Democrats divided on new Medicare for all bill

At left, Rep. Pramila Jayapal, a Washington Democrat and the leader of the Progressive Caucus, introduced a bill that would implement a Medicare for All system. It has divided the Democratic party, and many freshmen lawmakers are weighing in, such as Rep. Alexandria Ocasio-Cortez, at center, of New York, and Rep. Lauren Underwood of Illinois, at right.

(CNN)Democratic Rep. Lauren Underwood was a kid in a swimming class when her heart began to race. She was diagnosed with supraventricular tachycardia, which has since shaped her life in every way, from her preference for caffeine-free diet Coke to her career starting out as a registered nurse.

In 2017, when she saw her Illinois congressman, Republican Randy Hultgren, promise to protect those like her with preexisting conditions, but then later vote for a bill that would have increased their costs to get covered, a heart that sometimes beats too fast also gave her a reason to run for Congress.
Democrats took the House in 2018 by campaigning against the Republican efforts to repeal and replace the Affordable Care Act, tying personal stories to a larger narrative of protecting the coverage of millions of Americans. The strategy worked for Underwood, who won her exurban Chicago district in an upset.
"A lot of these provisions impact me personally," she told CNN last year. "I still don't know how to tread water."
    Yet while health care propelled the Democrats to success, the issue has already begun to divide the party as its members propose what to do next.
    On Wednesday, Rep. Pramila Jayapal, a Washington Democrat and the leader of the Progressive Caucus, and Democratic Rep. Debbie Dingell of Michigan will unveil the most significant single payer proposal in the House yet. It has the support of more than 100 members — many more than support less radical House bills that would permit states to create a Medicaid buy-in option or allow Americans at age 50 to buy into Medicare. It's based off a bill by Sen. Bernie Sanders, who got other senators running for president — Elizabeth Warren, Kamala Harris, Kirsten Gillibrand and Cory Booker — on board too.
    Nevertheless it has split the 235-member House Democratic caucus, and the vast majority of the new freshman class — roughly 75% — has not signed onto the Medicare for All bill.
    Some of those who haven't co-sponsored the bill are freshmen Democrats from competitive districts like Underwood, Rep. Donna Shalala, the former Health and Human Services Secretary, and Rep. Colin Allred of Texas, who said in interviews that they are focused on fixing the Affordable Care Act and lowering the price of pharmaceuticals rather than a total overhaul of the health care system.
    Underwood told CNN that her priority in Congress is to "stabilize the Affordable Care Act and make sure it's affordable for folks seeking coverage," pointing out that there are 37,000 people in her district who use its marketplace.
    "I think it's very clear that the American people are looking for lower premium prices, lower prescription drug prices, and higher quality coverage," Underwood said. "There are many routes to achieving those goals."
    When it comes to debating one of those routes — such as a government-run plan — she raises a host of questions.
    "How much is it going to cost?" she asked. "How are we going to pay for it? Who specifically it covers? What happens with private insurance? What happens to all types of coverage?"
    The bill introduced Wednesday aims to answer some of those questions, although not in regards to cost, which would likely run into the trillions of dollars. The lack of those critical details will fuel the doubts of its skeptics.
    "We certainly have some great freshmen members who are trying to put out big ideas," Allred told CNN. "And then we have a lot of freshmen members like me who I think are focused on concrete things that we can deliver in this session of Congress — in the next two, four, six years — because we come from districts who expect results."

    What's in the bill?

    The House bill, named the Medicare For All Act of 2019, would remake the nation's health care system by creating a government-run plan that would insure all Americans. It would provide generous coverage to patients, but could cut payments to many hospitals and doctors.
    Like Sanders' bill, the House version would provide comprehensive coverage, including not only primary and specialty care, hospitalization, mental health, maternity care and prescription drugs, but also vision, hearing and dental care. Unlike Sanders' bill, the transition to the new system would take a little more than two years instead of four. Plus, it would provide long-term care services for the elderly and disabled, including covering home health aides, rehabilitation services and nursing home stays.
    Insurance premiums, deductibles and co-payments would, for the most part, disappear along with private insurance, including the job-based coverage that now covers half of Americans. Employers and insurers could only sell supplemental coverage for items such as cosmetic surgery. And a fund would be set up to help the workers in the private insurance industry who are displaced to transition to other jobs.
    Its supporters talk about Medicare for all in deeply personal, even ethical terms.
    Rep. Andy Levin, a Democrat of Michigan, is a two-time cancer survivor with two kids who have Crohn's disease, a chronic inflammatory condition that affects their digestive tracts. In one 2018 campaign ad, he held up an $18,000 bill to treat one of his children. He said in an interview that it's a "moral" issue to him that the country ensures every citizen is insured.
    "You might not be here tomorrow," said Levin. "That's what you learn when you get cancer."
    "I'm not that much of an incrementalist about anything," he added.
    Rep. Alexandria Ocasio-Cortez, the youngest congresswoman ever, co-sponsored the bill since Medicare for all is "part of my values."
    "Single-payer is where I think we need to go as a country in order to fully realize the vision of health care as a human right," she told CNN.
    Democrats have been pushing national health insurance plans for decades. After Sanders' campaign and the Republicans' attempt to repeal the Affordable Care Act, the idea has gotten modestly more popular in recent years.
    About three-quarters of the public support less disruptive changes like a Medicare or Medicaid-buy in plan, while about 56% of respondents favor every American getting insurance from a single government plan,