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By Alex Ruoff
A bill to create a single-payer health system is more popular than ever, which is why it’s going to be a challenge to find it a new lead sponsor in the House, lawmakers and supporters told Bloomberg Law.
House Democrats’ Medicare-for-all bill, now at the height of its popularity, has been left without its author, Rep. John Conyers (D-Mich.), who left Congress amid sexual harassment allegations earlier this month. In his absence, supporters of a universal, public health insurance system are trying to determine who is best suited to carry the bill forward and what shape the proposal will take in coming years.
House Democrats for more than a decade honored Conyers’ seniority as the longest-serving member of Congress and an early advocate for single-payer. The goal for now, Democratic supporters said, is to stay united around his bill and avoid any ideological divides among themselves.
“Whoever’s name is first on the bill is important, but it’s also important we keep the cohesiveness of the caucus,” Rep. Pramila Jayapal (D-Wash.), who won her seat in Congress in 2016 on a single-payer platform, told Bloomberg Law.
More than 60 percent of House Democrats signed on as co-sponsors of Conyers’ Medicare-for-all bill ( H.R. 676) this year, the most of any Congress.
Several House Democrats and aides said a successor has not been named. Usually, when lawmakers leave Congress, they will name a successor for their signature legislation, Democratic aides told Bloomberg Law. However, Conyers’s abrupt exit means that hasn’t happened.
There are several likely candidates to take over the bill: Reps. Debbie Dingell (D-Mich.), Keith Ellison (D-Minn.), Jayapal, Ro Khanna (D-Calif.), Barbara Lee (D-Calif.) and Peter Welch (D-Vt.).
Longtime supporters of a single-payer health system told Bloomberg Law they also want a say in who takes over the bill. Carol Paris, president of Physicians for a National Health Program, said she wants someone who could win over moderate Democrats and Republicans.
House Minority Leader Nancy Pelosi (D-Calif.) is unlikely to get a say because she has never signed onto single-payer legislation, nor have 73 other Democrats in the House.
Opponents of the legislation say it’s too much of a departure from the current health system. Republicans have criticized it as deficit-busting and Sen. Lindsey Graham (R-S.C.) repeatedly pointed to it as the alternative to repealing the Affordable Care Act.
Progressive groups, however, plan to make health care and support for a single-payer system major issues during the 2018 midterm elections, Ken Zinn, political director for National Nurses United, a national union of registered nurses, told Bloomberg Law. Zinn said his group will push Democrats to support single payer in 2018.
Supporters of the Conyers bill have long called it aspirational, a platform for Democrats to show they have big ideas about reforming the nation’s health-care system. The bill leaves out crucial details about how the nation would transition from its current mix of public and private payers to one where the government foots the bill for nearly every health service.
It also doesn’t specify how to pay for this new single-payer system, estimated at over $30 trillion, other than using existing government revenues, increasing taxes on the income of the wealthiest 5 percent of Americans, and other taxes.
As they discuss filling in those details, Democrats risk dividing themselves over a bill they know won’t become law in the current Congress, where Republicans hold majorities in both chambers, or under a Republican president.
Conyers’s bill would completely overhaul the country’s health insurance industry by offering free health-care coverage for all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care, according to a Bloomberg Government analysis.
Private insurers could not offer similar care and could only sell plans that cover services not considered medically necessary, such as cosmetic surgery.
Khanna, a supporter of single payer, told Bloomberg Law he thinks this may be a bridge too far. He thinks private insurance could continue within a Medicare-for-all system, where public insurance is offered to anyone who can’t afford it.
“We all have different sense of the actual mechanics of how to get Medicare-for-all,” Khanna said.
Other co-sponsors of Conyers’s bill have also noted the bill needs changes, but said the bill stands as a placeholder for the issue of single payer.
Two potential torchbearers for a House Medicare-for-all bill, Dingell and Jayapal, told Bloomberg Law they plan to work together next year to iron out many of these details and draw more support among Democrats for it.
Jayapal said they need to determine how to transition the country into a single-payer system without throwing people off their insurance or altering how they get care.
Dingell said she wants a serious, specific proposal ready to go if Democrats take control of Congress and the White House again. She’s hoping to get it ready sooner rather than later, too.
“I’m going to travel the country to sell this bill,” Dingell said. “I’m going to look at how we finance this, how other countries finance this, and how to get every American access to health care.”
Whether in 2019 House Democrats reintroduce Conyers’s bill, which has been H.R. 676 since 2003, so it retains that number for supporters, or replace it with Sen. Bernie Sanders’s (I-Vt.) bill, (S. 1804), in Conyers’s absence is unclear.
Sanders’s bill contains details about phasing in single payer than Conyers’s bill doesn’t, Jayapal said. For example, the Sanders bill would convert Medicare into a more generous program, eliminating deductibles and other payments, then gradually expand it over four years.
Some Democrats contend the details of a single-payer bill won’t matter unless they can win more elections and take control of Congress.
Ellison said working out who takes over Conyers’s bill isn’t as important as showing Democrats can be united on the issue.
“My main concern is: Can we achieve the majorities in which we can pass it,” he said. “I"m going to focus on getting in a position to pass something.”
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