Advocates acknowledge that a Medicare-for-all bill has never cleared Congress, let alone a single committee. But Jayapal, co-lead author Rep. Debbie Dingell (D-Mich.) and their 109 co-sponsors, who represent more than half of the Democratic caucus, argue the case for it has never been stronger. They cite data that the coronavirus disproportionately affected low-income Americans who lacked sufficient health coverage and had preventable preexisting conditions, and that millions of Americans lost their job-based health insurance as businesses shuttered.
What is different this time round is that their most formidable opponent is a president from their own party who won last year’s Democratic presidential primary after breaking from his rivals’ embrace of a single-payer health system.
“Throughout his campaign, the President did not support Medicare-for-all,” said a White House official, who spoke on the condition of anonymity to discuss a bill that had yet to be formally introduced. “He campaigned on his own plan and that is the plan the American people voted for. He is continuing to pursue his own plan, not Medicare-for-all.”
But the effort by the party’s progressive flank poses a predicament for a president who needs to hold his governing coalition together and who’s pledged to focus on “unity.” Allies fear the single-payer health-care bill will distract from Biden’s other priorities, with many Democrats and independents saying they’d prefer to keep their private health plans and Republicans heavily opposed to the idea.
“The polling for two years was very consistent,” added ALG Research’s John Anzalone, a pollster who advised Biden’s campaign. “The best way to approach this is to improve and build on the Affordable Care Act and pursue other health care steps … people are in love with their private health insurance.”
Biden will find himself on the same side as health-care industry lobbyists willing to spend tens of millions of dollars to protect their business interests; congressional Republicans eager to paint the legislation as an effort that will weaken existing Medicare benefits for seniors; and skeptical Democrats worried about risking the party’s narrow political edge in Congress.
Larry Levitt, the executive vice president for health policy at the Kaiser Family Foundation, which is unaffiliated with the health insurance company Kaiser Permanente, said that Dingell and Jayapal’s bill “has no clear path” to becoming law given Biden’s opposition. But he argued that its reintroduction “could still have important political implications” by pushing the president to stick to his other health-care commitments.
“President Biden campaigned on a Medicare-like public option and lowering the age of Medicare eligibility, but has not yet sent those proposals to Congress,” Levitt said. “The stronger the push for action on health care from the progressive wing of the party, the more pressure there will be on President Biden to carry out his health agenda.”
KFF in October 2020 found that 53 percent of adults supported the idea of a national health plan, although the organization halted polling on Medicare-for-all after Biden won the presidency. “There has consistently been majority support among the public for Medicare-for-all, but that’s before the inevitable lobbying onslaught from the health-care industry,” Levitt said. “Bumper sticker reform is always more popular than actual legislation.”
Still, Medicare-for-all champions say they’re not dissuaded by Biden’s expected resistance. “I think he gets nervous about going too far. But I’m too nervous about us not going far enough,” said Dingell. “And if we create the momentum in the Congress, he can’t ignore it.”
Thirteen Democratic committee leaders, including the chairs of the House budget, oversight and financial services panels, are joining the effort led by Dingell and Jayapal, who will hold a virtual kickoff event on Wednesday with colleagues, unions and progressive groups. The legislation also boasts backers like Rep. Alexandria Ocasio-Cortez (D-N.Y.) and Sen. Bernie Sanders (I-Vt.).
“Senator Sanders agrees with his colleagues in the House of Representatives that now more than ever, that we must guarantee health care as a human right,” said Mike Casca, a spokesperson for Sanders. “He will soon introduce Medicare-for-all legislation in the Senate.”
But many influential Democrats, including House Speaker Nancy Pelosi (D-Calif.), continue to distance themselves from the bill. House Energy & Commerce Chair Frank Pallone Jr. (D-N.J.) — whose committee hearing room is named in honor of former congressman John Dingell, Debbie Dingell’s deceased husband and a longtime Medicare-for-all sponsor — initially balked at scheduling a hearing on a single-payer bill in the last session of Congress.
Pallone’s committee is “where I’m very focused,” said Dingell, given that the wide-ranging panel helps oversee health-care legislation. “I’ve talked to Frank, I’ve talked to Anna [Eshoo, the California congresswoman who oversees the panel’s health subcommittee]. We’re going to have hearings.”
Pallone said he was committed to a hearing on Medicare-for-all, telling The Washington Post “the goal of universal coverage is going to be at the center of everything we’re going to do on health care.”
Biden and other centrist Democrats, meanwhile, have focused on touting health reforms contained in their $1.9 trillion American Rescue Plan, which passed last week and overhauls the Affordable Care Act’s insurance provisions.
“When I travel around my district talking about what it means for a family that was paying 20 percent or 25 percent of their income on premiums, to now having this legislation offering people great care at 8.5 percent of their income, it’s significant,” said Rep. Lauren Underwood (D-Ill.), referencing a bill she introduced that was included in last week’s stimulus package.
“I think the Medicare-for-all conversation was certainly important in the context of the Democratic presidential primary,” added Underwood, who flipped a district long-held by Republicans in 2018 and narrowly defended her seat last year. “At least in my community, people were very oriented around a solution that could pass and a solution that would make a difference in their lives.”
The bill’s champions insist that they’re taking both the short- and long-term approach.
“This has been a Dingell priority for a long time,” said Dingell, referring to the decades of work by her husband and deceased father-in-law, a former House Democrat who was also a Medicare-for-all champion. “The day John died, I made a promise to him that I would get it over the finish line somehow, some way, and I have every intention of doing it.”
