Sen. Bernie Sanders’ vote for the Affordable Care Act was crucial to the passage of the health care legislation. So was every single other vote cast for it when Democrats passed the landmark bill by a thread.
Now Sanders is talking about undoing it with a Medicare-for-all plan. Congressional Democrats have a range of views on it. Some simply say it is unrealistic. Others are openly frustrated that he’s proposing to reopen the health care debate after the enormous effort it took to pass the ACA.
“People don’t realize how hard-fought it was,” Rep. Sander Levin (D-Mich.) told Morning Consult in an interview. “When you win a hard-fought battle, it’s a serious mistake for, in a Democratic campaign, to say, ‘Let’s go on and do something else.’”
“Everyone who’s supporting [Sanders] needs to take a sober look at what would actually happen with these proposals,” Sen. Claire McCaskill (D-Mo.) said. “I mean, this is a House that has voted to repeal the ACA 63 times. What, all of a sudden [House Speaker] Paul Ryan’s going to go, ‘Hey, I’m really down with single-payer?’ Of course not. I mean, it’s almost laughable.”
Democrats have spent the six years since the health care law’s passage defending it against relentless criticism from Republicans. Now, in an ironic twist, Sanders would also like to replace Obamacare. Congressional Democrats say that’s harmful to the ACA, particularly because it will make the law harder to defend in the general election.
“It’s a mistake to say with all the progress we’ve made, we now should do something else,” said Levin, who was chairman of the powerful House Ways and Means Committee when Obamacare passed. He is now the ranking Democrat.
“We’re going to have to, in the general election, defend the health care reform. We have to defend it. And you can’t effectively defend it when essentially you’ve been talking about all of its shortcomings.”
“The failure to focus on the pluses of ACA gives ground, I think, to those people who want to destroy it altogether,” said Levin. “I think [Sanders is] hurting the progress we’ve made under ACA.”
Health care has become a major point of contrast between Sanders and Hillary Clinton, who has embraced the ACA and pledged to strengthen it. There is no doubt that the law has restructured the healthcare landscape, but it still relies on private insurers. Sanders’ plan, while lacking crucial details, would upend the current structure of private health insurance by expanding the government-run Medicare program to all Americans.
Much of the campaign discussion of Sanders’ plan has revolved around how much it would cost. But Democrats in Congress, many of whom were around during the battle for health reform in 2009 and 2010, don’t even take the evaluation that far. To them, passing a markedly more liberal health care system than the one created under the ACA is impossible. The idea that Sanders would propose reopening the health care debate after everything they went through passing Obamacare is downright aggravating.
Obamacare was passed using creative legislative gymnastics. To recap, both chambers passed their own versions of the bill, with the Senate needing all 60 members of the Democratic caucus to get it through. Then-House Speaker Nancy Pelosi finally wrangled together 220 members of her own caucus, only two more than the 218 she needed. Even these slim margins were only made possible by aggressive dealmaking and compromising by Pelosi and then-Senate Majority Leader Harry Reid.
But then Senate Democrats lost a seat after the death of Sen. Ted Kennedy (D-Mass.). The bill looked dead until the House finally agreed to pass the Senate version. It then created and passed a set of additions to the law, which the Senate passed using a budget tool that bypasses a Senate filibuster, thus needing only 51 votes. It took every last tool in their toolbox to get it done.
“I think Hillary has a real good point, that it was tough to get the ACA in 2010, or 09…If you’re dealing in idealism, all of us would like to have it better. But, you know, don’t trash it, because that’s all we got,” said Rep. Gene Green (D-Texas), a member of the Energy and Commerce Committee.
“The ACA’s not perfect,” he added. “Some of the things I’d like to do would be what he’s suggesting.”
Since the passage of the ACA, the political landscape has only become bleaker for any kind of bipartisan compromise on health care. The massive health care law has not been reopened for any tweaks since its passage, the normal process for programs of its size. Democrats will easily admit the law needs some work, but Republicans are unwilling to engage in those discussions while campaigning on the premise that a Republican president in 2017 would repeal and replace Obamacare in its entirety.
A single-payer health care system is popular among Democrats, which helps explain its resonance with primary voters. Some congressional Democrats acknowledge that while the idea itself isn’t bad, it’s just not based in reality. It’s also an idea Sanders has long stood for, so it’s not surprising he’s stuck with it in his shot at the presidency.
“I know where he’s coming from. Even during the [ACA] debate, he was for single payer. And he supported this bill with some hesitation, because he believes in it – you know, Medicare-for-all I believe is his approach. But he was there when we needed him,” said Majority Whip Dick Durbin (D-Ill.).
“Reopening [the health care debate] is a good idea as long as we’re doing it in a constructive fashion,” he told Morning Consult. “Whether Bernie could sell his idea to a majority in the House and the Senate, today he could not. I’m sure he would admit that. But there is strong public support for what he’s saying.”
Other Democrats oppose single-payer health care for more ideological reasons. Sen. Dianne Feinstein (D-Calif.) said that she believes the private sector should be allowed to operate in the areas in which it works well. Health care is one of those areas. Furthermore, Obamacare just caused a “huge upheaval” that is coming to an end. The law is “now beginning to work.”
There are the basic political problems with Democrats fracturing over Obamacare. For those like Levin, who are afraid the divide between keeping the ACA and moving on to single-payer gives credence to Republicans messaging against the law, there are early signs that this fear is well founded.
“Bernie Sanders’ comments about the health care law show how deep the dissatisfaction is with Obamacare across the country. So we know it, and the Democrats know it,” said Sen. John Barrasso (R-Wyo.), the No. 4 Republican in the Senate and its chief messenger against the ACA. “People understand that this health care law is not working in spite of what the president says.