Dems offer smaller step toward ‘Medicare for all'

House and Senate Democrats on Wednesday introduced a Medicare buy-in bill, legislation that they presented as an alternative to the single-payer proposals backed by the progressive wing of the party.

The new measure would allow people to purchase Medicare plans after turning 50, instead of waiting until 65. Supporters say it’s more politically palatable and easier to implement than “Medicare for all,” which would upend the entire health care system.

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“This is something that is not pie in the sky or aspirational,” said Rep. Joe CourtneyJoseph (Joe) D. CourtneyHouse votes to repeal ObamaCare's 'Cadillac tax' Overnight Defense: Pompeo blames Iran for oil tanker attacks | House panel approves 3B defense bill | Trump shares designs for red, white and blue Air Force One Trump shares renderings of red, white and blue Air Force One MORE (D-Conn.), a co-sponsor of the buy-in bill. “This is a piece of legislation where you could turn the switch on overnight.”

The measure was introduced by Sens. Sherrod BrownSherrod Campbell BrownThe Hill's Campaign Report: Battle for Senate begins to take shape Dayton Democrat launches challenge to longtime GOP rep Dayton mayor: Trump visit after shooting was 'difficult on the community' MORE (D-Ohio), Debbie StabenowDeborah (Debbie) Ann StabenowUSDA eases relocation timeline as researchers flee agency USDA office move may have broken law, watchdog says Senate Democrats see Warren, Sanders proposals as unfeasible MORE (D-Mich.) and Tammy BaldwinTammy Suzanne BaldwinTrade wars and the over-valued dollar Overnight Health Care: Senate panel advances drug pricing bill amid GOP blowback | House panel grills Juul executives | Trump gives boost to state drug import plans | Officials say new migrant kids' shelter to remain open but empty Senators vow to bring transparency to drug pricing MORE (Wis.) and Reps. Courtney, Brian HigginsBrian HigginsHere are the 95 Democrats who voted to support impeachment On The Money: Sanders unveils plan to wipe .6T in student debt | How Sanders plan plays in rivalry with Warren | Treasury watchdog to probe delay of Harriet Tubman bills | Trump says Fed 'blew it' on rate decision Democrats give Trump trade chief high marks MORE (D-N.Y.) and John Larson John Barry LarsonThe Social Security 2100 Act is critical for millennials and small business owners Warren introduces universal child care legislation Unchain seniors from chained inflation index MORE (D-Conn.).

Meanwhile, progressive House Democrats are preparing their Medicare for all bill, which would largely eliminate the private insurance industry and move everyone into a single-payer, government-run system.

“I have respect for people that are trying to find other ways to go forward,” said Rep. Pramila JayapalPramila JayapalMedicare for all: fears and facts House Democrats urge Trump to end deportations of Iraqis after diabetic man's death 'KamalaCare' fails to address big problem: That we cannot trust insurance companies MORE (D-Wash.), who plans to introduce Medicare for all legislation at the end of the month, followed by a hearing in the House Budget Committee in late March or April.

“But you know, I think what we’re proposing is really a transformation of the health care system to get out the pieces that are so embedded into it that continue to make health care costs equivalent to 19 percent of the GDP. We’ve got to get at those costs,” said Jayapal, a co-chair of the Congressional Progressive Caucus.

For some, Medicare buy-in is a reasonable step toward universal health care or Medicare for all.

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“I’ve always supported universal health care, but we are not there yet,” said Baldwin, who is also a co-sponsor of Sen. Bernie SandersBernie SandersJoe Biden faces an uncertain path Bernie Sanders vows to go to 'war with white nationalism and racism' as president Biden: 'There's an awful lot of really good Republicans out there' MORE’s (I-Vt.) Medicare for all bill.

“Medicare at 50 is a very bold step in the right direction,” she said.

The buy-in bill would leave the American health care system intact, while Medicare for all would largely do away with the private market where 50 percent of the population gets coverage through work.

But some Democrats are wary undoing the existing infrastructure, as highlighted by the response to presidential candidate Sen. Kamala HarrisKamala Devi HarrisJoe Biden faces an uncertain path Biden: 'There's an awful lot of really good Republicans out there' Fighter pilot vs. astronaut match-up in Arizona could determine control of Senate MORE’s (D-Calif.) comments last month about “eliminating” private insurance via Medicare for all.

“We’ve got an employment-based system that a lot of people depend on,” Larson said. “[Buy-in] would accommodate that. That’s what makes so much sense about this.”

Like-minded supporters argue it is the most popular approach out there and could lead to universal care further down the line.

A recent Kaiser Family Foundation poll found 77 percent of Americans support a Medicare buy-in approach for adults between the ages of 50 and 64.

“I think it’s good in and of itself because it would provide the protection of Medicare now, and it could be a pathway to something greater,” Higgins said. “The most important thing to keep in mind is the ACA has not been improved since inception. This is the next improvement of the Affordable Care Act.”

Any expansion of Medicare is unlikely while Republicans control the Senate and White House. But the looming 2020 elections have intensified the debate about health care among Democrats, especially since they credit the issue as a key reason why their party won back the House in the 2018 midterm elections.

Divisions over how best to move forward are already apparent among Democrats running, or considering a run, for president.

“We have some colleagues that are supporting this as a first step, and others who are saying, ‘I think this is what we ought to do and have a private marketplace addressing those between 27 and 49,’” Stabenow said. “There are differences of opinion, but the great news is this can be done now and has broad support.”

Almost every Senate Democrat running for president is a co-sponsor of the buy-in bill, including Cory BookerCory Anthony BookerThe Hill's Campaign Report: Battle for Senate begins to take shape Steve King to Gillibrand: Odds of me resigning same as yours of winning presidential nomination We need a climate plan for agriculture MORE (N.J), Kirsten GillibrandKirsten Elizabeth GillibrandGillibrand: Rosy economic outlook not 'reflected in everyday, kitchen-table issues families are facing' Chris Wallace becomes Trump era's 'equal opportunity inquisitor' Steve King to Gillibrand: Odds of me resigning same as yours of winning presidential nomination MORE (N.Y.), Harris and Amy KlobucharAmy Jean KlobucharPoll: Nearly 4 in 5 say they will consider candidates' stances on cybersecurity The Hill's Campaign Report: Battle for Senate begins to take shape Native American advocates question 2020 Democrats' commitment MORE (Minn.).

Brown, who has said he is considering a White House bid, is also a co-sponsor.

But Brown and Klobuchar, moderate Midwest Democrats, say they aren’t ready to support Medicare for all, while their other colleagues running for president have signed on to the Sanders bill from 2017.

“Eventually we probably get to something like Medicare for all, but we start by expanding it and helping people now,” Brown said Tuesday at a Christian Science Monitor breakfast.

The introduction of various Medicare expansion bills could also create tension between the party and House Democratic leadership, which has tried to keep the caucus united on protecting ObamaCare from legal challenges and “sabotage” from the Trump administration.

As the Democrats introduced their buy-in bill Wednesday, the House Energy and Commerce Committee was holding a hearing on shoring up the ObamaCare marketplace.

The chairmen of the committees with primary jurisdiction over health care issues haven’t agreed to hold hearings on Medicare for all.

Higgins on Wednesday wouldn’t say whether he had a commitment from Speaker Nancy PelosiNancy PelosiObjections to Trump's new immigration rule wildly exaggerated Latest pro-democracy rally draws tens of thousands in Hong Kong Lewandowski on potential NH Senate run: If I run, 'I'm going to win' MORE (D-Calif.) for a floor vote on his bill, but said they have spoken about “having the bill taken up in some way.”

Both buy-in and Medicare for all are fiercely opposed by outside interests that would stand to lose under both proposals.

“We can all agree that every American deserves access to affordable health coverage and high-quality care, but this proposal — whether you call it Medicare for all, Medicare buy-in, single-payer or a public option — moves us toward a one-size-fits-all health care system that is wrong for America,” said Lauren Crawford Shaver, executive director of the Partnership for America’s Health Care Future, a coalition of industry groups that launched last year to oppose expansion of Medicare.

Updated at 5:50 p.m.