As part of her effort to lay out her plans to enact Medicare for All in greater detail, Senator Elizabeth Warren has now released a procedural timeline that makes it clear she will initially push legislation to open up Medicare to parts of the population without any direct interference with private insurance. A second bill implementing Medicare for All fully would come later in her first term. This distinguishes her approach from that of Bernie Sanders, who will push for immediate adoption of Medicare for All, though it will be phased in over his first term. Warren seems to be recognizing the political implausibility of immediate adoption of the big structural change that both she and Sanders have been calling for. CNN has some details:
During the first phase, Warren would use the Senate budget reconciliation process to pass legislation that would immediately offer Medicare for All’s full suite of benefits — at no cost — to children under 18 and people at up to 200% of the poverty level, around $51,000 in income for a family of four. The option would be open to any American who wants to use it, but they would have to pay for it, though costs would decline over time. Additionally, the legislation would lower the current Medicare eligibility age to 50 from 65, while while also expanding the program’s benefits and lowering what enrollees have to pay.
Using reconciliation means the plan can be passed with 50 Senate votes (and the narrower the approach, the more likely health-care legislation can pass muster with the Senate parliamentarian as eligible for reconciliation). Obviously, prospects for such passage would go up considerably if Democrats can gain control of that chamber next year, which at the moment is a reach; if he’s still in charge of the Senate, Mitch McConnell is not going to be cooperative. But an incremental bill will have a much better chance of attracting the support of both centrist Senate (and House) Democrats and perhaps the odd Republican heretic. At present, there is no way a full-on Medicare for All plan would get 50 Senate votes. Under Warren’s plan, that would now happen a bit later, in a second bill:
[N]o later than my third year in office, I will fight to pass legislation that would complete the transition to full Medicare for All. By this point, the American people will have experienced the full benefits of a true Medicare for All option, and they can see for themselves how that experience stacks up against high-priced care that requires them to fight tooth-and-nail against their insurance company. Per the terms of the Medicare for All Act, supplemental private insurance that doesn’t duplicate the benefits of Medicare for All would still be available. But by avoiding duplicative insurance and integrating every American into the new program, the American people would save trillions of dollars on health costs.
So the idea is that with a couple of years of being able to compare the new, improved Medicare benefits to private insurance, political momentum for the whole enchilada will grow enough to make its passage possible.
The immediate problem with that supposition is that new presidents generally lose ground in their first midterm election (the only post–World-War II exception was in 2002, in the wake of 9/11). A President Warren would likely have less, not more, control of Congress. So this second-phase legislation might need to happen in her second year in office to have a chance of passage, and that’s mighty quick.
Whether or not her second-phase plans actually make any political sense, Warren’s timetable shows she continues to have a more concrete “theory of change” about Medicare for All than Sanders, who vaguely expects a “political revolution” to magically make full enactment of his plan overnight, and other militant advocates. Those Democrats who oppose the elimination of private insurance, or just fear the political blowback from trying to eliminate it, can now envision a Warren administration where the first step toward Medicare for All is the last — for at least the immediate future. We’ll soon see whether this appeases some centrist critics of Warren, and also whether hard-core Medicare for All champions accuse her of backtracking or selling out.