Democrats showed uncommon unity in fighting Republican efforts to repeal and replace the Affordable Care Act, and it appeared to be working Monday as two more GOP senators said they can’t support the latest version. But Democrats’ discipline masks a deep and fundamental divide within the party that could complicate efforts to gain ground in the 2018 election and beyond.
Even as Republicans fight among themselves to dismantle the law, the liberal wing of the Democratic party is aggressively pushing Democrats to embrace a single payer system, in which the government pays for health care rather than private insurance companies. Sen. Bernie Sanders, the independent senator from Vermont who has long championed the effort and made it a key plank of his 2016 presidential bid, plans to file legislation calling for “Medicare for all” after the Obamacare repeal debate has ended.
“I think we should join the rest of the industrialized world in guaranteed health care,” Sanders said in an interview, insisting he’s first “working overtime” to help quash the Republican effort to erase former President Barack Obama’s signature legislative effort.
For Democrats, the push for a fully government-run health care system isn’t new: Harry Truman in 1945 proposed a “universal” national health insurance program, and it’s long been a goal for many in the party.
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Yet some of those who support single payer urge caution at this point, even as Republicans continue to grapple with efforts to overturn Obamacare. The push appeared to fail late Monday, with two more senators saying they could not support the measure. Majority Leader Mitch McConnell acknowledged the loss and said he’d instead hold a last-ditch repeal vote with a two-year delay for replacement.
“This is where I would hope that members of our party don’t do what Republicans did, which is promise stuff they can’t deliver,” said Democratic strategist Rodell Mollineau, a former adviser to then-Majority Leader Harry Reid when the Affordable Care Act cleared the Senate. “I actually believe in single payer, but I’m also a pragmatist and a believer in the art of the possible.”
The party’s more liberal wing, however, is convinced that advocating for a government-run plan better motivates voters than tinkering around the edges with the existing health care system.
In many ways, the debate mirrors the divide over the direction of the party itself. Progressive Democrats believe the party made a mistake by nominating for president a centrist such as Hillary Clinton, rather than embracing a more progressive agenda embodied by Sanders.
“If you go to a meeting of Democratic party volunteers anywhere in country and ask if fighting for Medicare for all motivates them to pour their time and sweat into a campaign, the answer will be the same every time,” said Ben Wikler, Washington director for MoveOn, which is fighting the Republican repeal efforts but “enthusiastically supports” single payer.
“For Democrats thinking about which side of debate they want to be on, it’s a choice between a broken past or a future that gives people a reason to knock on doors and get involved in campaigns,” Wikler said, calling it a “core issue that motivates Democrats to get up in the morning and fight.
“Harnessing that kind of grassroots energy is a key to making 2018 the Democrats’ answer to 2010,” when the party lost control of the House, he said.
Activists pressed House Minority Leader Nancy Pelosi to push for single payer at a rowdy San Francisco town hall this year after Republicans in the House initially failed to pass legislation. But Pelosi, who said she has always supported a single payer system, told the audience to “recognize the fight we’re in now” to keep the Affordable Care Act.
“The comfort level with the broader base of the American people is not there yet,” she said of single payer at a May press conference.
Activists say that’s wrong, pointing to polls that show increasing support for the measure, particularly among Democrats. A recent Pew Research Center poll found that 60 percent of Americans believe the federal government is responsible for ensuring health care coverage for all Americans – the highest level in nearly a decade.
Among those 60 percent, more now say care should be provided through single payer, Pew found. It said 33 percent of the public now favors a “single payer” approach – a 5 percentage point increase since January and a 12-point boost since 2014.
In the House, there are more sponsors than ever before for single payer legislation that Rep. John Conyers, D-Mich., has sponsored since 2003.
And a number of Senate Democrats have picked up Sanders’ torch: Massachusetts Sen. Elizabeth Warren is encouraging Democrats to run on single payer, telling the Wall Street Journal last month that “the next step is single payer.”
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Still, most Democrats in the Senate remain firmly focused on preventing Obamacare repeal.
“Yes, there is an important conversation within our caucus about what the health care system should look like 10 years from now,” but it didn’t affect Democrats as they pushed back against the GOP plan, said Sen. Chris Murphy, D-Conn., calling single pay “a wonderful, theoretical exercise that Republicans would like to have Democrats spend all their time talking about.”
Yet, there already is a backlash in the party for not fully supporting the concept.
In California, Assembly Speaker Anthony Rendon, a Democrat, said he and his family experienced death threats after he shelved a universal health care bill passed by the Democratic Assembly. Rendon, who says he supports the approach, said the bill lacked basic details, like how to pay for the estimated $400 billion price tag.
“We are nearing the point where support is going to become a litmus test, not just for progressives, but for Democrats writ large,” said Neil Sroka, a spokesman for Democracy for America.
Republicans are watching the internal convulsions across the aisle with elation, believing that single payer is a bridge too far for most Americans. The National Republican Congressional Committee has been running web ads, complete with ominous music, to charge that Democrats back a single payer plan “so outrageous it could bankrupt the country.”
The nonpartisan Urban Institute pegged the cost of Sanders’ campaign proposal at $32 trillion over 10 years. He has disputed those figures, saying his plan would decrease total health spending.
Democrats are hoping to take back the House in 2018, but the National Republican Congressional Committee, or NRCC, notes that Democratic candidates running in centrist districts risk being pulled to the left in competitive primaries.
“It’s really becoming a litmus test on the far left,” said NRCC spokesman Matt Gorman. “And we gleefully look to use this in ads against Democrats who come out in support of single payer in a general election.”
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Vice President Mike Pence has weighed in, raising the specter of Charlie Gard, a terminally ill British baby, to warn against single payer. Gard’s parents are fighting the British courts to allow the child to receive experimental treatment in the United States.
“That’s what single payer looks like,” Pence recently told radio talk show Rush Limbaugh.
Recent polls show the Republican effort to repeal the Affordable Care Act is increasingly unpopular and Democrats argue that outcome will be the defining issue for the 2018 election.
“If I was a Republican operative looking at how historically toxic this health care bill is, I would be coming up with every way from Tuesday to talk about anything else,” said Jesse Ferguson, a veteran Democratic strategist who is working with a coalition of groups fighting the repeal efforts.
“What voters are hearing is that Democrats are having an actual conversation about ideas that would lower health care costs and expand access,” he said. “That is in contrast to Republicans who are taking a lemming-like approach to forcing through something that is unpopular and devastating.”