Democrats paper over rifts at 'Medicare for All' hearing

House Democrats on Tuesday turned a potentially divisive "Medicare for All" hearing into a high-profile show of solidarity, making a forceful case for universal health care and casting Republicans as the main obstacle to improving the nation’s medical system.

The Rules Committee session, the first to examine single-payer health care in a decade, skirted the Democrats’ deep divisions over how far left to veer in pursuit of guaranteed health coverage.

Instead, Democrats who've spent much of this year mired by infighting closed ranks to amplify the party’s broader ambitions on a critical political issue ahead of the 2020 elections — and blunt GOP attacks over Medicare for All’s cost and government expansion.

“We’re spending an awful lot on health care right now, and we’re not getting the services and the effectiveness that we’re all demanding,” Rules Committee Chairman Jim McGovern said at the outset of the hearing, which was briefly attended by Speaker Nancy Pelosi. “I’d like to think we all believe we can do better.”

The show of unity could be short-lived. National Nurses United — which is closely allied with the Congressional Progressive Caucus — quickly seized on the hearing to urge Pelosi to bring Medicare for All legislation to the House floor for a vote.

That rallying cry threatens to intensify in the coming weeks. The Congressional Budget Office will publish an analysis Wednesday on the single-payer concept, and House Budget Chairman John Yarmuth told POLITICO his panel will hold its own hearing on Medicare expansion proposals in late May.

House Ways and Means Chairman Richard Neal on Tuesday promised Progressive Caucus co-chair Pramila Jayapal an eventual hearing on Medicare for All as well — marking a major win for progressive Democrats who have proven increasingly willing to flex their muscle in pursuit of liberal priorities.

And on the campaign trail, Medicare for All is taking on a heightened profile as competition within Democrat’s crowded presidential field heats up.

Sen. Bernie Sanders, a top presidential contender, has vowed to jam a single-payer bill through Congress if he’s elected — dismissing more incremental coverage expansions as insufficient. Vice President Joe Biden, perhaps Sanders’ main Democratic rival, is embracing the more moderate concept of a public health insurance option that would keep the current system of employer-sponsored insurance intact.

House Democratic leaders have sought to keep the party’s broader focus elsewhere in the meantime, downplaying the significance of the Medicare for All hearing in favor of emphasizing more immediate health care goals. Leadership, wary of complicating life for dozens of swing-district members essential to retaining the majority, has no plans to hold a Medicare for All vote, even as it’s sought to assuage a growing progressive wing.

Caucus Chairman Hakeem Jeffries and Vice Chairwoman Katherine Clark made no mention of Medicare for All at a press conference that coincided with the start of the hearing, instead focusing on the need to lower drug prices. They demurred when asked about the single-payer bill.

“Every single House Democrat supports the notion that we must strengthen the Affordable Care Act and protect people with pre-existing conditions,” Jeffries said.

“I think [Pelosi’s] placating some members of her own party,” said Rep. Tom Cole, the Rules Committee’s ranking Republican, noting the panel has little jurisdiction over health care legislation. “If it’s going to be a good faith effort on the speaker’s part, she’s going to have to let it go to the major committees.”

Still, progressive leaders, backed by an enthusiastic Pelosi, have made a show of tamping down tensions over single-payer ahead of a crucial few months for the party’s policy agenda. Jayapal, the lead sponsor of the Medicare for All bill, on Monday night disputed a report that liberal Democrats were unhappy with the lack of single-payer supporters testifying at the hearing. She later heralded the session as a “massive victory” in progressives' bid to build popular support for Medicare for All.

And Pelosi — who has questioned the merits of Medicare for All on multiple occasions — accompanied high-profile health advocate Ady Barkan to the hearing. Barkan, who has ALS, became a late addition to the witness list after he texted Pelosi about his desire to testify.

Using a text-to-voice computer program, Barkan made repeated appeals in favor of the single-payer system, contending that there’s little economic or political reason to oppose a plan that guarantees health care to all Americans.

“No more half measures, no more health care for some,” he said. “We should instead have a rational, fair, comprehensive social safety net that actually catches us when we fall.”

Democrats on the committee used the bulk of the hearing to make moral arguments in favor of the broad goal of coverage expansion — litigating the policy specifics and financial tradeoffs needed to achieve universal health care rather than banging the drum for a single plan.

“I think all are improvements over where we are today,” said Rep. Ed Perlmutter, who supports both Medicare for All and more incremental coverage expansions. “It’s a very important conversation for this nation to have.”

Republicans have pressed top Democrats to fully embrace Medicare for All, hoping to drive a wedge through the caucus over a plan that envisions a massive restructuring that could cost more than $30 trillion over a decade.

“The speaker has elevated this,” said Rep. Michael Burgess. “This is what the speaker wants us to be talking about.”

But with the plan having no chance in the Republican-controlled Senate, Yarmuth said the point of these hearings is to look ahead past the elections.

That’s not going to stop the GOP from highlighting the Democratic momentum behind Medicare for All, with lawmakers and the Trump administration eager to brand it as a socialist scheme that risks collapsing the nation’s health system.

Republicans during the hearing vowed to fight the plan, and slammed its supporters for trying to upend the current system in the space of just a couple years.

“This is a very partisan bill and I’m sure you know that most, if not all, Republicans in the House are going to vote against it,” said Rep. Debbie Lesko. “I don’t know why we’re doing this.”

Even some centrist Democrats expressed some reservations about political ramifications of pursuing another major health care overhaul.

“People are just afraid of change — they want to know how it’s all going to work and what it’s going to mean personally for them,” said Rep. Mary Gay Scanlon, a Rules Committee member who flipped her Pennsylvania district last year and favors strengthening the ACA. “I think we should put energy into getting things done that we can pass now, because people are hurting now.”

Progressives, though, pointed to the hearing as evidence that Democrats can juggle Medicare for All alongside shorter-term efforts to defend Obamacare without tearing apart its fragile caucus.

“I believe we can do great things here if we want to,” McGovern said. “We don’t have to be picking and choosing.”

Article originally published on POLITICO Magazine