Why you should care
Because health care will be a defining fight in 2018.
As Dave Min, running in one of the most pivotal congressional races in the country next year, chats with voters around Orange County, California, health care is on the tip of everyone’s tongue. While many want nothing less than a single-payer federal plan, as proposed by Vermont senator Bernie Sanders, “I don’t see consensus around that direction,” Min says.
Incremental steps such as allowing nonseniors to buy into a Medicare “public option” as part of Obamacare are more feasible — and have broader appeal in a “historically Republican, fiscally conservative district like mine,” he says. But Kia Hamadanchy, another of the seven Democrats who want a shot at Republican incumbent Mimi Walters, is all-in for single-payer. “You’re not a progressive unless you’re single-payer, for a lot of people,” Hamadanchy says. “It’s become a line-in-the-sand issue, kind of the way the Iraq War was in 2008.”
Democrats across the U.S. are divided over Medicare for all as part of a larger ideological question: Does the party need a moderate approach to capture Republican seats, or should it embrace the energy of Sanders acolytes and swing left with a more populist agenda? The debate is a critical part of the party’s discourse in Texas, Nebraska and New York, where Democrats are aiming to unseat Republican incumbents. But it’s a particularly combustible fight in California, where the state legislature held a heated debate this year over a state single-payer program that was blocked by the House speaker.
Medicare for all is such a political winner that it would be almost political malpractice for candidates not to run on it.
Adam Green, co-founder, Progressive Campaign Change Committee
Creating a single national health insurance system has long been a goal of the left, but Sanders’ campaign helped juice the idea’s popularity among Washington Democrats. Medicare-for-all bills are now co-sponsored by 17 Senate Democrats and 121 House Democrats — the majority of the caucus. But many voters are uneasy with the trillions of dollars in tax increases needed to fund a national health care system.
Polls show a slim majority in favor of the idea nationally: The Kaiser Health Tracking Poll found 53 percent support in June, while the Harvard-Harris Poll found 52 percent support in September. But looking at the key congressional districts where Democrats are seeking their 24 pickups to conquer the House, Republicans are eager for the discussion. “Single-payer health care is not very popular, generally speaking, but even more so in some of these upper middle-class suburban districts,” says Jesse Hunt, spokesman for the National Republican Congressional Committee. “How do they square issues like single-payer with that electorate? That is an issue that will continue to fester this cycle.”
By drilling in on single-payer, Republicans hope to flip an apparent strength for Democrats. Republican legislative efforts to dismantle Obamacare have thus far proven unpopular and unsuccessful. This month in Maine, voters expanded Medicaid by a wide margin in a ballot referendum. In Virginia, a plurality told exit pollsters that health care was their most important issue — and that group overwhelmingly backed Democrat Ralph Northam for governor. Tyler Law, spokesman for the Democratic Congressional Campaign Committee, says, “Democrats have a huge advantage on health care,” and the “robust primaries” are a sign of his side’s bountiful energy. “Every candidate will be carrying their own authentic message because there’s no one-size-fits-all approach when you’re competing across the largest battlefield in a decade,” he says.
Liberal pressure groups such as the Sanders-tied Our Revolution, Justice Democrats and National Nurses United are pushing for single-payer. But the Progressive Campaign Change Committee, which has at times clashed with the DCCC, is seeking consensus. PCCC co-founder Adam Green says he defines “Medicare for all” more broadly to include an optional Medicare buy-in of the type that Min supports in Orange County and Sen. Chris Murphy, D-Conn., is proposing in Washington. A January 2015 poll by Green’s Progressive Change Institute found 71 percent support for a Medicare buy-in, with just 13 percent opposed. “I don’t think single-payer or even the broader goal of Medicare for all will be a litmus test in 2018, but Medicare for all is such a political winner that it would be almost political malpractice for candidates not to run on it,” Green says.
Bob Mulholland, a veteran Democratic strategist in California, remains wary of the idea, even as he says of the activists: “Their hearts are in the right place.” He points to last year’s failure of a ballot measure to create a state single-payer plan in Colorado, which garnered just 20.6 percent of the vote — even as Hillary Clinton won the state. Ballot measures to limit drug prices also failed last year in California and this year in Ohio.
The party schism is hitting the heartland too. In Nebraska, Kara Eastman is running an insurgent primary campaign against former U.S. Rep. Brad Ashford — a Blue Dog who lost the Omaha-based seat in 2016 to Republican Don Bacon. Eastman, a 46-year-old social worker who recently came to support single-payer after conducting more research into the costs and benefits, says health care is a defining issue in her primary. And what about those who say Ashford’s centrism is the better general-election play? “If that were true,” Eastman says, “he would have kept his job.”
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