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COVENTRY, R.I. – At their first town meeting since the Republicans’ surprise surrender on the Affordable Care Act, progressives in blue America celebrated – then asked for more. Rhode Island’s two Democratic senators, joined by Rep. Jim Langevin, told several hundred happy constituents that the next step in health reform had to mean expanded coverage, provided by the government.
“We have to look harder at a single-payer system,” said Langevin, D-R.I., using a term for universal coverage.
“I’m old enough to have voted for a single-payer system in the House,” said Sen. Jack Reed, Rhode Island’s senior senator.
“The very best market-based solution is to have a public option,” said Sen. Sheldon Whitehouse.
Progressives, emboldened by Republicans’ health-care failure, are trying to shift the political debate even further to the left, toward a longstanding goal that Democrats told them was unrealistic. They see in President Trump a less ideological Republican who has also promised universal coverage, and they see a base of Trump voters who might very well embrace the idea.
The weekend after the implosion of the GOP’s American Health Care Act brought that into the open. In several TV interviews, Sen. Bernie Sanders, I-Vt., promised to reintroduce a “Medicare for All” bill when the Senate returns to work. House Minority Leader Nancy Pelosi, D-Calif., held a town hall in her San Francisco district where she happily egged on protesters demanding a plan like Sanders’s.
“I supported single payer since before you were born,” said Pelosi, who has argued since the passage of the Affordable Care Act that it could be a bridge to European-style universal coverage. (The House passed a bill with the “public option” jargon to describe a Medicare-style national plan that could work as a competitor against private insurers.)
In the glow of victory, Democrats spent the weekend thanking activists who showed up at Republican town halls, worked congressional phone lines and made the AHCA politically untenable for many Republicans – especially moderates. Activists also had succeeded in getting most Senate Democrats on the record against Supreme Court nominee Neil Gorsuch.
In Rhode Island, where Democrats hold every major office, activists have been pushing the local party to the left. Sanders won the state’s 2016 primary, and the Working Families Party, which endorsed him, has held weekly organizing meetings to find targets for activists. Gov. Gina Raimondo, D-R.I., a former venture capitalist, has pitched a version of the free public college tuition plan Sanders ran on. Whitehouse, who emerged in the Gorsuch hearings as a key critic, was even protested after he’d voted for several Trump Cabinet nominees.
“That was key,” said David Segal, a former Rhode Island legislator and executive director of the progressive group Demand Progress. “Fifteen hundred people showed up to demand that a senator who’s generally seen as progressive be more progressive.”
But health care was the issue with the most apparent running room for the left. Since January, Democrats and activists had held events that promoted the Affordable Care Act – which for the first six years since its passage had been a loser in polls – by presenting people who’d been helped by the law. In the three weeks that the American Health Care Act was debated in public, even some conservative allies of the president argued that it had become politically impossible to scale back health coverage.
The victory of a Republican candidate who promised “insurance for everybody,” and who once favored universal insurance, made some Democrats ask if an idea once dismissed as socialism might have some bipartisan openings in the post-ideological era of Trump.
“Donald Trump staked out the high moral ground by calling for a feasible system of universal healthcare to replace Obamacare,” wrote Newsmax publisher Christopher Ruddy, a Trump friend, 11 days before AHCA crashed to earth. “He shouldn’t retreat from that no matter how much the establishment GOP dislikes it.”
In response, elected Democrats have felt freer to make health-care demands, despite controlling no branch of government. The windup often suggests that Republicans are right, and that the health-care system must be tweaked.
“We have ideas, they have ideas, to try to improve Obamacare,” Senate Minority Leader Charles Schumer, D-N.Y., said in a Sunday interview with ABC News. “We never said it was perfect. We always said we’d work with them to improve it.”
On the details, Democrats now argue that Trump should move to the left. Asked where Democrats might work with the president to fix health care, Rep. Frank Pallone, D-N.J., suggested “expanding Medicaid in states that haven’t expanded it yet” – anathema to Republicans and conservative groups that fought against it. (Medicaid expansion is optional-only because of the 2012 National Federation of Independent Business v. Sebelius decision, which was argued by conservatives and struck down small parts of the ACA.) Sanders, who couldn’t get all of his colleagues in the Democratic caucus to endorse a prescription drugs importation bill, said he believes that this Republican president might.
“President Trump said a whole lot of stuff on the campaign trail,” Sanders said on CNN’s “State of the Union” on Sunday. “One of the things he talked about was lowering the cost of prescription drugs. There is wonderful legislation right now in the Senate to do that. President Trump, come on board. Let’s work together.”
Some Democrats remain skittish about the threat of being tarred by ideological conservatives in tough elections. Saving the Affordable Care Act from repeal united Democrats and healed divisions between the party’s base and its politicians. The next health-care debate might not do that. The only Democrats facing elections soon are candidates for open House seats in deep-red districts, and few have endorsed single payer.
Instead, they’ve cautiously discussed fixes that might be worked out between the parties. Jim Thompson, a candidate for an open seat in Kansas, said after the AHCA’s collapse that parties should “sit down and find a plan that expands coverage, lowers costs, and brings us together.” Jon Ossoff, whose bid for an open seat in Georgia has become surprisingly competitive, has run TV ads saying he opposes repeal but favors tweaks to the law. “Both parties should sit down and deliver more affordable health care choices,” he said after Friday’s debacle.
That approach reflects how, despite Friday’s setback, Republicans have long benefited from attacking a “government takeover” of health care. And most special-election Democrats aren’t ready to test whether the landscape has changed.
“Obamacare’s ongoing collapse is a case study in what occurs with a top-down, government centered approach to healthcare,” said National Republican Congressional Committee spokesman Jesse Hunt. “Candidates who advocate for a Bernie-style single payer system do so at their own peril.”
That hasn’t stopped the Democrats’ base, just as Republicans demanded years of fealty to a repeal message, from seeking more on health care. The Coventry town hall, which filled most of the city’s largest high school auditorium, was a target-rich environment for local groups trying to get signatures to support expanded health care. J. Mark Ryan, 49, who led the local chapter of Physicians for a National Health Program, walked from row to row with cards that people could sign if they wanted the state to pass a single-payer bill.
“Any Republicans who are interested in being re-elected should be interested in this, too,” he said.
Michael Fuchs, 55, got Whitehouse to sign a different card, for a campaign simply to get Rhode Island to endorse the “essential health benefits” that were negotiated away in the final version of the AHCA. Doing so, he pointed out, would protect the state’s customers even if Republicans made a successful run at the law. But in the long run, he, too, wanted national health insurance.
“We could at least lower the buy-in age for Medicare to 55,” he said.
Over more than two friendly hours, the elected Democrats got the most applause when they swerved left on health care.
“The very best market-based solution is to have a public option,” Whitehouse said. Paraphrasing Benjamin Franklin, he said that a government-managed insurer would reveal what games private insurers had been playing. “The best way to show that a stick is crooked is to put a straight stick next to it. If you do that, the private sector can’t manipulate the market by withdrawing.”
But as the town hall went on, activists demanded to know if Whitehouse could go further. After several rounds of questions about the need to investigate Russia’s involvement in the 2016 election, and the need to filibuster Gorsuch, Ryan, with the physician group, asked the senator if he could get behind universal coverage.
“Why not endorse it this year?” Ryan asked.
In the spirit of the weekend, Whitehouse didn’t rule it out. “We already do it for the people we care the most about – our veterans and our seniors,” he said.