitics. He can be reached at Follow him on Twitter @JamesArkin.

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