En route to Congress, California Democrats hit wall on ‘Medicare-for-all’

Reviewed by Kate Anderton, B.Sc. (Editor)Jan 2 2019

Each of the seven California Democrats who flipped Republican congressional seats in the midterm election campaigned for more government-funded health care — with most of them calling for a complete government takeover.

So when they join the Golden State's delegation this week, they will make it the largest state bloc to support "Medicare-for-all" in the U.S. House of Representatives. And Democrats, of course, will control the House.

Despite this political shift, the reality is that there's probably not going to be much progressive health care legislation coming out of Congress in the next two years — a point on which even Democratic lawmakers agree.

"We need to do the things that are doable — that aren't pie in the sky," said U.S. Sen. Dianne Feinstein, a Democrat and the dean of the California delegation.

Democrats will hold 46 of the state's 53 congressional seats in the House. It's the largest contingent of Democrats the state has ever sent to Congress, according to membership rosters on the congressional History, Art & Archives website. All but seven of them have publicly supported, at one time, some form of government-financed health care — whether a sweeping Medicare-for-all program that would provide health insurance to all Americans, or an optional "public option" plan for those who want it.

California's Democratic junior senator, Kamala Harris, who is contemplating a presidential bid, also supports Medicare-for-all, calling it “the moral and ethical thing to do.”

But the U.S. Senate will remain under Republican control, and Republican President Donald Trump has lambasted the idea of more government involvement in health care. Because of that political reality, Feinstein and others have said, the state's freshman lawmakers who are eager to push forward on Medicare-for-all or a public option ought to refocus.

In a midterm election where health care ranked as the No. 1 concern of many voters, congressional newcomers Josh Harder, Katie Porter, Katie Hill, Harley Rouda and Mike Levin won their elections after campaigning for Medicare-for-all, the concept of one government-run health care program made popular by Sen. Bernie Sanders (I-Vt.) during his 2016 presidential bid.

Meanwhile, candidates Gil Cisneros and T.J. Cox promoted a public option, which would allow consumers to voluntarily buy in to a government-financed health care plan, such as Medicare or Medicaid.

None of the seven freshmen Democrats agreed to an interview to discuss their ideas about health care in the new Congress, nor would they provide a spokesperson. It's unclear whether they'll make a big push for the progressive causes they pitched on the campaign trail.

In a twist, a mid-December ruling by a Texas judge that declared the Affordable Care Act unconstitutional could actually help Democrats. Instead of arguing for Medicare-for-all, they can now pivot to protecting the law and its popular provisions, including protections for people with preexisting conditions.

"A conservative judge in Texas may have given new Democratic representatives in California a lot more leeway on health care than they had a week ago," said Dan Schnur, a University of Southern California professor and former Republican strategist. "There's a lot of potential health care legislation that's going to be very popular in their districts."

In the weeks leading up to the election, Harder, who beat Republican incumbent Jeff Denham in the Central Valley, was already tempering expectations about how effective Democrats could be next year.

"I think the reality is under a Trump presidency, it's probably not going to be passed in the next two years," Harder said about Medicare-for-all. "But we need to be making it very clear what we're standing up for, and we're standing up for the fact that every individual needs to be covered."

A day after she won her congressional seat, Porter, who made Medicare-for-all an integral part of her campaign, told supporters it would have to wait.

"I think until we pass campaign finance reform, doing anything on health care is going to be a big challenge," she said.

Part of the challenge for Porter, along with the rest of her new colleagues, is that they hail from swing districts. Each of them flipped Republican seats, and they will need to adopt a more centrist tone if they want to stay in Congress, political observers say.

"The reality of advocating for single-payer and the actuality of what it means is sobering," said Lanhee Chen, director of domestic policy studies at Stanford University. "If you're vulnerable, on Day One, by the nature of demographics of your district, I think it becomes harder to embrace."

And while California voters ushered in a new class of progressives, they also gave a sixth term to Feinstein, who has openly warned against the cost and feasibility of a Medicare-for-all system. And likely incoming House Speaker Nancy Pelosi (D-San Francisco) has said she intends to focus on fixing lingering issues with the federal health care law, not push ahead with Medicare-for-all.

Other centrist Democrats say Congress ought to work out how to stabilize the health care markets or allow Americans 55 and older to buy into Medicare, which is currently open to those 65 and older. Feinstein, for example, also supports giving Medicare the ability to negotiate the price of drugs.

"Let's build off of the gains we made in the Affordable Care Act," said Rep. Ami Bera (D-Elk Grove), "but let's also address some of the things Republicans did to undermine the ACA markets."

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.