While their power is severely limited due to a Republican president and a GOP-controlled Senate, Democrats of different ideological stripes are pushing to use their new majority in the House of Representatives to shape U.S. health care policy.

For starters, some of the most liberal members of Congress, such as Bernie Sanders and recently-elected Rep. Alexandria Ocasio Cortez, D-N.Y., are going to continue their vocal advocacy for a single-payer “Medicare For All” plan.

Single-payer has no chance of passing a GOP-controlled Senate and many Democrats are uneasy with the idea as well, but some progressives believe that if they keep pushing the idea, the public support will eventually become strong enough for it to become law some day. Polls show that most Americans are receptive to the idea, but they also show that many are scared off by talk about the tax hikes that would be needed to finance the plan.

A more moderate proposal that has attracted support among Democrats is to allow those over 50 to buy into Medicare. Rep. Brian Higgins, D-N.Y., who made noise about not supporting Nancy Pelosi to be Speaker of the House, reportedly agreed to back Pelosi in exchange for help crafting the legislation.

The proposal Higgins has outlined would not only allow individuals to buy into Medicare, but it would allow employers help pay for their employees to enroll.

While Republicans and insurance companies will likely frame the Medicare Buy-in as another big step towards single-payer, those who do support single-payer worry that the buy-in policy will be a distraction from the ultimate goal of providing universal public health care.

“We have to be careful not to perpetuate the system we have,” Rep. Pramila Jayapal, D-Wash., who leads a group in Congress that supports Medicare for All, tells The Hill. “I would prefer to have a reduction of the age of Medicare so that more people could qualify but not a buy-in, because that continues the problems that we have right now.”

Meanwhile, Sen. Patty Murray, D-Wash., is hoping to revive a bill to shore up the Affordable Care Act marketplace that fell through earlier this year. The legislation, which a number of moderate Republicans supported, aims to restore the payments to insurers that the Trump administration cut off last year. Those funds are key to reducing the premiums paid by ACA customers who aren't eligible for subsidies.

Sen. Lamar Alexander, R-Tenn., who co-authored the bill with Murray, said he is skeptical that it will be able to pass both chambers of Congress. However, the fact that Democrats will soon control the House removes one key obstacle to passage. Also unclear is what President Trump will do.

Perhaps the health measure with the greatest chance of passage is a bill to further delay implementation of the “Cadillac Tax” on expensive health plans. The policy, which is included in the ACA, imposes a 40 percent tax on whatever an employer spends beyond a certain threshold for employee health plans –– currently $10,200 for an individual or $27,500 for a family. The policy is popular among economists, who argue that it discourages employers from shifting too much of compensation into health care benefits and driving up health care costs. However, it's unpopular among just about everybody else. Congress has already voted to suspend its implementation until 2020, but some are agitating to approve another two-year suspension.

Instant Insights /

Dems offering up myriad health policy reform ideas

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