The Republican Party’s failure to pass a health care bill has left most Democrats overjoyed, confident now that former President Barack Obama’s landmark Affordable Care Act will remain law for the foreseeable future. But not everybody in the party is satisfied.
A small but growing group of liberals – some of them leaders in the Democratic Party -- are already pushing their colleagues to embrace a more progressive vision for health care.
At the top of this band of activists’ wish list is a radical change, converting the country into a so-called single-payer system that would act much as Medicare does for people 65 and older. But they’re also pursuing a series of smaller objectives, including letting people who sign up for the ACA’s state-based exchanges enroll in a government-backed plan, known as the public option.
It’s a debate that’s likely to shape the Democratic Party for years to come, as its leaders grapple with the issue’s deep political risks – a lesson many of them learned well after Obamacare passed in 2010 and immediately became a focal point of GOP attacks.
As former presidential candidate and liberal icon Bernie Sanders put it, the ACA is “far, far, far from perfect.”
“We have got to have the guts to take on the insurance companies, the drug companies, and move forward toward am Medicare for all, single-payer program,” the senator from Vermont said on MSNBC after the GOP’s health care bill died in the House. “And I’ll be introducing legislation shortly to do that.”
A Sanders spokesman confirmed the senator will introduce single-payer legislation in the coming weeks, similar to measures he’s previously pushed.
Even before the implementation of Obamacare, most Democrats dismissed serious talk of creating a single-payer system. Many in the party feared the politics of an enormous expansion of government and the disruption it would bring to the health care market.
Progressive activists now wonder if the political calculus has shifted in their favor. To them, the failure of the GOP plan supported by President Donald Trump – the American Health Care Act – was proof that the public will reject any plan that reduces coverage.
That leaves only one option for health care reform, these Democrats argue: legislation that increases government involvement and coverage for the poor and uninsured.
“We’ve check-mated Republicans,” said Kaitlin Sweeney, spokeswoman for the Progressive Change Campaign Committee. “The only choice is to go for a forward looking solution that lowers costs improves care and covers everyone. And that’s Medicare for all.”
Absent a plan for change, she added, Democrats will be forced to defend an unpopular existing system that will anger moderates and underwhelm the party’s base.
“Sticking with a defensive posture and just protect the status quo is not going to be something that fires up voters in 2018 or 2020,” Sweeney said. “It’s not something you can hold to as an effective strategy to go after Republican.”
Taking a progressive stand on health care is something liberal activists plan to make a campaign issue in next year’s congressional elections. The PCCC on Tuesday is sending its members a petition demanding that all 2018 Democratic candidates pledge to “publicly support and run on Medicare for all.”
On the surface, at least, polls suggest that the public is open to such an enormous overhaul. A 2016 survey from Gallup found that 58 percent of Americans supported replacing the ACA with a federally funded system that provided insurance to everybody.
That same year, a poll from the Kaiser Family Foundation found that 64 percent of adults had a positive reaction to the expression “Medicare for all.”
Of course, the same poll found that only 44 percent of people had a positive reaction to “single-payer” and just 38 percent to the term “socialized medicine.”
And therein lies the rub for some Democratic strategists, who say a bold change to the health care system can, politically speaking, look good on paper but be much more difficult in reality.
They don’t have to look far for a relevant example. Obamacare, whose changes to the health care system were relatively small compared to those involved in a switch to a single-payer system, turned into a political nightmare for the party after its passage in 2010.
It became a marquee issue again four years later, in the 2014 midterm elections, after a difficult public rollout caused even President Obama to say his administration should have performed better.
“It might be popular to say Medicare for all,” said Rodell Mollineau, a Democratic strategist. “It becomes much more difficult when you talk about implementing such a large government program.”
To Democrats like Mollineau, Sanders introducing single-payer legislation makes some sense as a long-term effort if the party can gradually convince the public, over a period of decades, that it’s the right option.
In the short term, however, Democrats don’t have the votes in Congress to pursue legislation of any kind. And as recently as 2010, it didn’t even have the ability to incorporate a public option in Obamacare because of the resistance of some centrist and conservative Democrats.
These strategists also say Republicans may try again to pare back the ACA, either now or in the coming years. The party’s main objective should be trying to bolster and protect the law, not build on top of it controversial new measures.
“I don’t think the war is over,” said Mollineau. “And that should be our no. 1 goal, to protect what we as Democrats all believe in and worked very hard to enact in the first place.”
Alex Roarty: 202-383-6078, @Alex_Roarty