Democrats weigh how big to go on healthcare reform in midterm push

Democratic lawmakers and policy groups are all throwing their ideas for healthcare reform in the ring, but it remains to be seen what the party is willing to consider as it seeks to retake control of Congress.

After the Affordable Care Act (ACA) enhanced premium tax credits expired last year, and with no momentum to revive them at the Capitol, Democrat-aligned groups in recent months have been putting forward their proposals for new healthcare reform initiatives.

Ideas have ranged from proposals like Medicare by Choice to a public nonprofit option for all.

Sen. Andy Kim (D-N.J.) unveiled his bill , The MediKids Act, in July that would automatically enroll every child into Medicaid at birth, provide continued eligibility until the age of 26 and cover 100 percent of the federal medical assistance percentage for this cohort.

Kim said he believed it was necessary for Democrats to begin coming forward with ideas to fill what he perceived to be an “idea vacuum.”

“We do have to put forward our own solutions, our own vision, to be able to energize and inspire the American people,” he said.

As The Washington Post reported , House Democrats are eyeing not only reversing the GOP Medicaid cuts if they retake the House but expanding Medicare coverage and government-run insurance programs. According to the Post, discussions are touching on potentially lowering the age of eligibility for Medicare and expanding coverage to include vision, dental and hearing.

According to observers and insiders, there is a renewed appetite for healthcare reform within the Democratic Party — and a growing interest in going beyond the ACA.

“I don’t think the conversation is simply about defending the Affordable Healthcare Act anymore,” Amy Dacey, executive director of the Sine Institute of Policy & Politics at American University and former CEO of the Democratic National Committee, told The Hill.

“I think there’s a recognition that the ACA certainly solved an enormous coverage problem, but it didn’t necessarily you know solve some of the underlying affordability problem,” added Dacey.

Former President Obama famously called the ACA a “starter home” in 2016.

“It’s a lot better than not having a home, but you hope that over time you make some improvements,” he said at Miami Dade College.

Several progressive lawmakers are still pushing for Medicare for All, and Kim characterized his MediKids Act as a stepping stone to achieving this. But more centrist Democrats are rather leaning toward strengthening and expanding existing programs.

“To me, the interesting political question is whether these groups can agree on a common first step, you know, and go from there,” said Dacey. “The next Democratic healthcare project — I think it’s more likely to be about affordability and market power.”

Dacey’s Sine Institute recently released polling that found a third of young people between the ages of 18 and 34 reported being a regular caregiver for someone with a health condition, disability, injury or mental health need. Dacey said she expects the cost of caregiving to also become a bigger part of the healthcare reform conversation among elected officials.

Ideas like Kim’s are essentially on the back burner until Democrats can regain control over the House, Senate and White House, and advocates say in 2027 and 2028, the focus must be on winning first.

According to Brad Woodhouse, a longtime Democratic strategist and executive director of the healthcare advocacy group Protect Our Care, there is currently an “appetite for major healthcare legislation over the next several years” among Democrats.

He opined that delivering major healthcare reforms has to begin with restoring the ACA tax credits, and undoing the Medicaid cuts must come first if and when Democrats win back control.

“I understand that people want to talk about single-payer and Medicare for All and public option and all of those things, but … I think probably the easiest lift on that list is restoring the ACA,” said Woodhouse.

When asked if there are any ideas that may be a step “too far” for Democrats and their base, Woodhouse said proposals to do away with all existing coverage options and replacing them with a one-payer system would be one such example.

“I think that that would be a big step too far because that’s not what the American people are asking for,” Woodhouse said. “What they’re asking for are lower costs. So, part of that is restoring the tax credits.”

“We need to restore what we had, and so that that’s what the American people in our polling show that they want,” he added. “I think there’s an appetite for it. There’s going to be disagreements within the party about how far all of this goes, but just remember, even the even the small stuff isn’t going to get past Trump’s veto pen.”