The Jayapallegislation is mostly backed by Democrats in safe districts, withfew cosponsors among the 40 members who won seats previously heldby Republicans in 2018 to give the party control of the House.(Photo: Shutterstock)

The “Medicare for All” push is hitting serious obstacles in theU.S. House in the face of resistance from Democratic leadersconcerned that replacing the private insurance system would generatebacklash from voters who like their coverage.

The House Budget Committee is holding a hearing on Wednesday toexplore “design components and considerations for establishing asingle-payer health care system,” which could serve as apreliminary step toward overhauling how Americans get healthinsurance coverage.

But that may be a Pyrrhic victory for progressives championingfor Medicare for All legislation because the effort appearsunlikely to go much further. A bill sponsored by RepresentativePramila Jayapal of Washington State and 109 other Democrats hasn'tgained much support since its release in February, and the Budgetpanel's Democratic chairman said he doesn't see such legislationadvancing any time soon.

Related: Medicare for All: Where the 2020 presidentialcandidates stand

“The caucus understands that we're not going to pass Medicarefor All this year,” Representative John Yarmuth of Kentucky said inan interview. He said it would be a “long process” to developconsensus legislation and “nobody's going to wade into the weedsand spend a lot of time developing a bill.”

The divisions among Democrats extend to the party's nominationrace. Democratic presidential contenders Bernie Sanders andElizabeth Warren are among 15 cosponsors of Medicare for Alllegislation in the Senate, which would replace private healthinsurance with a government-run plan that covers primary care,hospital stays and prescription drugs for all Americans,dramatically changing America's $3.5 trillion health-careindustry.

Other senators, like Michael Bennet and Amy Klobuchar, favor a“Medicare X” bill that creates an option to buy into aMedicare-like plan as an alternative to private insurance. Andsome, like Kamala Harris and Cory Booker, have cosponsored bothbills.

Former Vice President Joe Biden, who is dominating the earlystage of the race, backs letting Americans buy into agovernment-run insurance option through Medicare.

'Fixing' Obamacare

“The vast majority of people are satisfied with their own healthcare system today,” Biden told reporters on May 14 whilecampaigning in New Hampshire. “What we should be doing is goingback, fixing the Affordable Care Act, and making a Medicare optionavailable to all people whether they have private insurance, or noinsurance, or their own insurance.”

President Donald Trump and Republicans are using the push forMedicare for All by Sanders and other progressives as a weapon intheir 2020 election strategy.

“The Democratic majority seems confused about the politicaltactics and the timing, but not about the ultimate goal – to imposea federal government-run health care system on the Americanpeople,” said Arkansas Representative Steve Womack, the seniorRepublican on the budget committee. Under a single-payer system, hesaid, “millions of Americans won't be able to keep the insurancethey like or see the doctor they trust.”

The Jayapal legislation is mostly backed by Democrats in safedistricts, with few cosponsors among the 40 members who won seatspreviously held by Republicans in 2018 to give the party control ofthe House. Winning their support will be tough; many of them preferto support incremental health-care changes rather than one asfar-reaching and politically risky as Medicare for All.

'Medicare Extra'

The Center For American Progress, an influential progressivethink tank, recently offered a competing plan called “MedicareExtra” that would preserve employer-based insurance. The goal wasto give Democrats who support universal coverage a more politicallypalatable path that doesn't require eliminating private coveragefor those who like their insurance.

Neera Tanden, the center's president, said the proposal provides“universal health care” while “maintaining consumer choice.”

“Everyone outside of the employer-based system would be inMedicare, and then people have the ability to choose betweenMedicare and their current coverage if they have employer-sponsoredcoverage,” Tanden said. “There is a wide and healthy debate fromMedicare as simply an option to single payer.”

A 2018 study by the libertarian Mercatus Center at George MasonUniversity found that Sanders' single-payer plan would raisefederal spending by a startling $32.6 trillion over a decade, butlower overall U.S. health expenditures by $2 trillion. That meanstaxes would have to rise sharply to cover the cost of universalcoverage but Americans would also save money in premiums andout-of-pocket medical costs.

Yarmuth said the term “Medicare for All is kind of a metaphor ora Rorschach test that means a lot of different things to a lot ofpeople,” whether it's mandatory or optional for everyone who wantsit.

Conversation victory?

House Democratic Caucus Chair Hakeem Jeffries of New York saidTuesday that the conference is unified around the “principle” ofuniversal coverage and will keep discussing “pathways” to the goal,but “our focus remains on what we can get done for the people ofthis country now.”

“Right now the legislation that has the support of the unifiedHouse Democratic caucus is legislation to protect people withpreexisting conditions, as we passed two weeks ago; legislation tostrengthen the Affordable Care Act, as we passed last week;legislation that we'll continue to bring to the floor to deal withthe anti-competitive practices of big pharma,” Jeffries said.

Some progressives see a long-term victory in having shifted theconversation so that moderates favor a government-run insuranceoption, which was excluded from the 2010 Affordable Care Actbecause of centrist Democratic opposition.

“We've moved the needle a little further on that,” saidRepresentative Jared Huffman, a California Democrat who'scosponsoring Jayapal's bill. “There's overwhelming support for thegoal of universal coverage or Medicare for all. There is a breadthof opinion on how you get there, how quick you get there —incrementalism versus the whole enchilada. I think we will getthere incrementally. I don't think you'll go all the way there inone policy leap. But we've got to keep out eye on the prize.”

Huffman said the Wednesday's hearing is about shaping publicoption for the long haul.

“We are demystifying the whole notion of Medicare for All, andhelping more of the American people understand that this is notsome radical socialist scheme,” he said. “This is simply a moreorderly way to provide a basic level of health insurance.”

Read more: 

• CBO: Medicare for All a 'majorundertaking'
• 4 approaches to expanding health care (and only oneis Medicare for All)
• Trump says GOP 'blew it' on health care and mustrun on new plan

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