As Bernie Sanders and Joe Biden negotiate behind the scenes in advance of the Democratic National Convention, progressive leaders are concentrating their efforts on pressing the former vice president to adopt liberal changes to his health care policies — such as creating a more robust public option than the one he has already offered.
Progressive groups that have been in talks with Biden’s campaign, including MoveOn, said lobbying the presumptive nominee on health care has shot to the top of the left's agenda amid the backdrop of the coronavirus pandemic, a once-in-a-century crisis.
“Obviously the pandemic, with both its health and economic impacts, has become the top issue that everyone is talking about,” said Dan Kalik, MoveOn’s senior political adviser. “It's all-encompassing. It’s impacting every aspect of our lives. It’s the key issue we’re working on, and it's going to be an issue through November.”
The push comes after a steep and sudden fall for the Medicare for All movement. In the span of just two months, activists went from cheering on Sanders, the single-payer champion who sprinted to the front of the Democratic primary, to mourning as Biden, who campaigned against Medicare for All and is considering a running mate with ties to the health care insurance industry, became the all-but-certain nominee.
With Sanders out of the primary and Capitol Hill consumed by COVID-19 relief, progressive elected officials and advocates now view Biden — who recently suggested he would veto Medicare for All — as their best chance at moving the country closer to single-payer health care.
Though Biden is a moderate, they think there is promise in the fact that he is setting up task forces with Sanders to advise him on policy. Sanders is eyeing Rep. Pramila Jayapal and former Michigan gubernatorial candidate Abdul El-Sayed — both top Medicare for All advocates — for the task force focused on health care, according to people familiar with his plans. The two would represent a radical change from policy thinkers in Biden’s orbit.
“I'd be fooling myself if I thought Joe Biden would embrace Medicare for All. But I do think there’s room for him to move much more than he has so far,” said Jayapal, who is the lead author of the House’s single-payer bill and co-chair of the Congressional Progressive Caucus.
“We are continuously considering and evaluating additional policies that would build upon Vice President Biden's progressive agenda,” said a Biden aide. “We are focused on identifying common ground, establishing where we can work together, and ensuring we broaden our coalition to defeat Donald Trump.”
Biden’s campaign declined to comment to POLITICO on who will serve on the task forces, other than to say they would “represent the diverse viewpoints of the Democratic Party.”
Single-payer activists said the fact that Biden recently proposed lowering the Medicare eligibility age to 60 — “Medicare for Some,” as one dubbed it — shows their pressure campaign is already working. The policy change could have a huge impact by immediately enrolling up to 23 million more people in Medicare, according to a new analysis by the consulting firm Avalere.
"That's only a very, very, very first step," said Jeff Weaver, Sanders’ longtime adviser. Still, he added, "That's a lot of people. Clearly not where we need to get to by any stretch of the imagination. But not nothing. And what people have to understand is that even that concession is a result of the movement around Medicare for All pushing the envelope on this.”
Biden released his plan to expand Medicare shortly after Sanders dropped out earlier this month. Sanders and Biden aides were already negotiating behind the scenes in the weeks before he exited the race, and health care was one of several issues they discussed.
“Bernie and Biden talked and [Biden’s decision to lower the age of Medicare enrollees to 60] came out of that,” said Wendell Potter, a former insurance executive turned Medicare for All activist. “I can’t imagine that that’s all Bernie is going to be asking for, or that’s all that Biden will say is needed to get us to a better health care system.”
The health care task force is one of six the Sanders and Biden campaigns are putting together on various policy issues, including the economy, climate change and criminal justice.
As the coronavirus consumes the attention of elected officials and advocates alike, advocates said the turmoil may provide an opening to win over skeptics of single-payer. A Morning Consult-POLITICO poll found that public support for Medicare for All has shot up to a nine-month high amid the pandemic.
“Looking back at history, Britain achieved its universal health care system in the ruins of depression and war, when they didn’t have two shillings to rub together," said Adam Gaffney, president of Physicians for a National Health Program. "Paradoxically, this may in fact be an opportunity.”
As Medicare for All activists try to force Biden to the left on health care, though, they’ll be contending with a health care industry pushing hard in the opposite direction. The Partnership for America’s Health Care Future, a lobbying behemoth backed by the biggest players in the hospital and insurance industries, spent $4.5 million on advertising combating Medicare for All during the presidential primary, according to TV data from Advertising Analytics.
The group argues Biden's decisive victory was another nail in the coffin for the single-payer dream.
“This is now the third cycle where it just never made it — if you look at 2016, 2018 and 2020,” said Lauren Crawford Shaver, executive director of the Partnership for America’s Health Care Future, of Medicare for All. “It didn’t ever hit a critical mass of support. Voters ultimately didn’t pick it as what they wanted to see.”
But in a sign that the Partnership for America’s Health Care Future doesn’t see health reform efforts as completely dead yet, it continues to advertise on Facebook promoting the industry’s efforts during the pandemic.
In addition to fighting single-payer, the Partnership also opposes Biden’s public option plan. Donors in the health care and pharmaceutical industries contributed $3.7 million to Biden and outside groups supporting him, according to the Center for Responsive Politics' Open Secrets.
At his first fundraiser during the campaign, Independence Health Group CEO Dan Hilferty was a co-host. And throughout the campaign, Biden warned that Medicare for All would strip union members of their hard-won benefits, bankrupt the federal government, and erase progress made under the Affordable Care Act.
Despite the enormous challenge facing them, progressives are drawing up a list of areas where they believe they can potentially push Biden in a more liberal direction on health care.
Weaver said the Biden-Sanders health care task force will likely discuss lowering the Medicare eligibility age to 55 and creating a universal health care insurance program for children.
El-Sayed also listed expanding Medicare for young people as they age out of their parents’ health care plans when they turn 26 as an additional potential place where progressives could win a concession. Other activists and lawmakers mentioned allowing employers to purchase group coverage through the public option, and adopting Sanders’ and Jayapal’s legislation to guarantee health care coverage to all uninsured people during the coronavirus pandemic.
“The most urgent priority is to support Medicare in this crisis for those without insurance,” said Ro Khanna, Sanders’ former campaign co-chair. “Sanders’ and Jayapal’s bill does that and would be a great starting point. Why offer to pay for COBRA when we can put folks on Medicare?”
Both El-Sayed and Jayapal declined to comment on whether they had been asked to sit on the Biden-Sanders health care task force. However, Jayapal said she has been “thinking through” what the group should look like with both politicians' teams.
“I hope I can work with Biden as our Democratic nominee and help him and his team to get to a place where they see what must be done with his leadership,” she said.
Progressives said they will also push for liberal appointees to health care-focused posts in Biden's potential administration, such as the heads of Health and Human Services and the Centers for Disease Control and Prevention.
Biden’s vice presidential pick is the subject of especially close scrutiny.
Single-payer advocates are particularly fearful of Biden choosing Michigan Gov. Gretchen Whitmer, whose father was the former CEO of Blue Cross Blue Shield of Michigan. In their view, such a decision would signal a very different approach to health care than some options — such as Sen. Elizabeth Warren, who called for initially implementing a public option and then transitioning to Medicare for All.
“For Biden to even pretend that he's going to put together task forces and listen to progressives while considering Whitmer for VP — they’re polar opposites,” said Bridget Huff, chairwoman of the Progressive Caucus of the Michigan Democratic Party. “He couldn't find someone less friendly to Medicare for All.”
A Whitmer spokesman declined to comment, but her home-state Rep. Andy Levin, a member of the Congressional Progressive Caucus, defended her health care record. Whitmer has said she supports Medicare for All “in concept,” though she said it was unrealistic for Michigan during her gubernatorial campaign.
One move of Biden's that has heartened the left, however, has been his recent support of free testing, treatment and vaccinations for COVID-19 — a kind of ‘Medicare for All Who Catch the Virus’ — though they would like him to promote the idea more.
In fact, progressives feel the coronavirus pandemic has made the case for Medicare for All for them. How can Biden argue that those who like their private insurance can keep it, they argue, as tens of millions of people are thrown off their plans when they become unemployed? And how can he say people shouldn't be on the hook for coronavirus treatment but should be allowed to go broke if they get cancer?
But few, if any, believe there is any chance of Biden ever backing single-payer, meaning their hopes have been dashed for another four years at least.
"Our general read of the issues has been that the quote unquote establishment is going to tell the left to f--k off on Medicare for All,” said the liberal think tank Data for Progress’ Julian Brave NoiseCat. However, he said, other progressive ideas, such as the government manufacturing generic prescription drugs, are "very popular."
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