Politics & Government

Can Democrats in the House keep health care reform alive? Nancy Pelosi is going to try.

FILE - In this Jan. 30, 2019, file photo, Rep. Pramila Jayapal, D-Wash, speaks at a news conference on Capitol Hill in Washington. Sen. Bernie Sanders is raising the stakes of the “Medicare-for-all” debate by expanding his proposal to include long-term care. (AP Photo/Andrew Harnik, File)
FILE - In this Jan. 30, 2019, file photo, Rep. Pramila Jayapal, D-Wash, speaks at a news conference on Capitol Hill in Washington. Sen. Bernie Sanders is raising the stakes of the “Medicare-for-all” debate by expanding his proposal to include long-term care. (AP Photo/Andrew Harnik, File) AP

The Democratic-run House plans to vote on ways to lower prescription drug prices and force insurers to provide stronger protection for people with pre-existing conditions, marking the next big step in a strategy to make health care part of its 2020 election fight.

Democrats are wrapping up their first 100 days in charge of the House this week, and they’ve been sending the same message over and over: We care deeply about more affordable, accessible health care.

“This is about a value system in our country,” said House Speaker Nancy Pelosi of California of the Democrats’ health care push, “about understanding that health care is a right for all Americans, not just a privilege.”

House votes on health care legislation are expected between April 29 and May 24.

The effort reflects a desire among party leaders to show a commitment to health care reform -- and gives some members a way to show support for greater coverage and lower cost without going so far as backing the Medicare For All platform being pushed by lawmakers on the far left.

“That’s pragmatic. Most Americans want that. They want a parallel track,” said Rep. Ro Khanna, a California Democrat and co-sponsor of Medicare for All legislation. “They want us to push for a bold policy track but get done what we can in the meantime.”

Republicans scoff at the idea that Democrats are trying to enact policy, and not just generate headlines. So far, “It’s 100 days of nothing,” said House Republican Leader Kevin McCarthy of California.

Republicans need 18 seats to win control of the House next year. Democrats need a net gain of four Senate seats to run that chamber, three if the party’s presidential candidate defeats President Donald Trump.

The House seats being most closely watched are in 31 districts where Democrats won last year but Trump won in 2016. In the Senate, Democrats are targeting pickups in Georgia, Arizona, Maine and Colorado. The party appears most vulnerable in Alabama.

Polling as well as anecdotal evidence from the campaign trail shows that health care matters, and voters want incremental improvements, not an overhaul.

Nationally, the Kaiser Family Foundation last month found half of those surveyed viewed the Affordable Care Act, or Obamacare, favorably, while 39 percent did not. And a Quinnipiac March poll said people were split on the idea of Medicare for All. Forty-three percent called it a good idea, while 45 percent said it was a bad idea.

A look at Washington state's SHIBA program, which provides help understanding Medicare and health care choices to people of all ages and backgrounds.

Fifty-five percent favored improving the current health system, while 32 percent preferred replacing it. Republicans preferred improvement by a 49-36 percent margin.

Those findings reflect the biggest challenge to Democrats as the campaign unfolds.

Medicare for All is the one piece of the health care puzzle that makes some Democrats nervous. Indeed, party officials are divided. Legislation to create the program has 108 House co-sponsors, which means another 127 House Democrats haven’t signed on.

Supporters of Medicare for All see momentum. A Senate version has 14 sponsors, including presidential candidates Bernie Sanders of Vermont, Elizabeth Warren of Massachusetts, Kirsten Gillibrand of New York, Cory Booker of New Jersey and Kamala Harris of California.

Rep. Pramila Jayapal, a Washington Democrat and key architect of the House bill, said Republican charges of socialism can be easily overcome. Democrats need to explain, “We’re preparing a full vision for how we deal with health care in the long run,” she said.

House leaders aren’t so enthusiastic. Pelosi last week told the Washington Post she was “agnostic” about Medicare for All.

The Democratic leadership’s vision is more incremental. Thirteen bills have been prepped for House floor action starting later this month, when Congress returns April 29 from a 17-day spring recess that begins Friday.

The bills that aim to make improvements in the current system. Some of the incremental bills feature Republicans as supporters.

Six bills are aimed at lowering costs by moving generic versions of drugs to markets sooner, while another would require drug-makers to provide more information about how they determine consumer prices.

The “Bringing Low-Cost Options and Competition while Keeping Incentives for New Generics Act of 2019” was introduced by Reps. Buddy Carter, a Georgia Republican, and Kurt Schrader, an Oregon Democrat. Rep. Doug Collins, a Georgia Republican, joined Democrats and other Republicans in sponsoring the “Creating and Restoring Equal Access to Equivalent Samples Act of 2019.”

Other bills would:

Limit the Trump administration’s ability to give waivers to states that want to undermine protections for people with pre-existing conditions. Current law bars insurers from denying coverage to people with such conditions.

Provide $200 million to help states establish state-based marketplaces where consumers can compare health plan prices.

Restore funding cut by the Trump administration for reaching out to and enrolling consumers in health care plans.

Provide $10 million to states that they could use for financial aid to reduce out-of-pocket costs for consumers enrolled in qualified health care plans.

While these measures get some Republican support, the GOP view remains that Obamacare is a disaster and needs to be replaced. Republican leaders insist that any new GOP-authored program would protect people with pre-existing conditions while lowering health care costs.

There are some signs that Republicans are worried about the Democrats’ health care push. The Justice Department triggered the latest partisan conflict last month when it backed a federal judge’s decision that Obamacare was unconstitutional. Pelosi tweeted that the White House had “declared all-out war” on affordable health care and moved quickly. And last week, House Democrats approved a nonbinding measure “condemning the Trump administration’s legal campaign to take away Americans’ health care.”

Eight House Republicans, most in swing districts, voted with the Democrats.

David Lightman is McClatchy’s chief congressional correspondent. He’s been writing, editing and teaching for 47 years, with stops in Hagerstown, Riverside, Calif., Annapolis, Baltimore and since 1981, Washington.
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