The two committees withjurisdiction over Medicare haven't agreed to hold hearings andthere is no push for a floor vote this year under discussion.(Photo: Shutterstock)

Speaker Nancy Pelosi is guiding House Democrats along a narrowpath as she seeks to convince party progressives that the idea ofproviding Medicare for everyone in the U.S. is being takenseriously, while assuring moderates that the House won't move toofar, too fast.

The House on Tuesday will gavel in the first-ever hearing on asweeping Medicare for All proposal, an idea that's energized theDemocratic left, which is pushing to make it a central part of the2020 campaigns for the White House and Congress.

If private health insurers are one day put out of business by agovernment-run single payer health system, they may look back atTuesday as the beginning of the end. Yet the bill coming before theHouse Rules Committee won't become law anytime soon and may neverget a hearing in the committees that oversee Medicare.

Related: Medicare for All: Where the 2020 presidentialcandidates stand

Representative Pramila Jayapal of Washington State, sponsor ofthe legislation and a leader of the Democrats' progressive factionin the House, said she's playing the long game.

“This is first step but certainly not the last step,” she saidin an interview. “There is tremendous amount of attention coming tothis issue because of the presidential candidates.”

Senator Bernie Sanders of Vermont, one of the leading contendersfor the 2020 Democratic nomination has introduced his own Medicarefor All bill in the Senate. Four of his Senate colleagues alsoseeking the Democratic nod, Kamala Harris, Cory Booker, KirstenGillibrand and Elizabeth Warren, have signed on as co-sponsors.

But some of the other candidates have stopped short of endorsingthe replacement of private insurance plans with the government'sMedicare program, which now covers those 65 and older. Former VicePresident Joe Biden, Sanders' main competitor at this stage of thecampaign, on Monday said he supported giving Americans an option tobuy into a Medicare-based insurance plan.

In the House, Jayapal's bill has backing from 109 out of 235House Democrats.

“From my read of the room, there isn't support for thatproposal,” said Representative Ben McAdams, a freshman Democrat whorepresents a swing district in solidly Republican Utah. “I'mworried it causes more problems than it solves.”

Obamacare

Pelosi and other House leaders are moving cautiously. They arepromoting a bill to shore up Obamacare and developing legislationto lower drug prices, while letting the debate ona more radical overhaul of the health system continue. The twocommittees with jurisdiction over Medicare haven't agreed to holdhearings and there is no push for a floor vote this year underdiscussion.

“Things are moving at a faster pace than some had anticipatedand I think that's good,” said Massachusetts Representative JimMcGovern, the Rules Committee chairman and a supporter of theMedicare for All bill. “This is not being slow-walked, we aretrying to ignite the discussion on this.”

Some Democrats have said they prefer lowering the Medicare ageto 55, allowing people to buy into the program or a public optionto compete with traditional insurance. A group of liberals led byConnecticut's Rosa DeLauro and Illinois's Jan Schakowsky areintroducing a bill that would allow traditional employer-basedinsurance to continue while enrolling the uninsured automaticallyin expanded versions of Medicare and Medicaid.

Quick expansion

Jayapal's bill, H.R. 1384, is far more generous than that planor the legislation proposed by Sanders.

It would expand Medicare to everyone over just two years andonce in place would waive all co-pays, deductibles and premiums forthe insured. Unlike Medicare now, it would cover long-term nursinghome care. Private insurers would be banned from competing with thenew Medicare for essential services but could offer new plans forelective procedures like plastic surgery, Jayapal said.

Jayapal and other supporters are focused on attracting morerank-and-file Democrats to the idea and addressing the qualms oftheir own leaders about embracing a concept that could cost tens oftrillions of dollars while threatening the revenue of healthproviders and hospitals.

“It's easy for people to shoot arrows at something at top-linelevel but when you really look at the problems of the existinghealth-care system, you really realize how desperate the situationis and what a pocketbook issue health care is for so manyAmericans,” Jayapal said. “We do want this discussion on Medicarefor All to help drive the presidential race.”

2020 push

Given Republican control of the Senate and President DonaldTrump in the White House, Medicare for All advocates outsideCongress are similarly realistic.

“We certainly see that is not going to be moving in the Senate,”said Melinda St. Louis of the Public Citizen advocacy group. “Ourwork over the next two years is to build the legislative record, todo the grassroots organizing and to do a big push after 2020.”

St. Louis and other advocates say they won't be satisfied withjust two hearings in this Congress on the Medicare idea and will beworking to secure more sponsors and hearings in the powerful Waysand Means and Energy and Commerce committees.

“Having a hearing is progress but that's not the end goal. Wewant it ultimately to be enacted into law,” said Jean Ross,co-president of National Nurses United, a group that's longsupported Medicare for All.

Primary threat

Adam Green of the Progressive Change Campaign Committeeorganization has threatened to support a primary challenge againstWays and Means Chairman Richard Neal of Massachusetts if he refusesto hold hearings on the plan. The group also complained that Nealwas moving too slowly to demand Trump's tax returns.

Neal said Monday that his panel may at some point hold a hearingaddressing “expanded access” to heath care that includes discussionof Medicare for All.

Energy and Commerce Chairman Frank Pallone of New Jersey saidhis committee, which also has jurisdiction over Medicare, needs tostay focused on protecting Obamacare.

The GOP has been eager to use Medicare for All as a politicalweapon. “Democrats are fully embracing socialism and a completegovernment takeover of the American health care system. Democrats'radical plan will rip health care from 158 million Americans. Taxeswould skyrocket and access to care would slow to a crawl,” HouseRepublicans said in a statement Monday.

Industry opposition

Industry advocates are also escalating their attacks.

“The result would be a single, one-size-fits-all system forevery American – young or old, sick or healthy – that leads tolonger wait times and a lower quality of care for everyone, whilehealth care decisions are shifted away from doctors and patients topoliticians and bureaucrats in Washington,” said Lauren CrawfordShaver of the Partnership for America's Health Care Future, anhealth provider and insurance industry coalition.

Most of the Democrats who last November unseated Republicans togive their party control of the House haven't put their supportbehind Medicare for All, partly because it's seen as an aspirationrather than a practical solution to issues like rising healthinsurance premiums.

The divided Democrats skirmished last week about who wouldappear at Tuesday's hearing.

After grumbling from liberal activists that witnesses were notenough in favor of Medicare for All, the leadership announced theaddition of Ady Barkan, of the Center for Popular Democracy, whohas amyotrophic lateral sclerosis.

Republicans are presenting their own witnesses, includingCharles Blahous, of the Mercatus Center, who has estimated that theSanders version of Medicare for All would require $32 trillion inincreased federal spending over a decade.

Read more: 

• Forget Medicare for All, Americans want help withhealth care expenses
• Sanders's Medicare for All: Too radical forAmericans?
• As 'Medicare for All' plunge continues, analyststell investors these companies at risk

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