Democratic governors are experimenting with new ways to expand health care, testing out progressive ideas that could go national if their party wins the Senate or White House in 2020.
The policies run counter to the Trump administration's ideas and are only now possible after a Democratic wave in the House helped secure the future of ObamaCare.
Prominent Democratic governors in California and Washington this week rolled out plans to extend government-run health coverage to more people.
Washington Gov. Jay Inslee (D) is proposing a “public option” — a government-run plan that will compete with private insurers. In California, newly elected Gov. Gavin Newsom (D) is asking the Trump administration to allow the state to create a single-payer system.
On Capitol Hill, progressive lawmakers are pushing for a form of single-payer legislation in the House, but those ideas won’t even be considered by Republicans who still control the Senate.
That means for now, the state level is likely the only arena for Democrats to test progressive health ideas for expanding coverage.
“I think these states will be seen as kind of trial balloons, even though they are proposing reforms that only apply to a relatively small share of their insurance market,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation.
Both California and Washington also have Democratic majorities in the state legislatures, which make them much more likely to implement ideas that have little chance of being approved by a divided Congress and President TrumpDonald TrumpTexas announces election audit in four counties after Trump demand Schumer sets Monday showdown on debt ceiling-government funding bill Pennsylvania AG sues to block GOP subpoenas in election probe MORE.
“There’s a natural synergy between what states are doing and the Democratic agenda nationally,” said Larry Levitt, a vice president at the Kaiser Family Foundation. “States have the ability to move forward that Democrats in Congress can’t.”
Democrats argue that it only takes one state to implement an innovate approach that, if successful, can be scaled up nationwide.
In the most prominent example, former President Obama used the insurance exchange in Massachusetts as a model for the Affordable Care Act.
Rep. Ro KhannaRohit (Ro) KhannaHouse passes sweeping defense policy bill Overnight Defense & National Security — Iron Dome funding clears House Overnight Defense & National Security — Presented by AM General — Defense bill takes center stage MORE (D-Calif.) is working with Newsom on the single-payer plan in California. He said he is working on a bill that gives states permission to create their own health care programs and still receive federal funding.
“I’m hopeful we will show that health care, Medicare for all, a single-payer system, can be good for the economy, good for economic growth,” Khanna told The Hill.
Khanna acknowledged that the Trump administration will not approve California’s request to create a single-payer system. Still, Newsom ran on single-payer and is signaling the direction in which he wants the state to move.
Working on these proposals now also lays a groundwork for the Democratic agenda if they retake the White House.
“I think they need to be ready and prepared in California so that when we have a Democratic president, they’re ready to go,” Khanna said.
In the meantime, Newsom is planning to enact a series of other measures to expand coverage, including a state individual mandate, increasing ObamaCare insurance subsidies, and extending Medicaid to undocumented young adults.
Both Inslee and Newsom said the ultimate goal is to move toward universal health care, a sharp contrast to the approach being taken by the Trump administration.
“Every person should have access to quality, affordable health care,” Newsom said in his inaugural speech. “Far-away judges and politicians may try to turn back our progress. But we will never waver in our pursuit of guaranteed health care for all Californians.”
Inslee faulted the Trump administration for introducing instability into the state’s insurance marketplace, resulting in higher costs and fewer options. The public option will fix that, he said.
“We’re going to do all we can to protect health care for Washingtonians. This public option will ensure consumers in every part of the state will have an option for high-quality, affordable coverage,” Inslee said in a statement.
Health care was a winning issue for Democrats across the country in 2018. In Congress, Democrats took control of the House on a promise to protect ObamaCare.
The state proposals show state lawmakers now feel empowered after the midterms to push beyond ObamaCare.
“Liberal states were doing everything they could just to implement the law and fight repeal," said Levitt about the years after ObamaCare first passed. "And now they have room to build on the law."
States see the Democratic-controlled House as a bulwark against efforts to repeal ObamaCare.
“For the last couple years, states have been fighting a rearguard action, and now that repeal and replace is off the table, they can start to think about the future,” Levitt said.
Rep. Pramila JayapalPramila JayapalDemocrats steamroll toward showdown on House floor Fifth House Republican comes out in support of bipartisan infrastructure bill The Hill's Morning Report - Presented by Alibaba - Biden jumps into frenzied Dem spending talks MORE (D-Wash.) told The Hill she thinks a Democratic House gives liberal states confidence to move ahead with progressive reforms.
“I think they feel like we can probably stop some of the worst things Republicans were pushing before,” Jayapal said.
“So I think it gives [states] the option to try and move forward and hope for a different result in 2020, where we can then get the federal government to support states’ efforts to even go further,” she added.
For now, progressives have high hopes for what Democratic governors can do.
Anthony Wright, executive director of Health Access California, said the election should be a call to action.
"It would be disappointing if we had this big election that was primarily about health care — you had a huge response by voters on health care — and that at the end of the year after that election there wasn’t major ... meaningful steps toward universal coverage,” Wright said.
Reid Wilson contributed.