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. CourtneyDems offer smaller step toward ‘Medicare for all' Overnight Health Care — Sponsored by America's 340B Hospitals — Powerful House committee turns to drug pricing | Utah governor defies voters on Medicaid expansion | Dems want answers on controversial new opioid House lawmakers look to reassure Australia after Mattis resignation 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 BrownOn The Money: Treasury misses second Dem deadline on Trump tax returns | Waters renews calls for impeachment | Dem wants Fed pick to apologize for calling Ohio cities 'armpits of America' | Stocks reach record high after long recovery Sherrod Brown asks Trump Fed pick why he referred to Cleveland, Cincinnati as 'armpits of America' Only four Dem senators have endorsed 2020 candidates MORE (D-Ohio), Debbie StabenowDeborah (Debbie) Ann StabenowDemocratic proposals to overhaul health care: A 2020 primer We can accelerate a cure for Alzheimer's Bipartisan senators offer bill to expand electric vehicle tax credit MORE (D-Mich.) and Tammy BaldwinTammy Suzanne BaldwinOnly four Dem senators have endorsed 2020 candidates Democratic proposals to overhaul health care: A 2020 primer More than 30 Senate Dems ask Trump to reconsider Central American aid cuts MORE (Wis.) and Reps. Courtney, Brian HigginsBrian HigginsDemocratic proposals to overhaul health care: A 2020 primer Democratic senators unveil 'Medicare X' bill to expand coverage US labor unions say NAFTA replacement doesn't go far enough for workers MORE (D-N.Y.) and John Larson John Barry LarsonDemocratic proposals to overhaul health care: A 2020 primer Democratic senators unveil 'Medicare X' bill to expand coverage Stop asking parents to sacrifice Social Security benefits for paid family leave 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 JayapalOvernight Health Care: Trump poised to roll back transgender health protections | House Dems plan 'Medicare for All' hearing next week | Walgreens, Rite Aid raise tobacco-buying age to 21 | Drug distributor faces charges for role in opioid crisis House Dems to hold hearing on 'Medicare for All' next week Overnight Health Care: How 2020 Dems want to overhaul health care | Brooklyn parents sue over measles vaccination mandate | Measles outbreak nears record 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 SandersBernard (Bernie) SandersDemocrats' CNN town halls exposed an extreme agenda Buttigieg says he doubts Sanders can win general election Meghan McCain: Bernie Sanders supporting prisoners being able to vote 'bats**t insane' 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 HarrisDemocrats' CNN town halls exposed an extreme agenda The Hill's Morning Report - Will Joe Biden's unifying strategy work? K Street support to test Buttigieg 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 BookerK Street support to test Buttigieg We should welcome workers' 'powerful victory' in the Stop & Shop strike Harris adds another to her list of endorsements in South Carolina MORE (N.J), Kirsten GillibrandKirsten Elizabeth GillibrandThe Hill's Morning Report - Will Joe Biden's unifying strategy work? K Street support to test Buttigieg Kamala Harris backs putting third gender option on federal ID MORE (N.Y.), Harris and Amy KlobucharAmy Jean KlobucharDemocrats' CNN town halls exposed an extreme agenda Spicer: 'Near impossible' for 2020 Democrats to refuse Fox News debate James Comey, wife donated ,400 to Klobuchar's presidential campaign 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 Patricia D'Alesandro PelosiTrevor Noah on lack of Pelosi nickname from Trump: 'There is a reverence for her' Trump says he would challenge impeachment in Supreme Court The Hill's Morning Report - Will Joe Biden's unifying strategy work? 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.