The House Rules Committee held the first ever Medicare for All hearing, something promised by Speaker Nancy Pelosi as part of her campaign to secure her leadership position in January. House Ways and Means is scheduled to follow suit in the coming weeks. Republicans, banking on their belief that most Americans would prefer Washington put an end to meddling in the U.S. Medical Economy, are gleefully encouraging as many hearings as they can.
The high wire act the Speaker is forced to perform is balancing pressure from the young progressive wing that supports causes like Medicare for All against the political realities that moderates face in swing districts. The House majority that delivered the Speakership to the Democratic leader was largely due to moderate members’ ability to flip quite a few suburban districts from Republican to Democrat.
If the Democrats’ health care agenda drifts too far to the right (tweaks to the ACA) the Speaker risks losing the support of progressives with large megaphones like Rep. Alexandra Ocasio-Cortez. If it moves too far left (Medicare for all) the Speaker risks losing the majority in 2020.
Not surprisingly, this first hearing was held in House Rules which is known as the Speaker’s Committee. Membership is weighted heavily toward the party in power. At this juncture, there are nine Democrats and four Republicans. If there is a place to control the narrative and keep the issue from spinning left or right, Rules is the right venue.
As a result, the debate and testimony were convivial with moments of rather mild partisanship.
Key takeaways:
- Majority witness where not uniformly committed to enactment of Medicare for All as written. One favored a transition like that provided for by the ACA. Another favored tweaks to the ACA
- The hearing was held in one of the smallest rooms available, thus ensuring limited appearances by activists and other members of the public that frequently disrupted ACA repeal hearings in 2017
- The cost to the federal government is going to be quite high – an estimated $32 to $38 trillion over ten years.
- Eliminating health care coverage by existing Medicare, Medicaid, the Children’s Health Insurance Program, Federal Employees Health Benefits Program and TRICARE within two years will be very disruptive and probably unpopular.
- Costs to providers, especially hospitals, was for the first time a talking point by witnesses but notably not Members
- Claims denials and administrative burdens imposed by insurers was also a hot topic
If the hearing had value it is this: work on health care, whether that be Medicare for All or changes to the ACA or drug price policy, solidifies Democrats position on those issues and keeps Republicans playing defense. The added value was in the Speaker keeping her word to the restless factions of her party.
What will persist in Washington for the next several months – until one presidential nominee pulls away from the pack – are two realities: the reality of pundits and hearings that makes Medicare for All look like a viable political idea and the reality of lobbyists and think tank members who know the outcome, if it occurs, will be much more benign.
Meanwhile don’t ignore that utilization is up at labs, hospitals and outpatient venues and that fact is immutable regardless of what happens in Washington’s many hearing rooms.
Call with questions.
Emily Evans
Managing Director – Health Policy
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