WASHINGTON ― Rep. Pramila Jayapal (D-Wash.) unveiled the Medicare for All Act of 2019 on Wednesday with broad support in Congress and among activist groups, as well as a number of influential labor unions that did not previously back single-payer health care legislation.
But there was something curious about the roster of 107 co-sponsors she rolled out for the legislation.
Twenty-five House Democrats who were co-sponsors of single-payer health care legislation in the last Congress did not sign on as original backers of Jayapal’s bill.
As a result, the previous single-payer bill ― the latest iteration of which was introduced by then-Rep. John Conyers (D-Mich.) in January 2017 ― had 125 co-sponsors by the end of the last Congress. (The attrition of some incumbents between bills was partly offset by the addition of freshman Democrats and Rep. Joe Kennedy [D-Mass.].)
The drop-off foreshadows a paradox as “Medicare for all” rises into the Democratic mainstream: The likelier single payer is to become law, the more some Democrats — who once viewed supporting it as a cost-free gesture — will have second thoughts about putting their names behind it.
On Wednesday, HuffPost caught up with three of the Democrats who were on H.R. 676 ― Conyers’ bill ― but have not yet signed on to Jayapal’s.
Rep. Zoe Lofgren (D-Calif.), a member of the Medicare for All Caucus who backed H.R. 676 from the moment it was introduced, said she was uncomfortable with the new bill’s two-year phase-in period.
“I just don’t think it’s possible to do in two years,” she said. The Bay Area Democrat instead favors plans that would expand Medicare by allowing people to buy into the program.
You can’t have just aspirational things anymore.
Rep. Zoe Lofgren (D-Calif.)
Reminded that she co-sponsored H.R. 676, which was not a buy-in plan and had a one-year phase-in, Lofgren invoked another explanation.
“We now have a rule that if a certain number of members sign on to a bill, it goes directly to the floor. So you can’t have just aspirational things anymore,” she replied.
Lofgren appeared to be referring to a compromise secured by members of the bipartisan Problem Solvers Caucus ensuring that legislation with at least 290 co-sponsors would receive some form of consideration in Congress, such as a committee markup.
The provision of the House rules package that ensures this form of consideration does not guarantee a vote on the floor, however. Also, it is highly unusual, if not implausible, for a partisan or ideological bill like Jayapal’s to accrue that level of support, which would necessarily be bipartisan in the current Congress.
One protocol that would enable a floor vote on legislation without requiring the blessing of House leadership predates the current Congress’ rules package. A discharge petition allows a simple majority of House members to circumvent the normal legislative process and force a floor vote on legislation. But doing so would also be highly unlikely, as it would amount to a revolt against the authority of the House speaker.
Rep. Anna Eshoo (D-Calif.) said that with Democrats in the majority, she is now the chair of the House Ways and Means Committee’s health subcommittee, which would have jurisdiction over “Medicare for all.” It is a “normal practice,” she argued, for committee chairs not to sign on to legislation for which they would be conducting hearings.
But Democratic leadership has guaranteed Jayapal only that there will be hearings on the legislation in the House Rules and Budget committees.
Does Eshoo plan to hold hearings on “Medicare for all” for the health subcommittee of Ways and Means?
“I have a very full agenda for the subcommittee,” she said. “And I hope that at some point” individual members’ priorities, such as “Medicare for all,” can receive hearings.
Rep. Lou Correa (D-Calif.) said he had not yet had a chance to read Jayapal’s legislation.
“I heard there’s a little bit of differences,” he said.
There are some differences in Jayapal’s bill. Its authors emphasize that unlike Conyers’ legislation, which served as more of an outline, it was drafted with the detail and substance befitting a bill that will be subject to hearings.
But in terms of material differences, Jayapal’s bill is just more comprehensive. It would eliminate the Hyde Amendment, which bars the use of public funds for abortions. It is also the first single-payer legislation that would cover long-term care services on which people with severe disabilities and many seniors rely.
It is unlikely that Correa would object to the abortion coverage. He has a 100 percent congressional scorecard from Planned Parenthood.
In a call with reporters on Tuesday, Jayapal emphasized that she expects her bill to pick up more co-sponsors and noted that Conyers’ legislation had fewer than half as many backers when it was introduced.
And it’s true that with Congress less than two months into this session, many members are still figuring out which bills they want to back.
Rep. Juan Vargas (D-Calif.) has not been individually approached to sign on to Jayapal’s bill and said he was unsure whether he had agreed to serve as an original co-sponsor. (He has not.)
“I’m for ‘Medicare for all,’” he said. “I haven’t seen the bill. I’ll take a look.”
But as Lofgren’s and Eshoo’s comments suggest, control of the House has raised the cost of co-sponsorship for some members.
The skittishness of some House Democrats about backing a bill that would nearly eliminate private health insurance echoes the conduct of Democratic lawmakers in California.
The Golden State’s Democratic-controlled legislature voted to enact a version of state-level single-payer twice during the tenure of Republican Gov. Arnold Schwarzenegger, who vetoed both bills.
But with full Democratic control of the state government, including the governor’s mansion, in June 2017, the state Assembly refused to consider a single-payer bill passed by the state Senate. Then-Gov. Jerry Brown signaled his opposition to the legislation, and the Assembly’s decision not to take it up shielded its members from a potentially politically harmful vote and spared Brown the need to veto it.
Rep. Anthony Brown (D-Md.), who signed on to Jayapal’s bill despite his opposition to the legislation’s elimination of employer-sponsored coverage, conceded that lawmakers tend to be more cautious about co-sponsorship when they are in the majority.
“We understand that when you’re in the minority ― and this is true for Republicans too ― a lot of what you do is messaging,” he said.
However, he added, “In my office, I try to stay consistent.”