Obamacare Repeal in Congress Is Dead. Next, a Battle Over Medicare for All

(Bloomberg) -- Obamacare repeal is officially dead. On to the battle over Medicare for All.

Tuesday’s midterm victories by Democrats mean that Republicans no longer have a path to make major changes to the Affordable Care Act. It also sets up a debate between Democrats’ liberal and moderate wings over whether to embrace a broad expansion of insurance to all Americans as they prepare to challenge President Donald Trump for the presidency in 2020.

Once considered an outlier position, Medicare for All has gained substantial support among Democrats thanks to midterm primary victories by progressives who embraced.

In its broadest terms, the proposal would expand benefits in Medicare -- which covers more than 50 million elderly or disabled Americans -- and offer it to working age people. It would be a radical change to U.S. health care, potentially dismantling much of an existing system where people get health benefits through work. It would also shift trillions of dollars that the country currently spends on private insurance.

“Medicare for All has really been a slogan that has not been well-defined, and it was weaponized by the Republican party as some kind of an attempt to socialize the medical system,” said Dan Mendelson, founder of the consulting group Avalere Health.

“It’s really going to be important for anyone running for president to define what they mean by Medicare for All,” he said.

A presidential primary may ratchet up pressure on candidates to move left on health care. In the Senate, 2020 hopefuls including senators Cory Booker, Kirsten Gillibrand, Kamala Harris, and Elizabeth Warren have all co-sponsored a Medicare for All bill from Senator Bernie Sanders. Another supporter of a public insurance option is Representative Beto O’Rourke, who lost a challenge Tuesday night to Republican Senator Ted Cruz in Texas, and who has emerged as one of the Democratic party’s young stars.

What individual politicians mean by Medicare for All may vary. Some early drafts of the Affordable Care Act included plans for a “public option” -- a government-financed competitor to private insurers. That proposal didn’t make it into Obamacare in 2010, but Democrats who want to expand coverage without disrupting employer-based health plans could revive it.

Target for GOP

As Democrats fight out their future position, health care is likely to remain a line of attack for Republicans as well. Medicare for All has become a top target for Trump and his surrogates, who seem eager to paint it as socialism and a threat to current benefits for seniors.

“I think the Republicans are all-in on spending the next two years saying that Medicare-for-All will break Medicare,” said Rodney Whitlock, a former health-care adviser to Republican Senator Chuck Grassley of Iowa, and now a consultant for ML Strategies.

An Oct. 10 op-ed in USA Today under Trump’s name warned that Democrats “want to outlaw private health care plans.” Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, tweeted on Halloween that the scariest costume was a T-shirt that said “MEDICARE FOR ALL.”

Democrats will have to consider whether they want to embrace that proposal or advocate more moderate, incremental changes. “If this had been a blue wave, we wouldn’t be having the conversation,” Whitlock said.

Obamacare Repeal in Congress Is Dead. Next, a Battle Over Medicare for All

Other results from Tuesday showed how the politics of health care may be shifting. Three states -- Idaho, Nebraska and Utah -- are projected to have approved Medicaid expansion by ballot initiative, which will expand coverage substantially in those states.

One Obamacare wild card is a federal lawsuit in Texas. A federal judge in Fort Worth could rule any day on whether to wipe out Obamacare, including a popular provision requiring insurers to cover pre-existing conditions. It’s likely that any decision by the judge would be stayed until a higher court can review it.

Republican politicians from Senate Majority Leader Mitch McConnell to the incoming Missouri Senator Josh Hawley have committed to protections for people with pre-existing conditions, one of the most popular elements of the Affordable Care Act.

The Trump administration remains responsible for running the law’s marketplaces. Executive actions Trump takes may strengthen those markets or, as the president once pledged, make them implode. A Democrat-controlled House is also likely to give scrutiny to any such actions by the administration.

©2018 Bloomberg L.P.