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 BrownGOP Green New Deal stunt is a great deal for Democrats Sherrod Brown pushes for Medicare buy-in proposal in place of 'Medicare for all' High stakes as Trump, Dems open drug price talks MORE (D-Ohio), Debbie StabenowDeborah (Debbie) Ann StabenowCongress must step up to protect Medicare home health care The Hill's Morning Report - Presented by the American Academy of HIV Medicine - Will there be any last-minute shutdown drama? Overnight Health Care — Sponsored by America's 340B Hospitals — Utah tests Trump on Medicaid expansion | Dems roll out Medicare buy-in proposal | Medicare for all could get hearing next month | Doctors group faces political risks on guns MORE (D-Mich.) and Tammy BaldwinTammy Suzanne BaldwinKlobuchar, O'Rourke visit Wisconsin as 2020 race heats up Dems 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 MORE (Wis.) and Reps. Courtney, Brian HigginsBrian HigginsDems 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 Assault weapons ban push tests Dem support MORE (D-N.Y.) and John Larson John Barry LarsonDems offer smaller step toward ‘Medicare for all' Lobbying world A bill to boost Social Security will finally get a full and fair hearing 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 — Sponsored by America's 340B Hospitals — Push for cosponsors for new 'Medicare for all' bill | Court lets Dems defend ObamaCare | Flu season not as severe as last year, CDC says Democrats seek cosponsors for new 'Medicare for all' bill Overnight Health Care — Sponsored by America's 340B Hospitals — Utah tests Trump on Medicaid expansion | Dems roll out Medicare buy-in proposal | Medicare for all could get hearing next month | Doctors group faces political risks on guns 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) SandersSenate Dems introduce bill to prevent Trump from using disaster funds to build wall Klobuchar, O'Rourke visit Wisconsin as 2020 race heats up Sherrod Brown pushes for Medicare buy-in proposal in place of 'Medicare for all' 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 HarrisSenate Dems introduce bill to prevent Trump from using disaster funds to build wall Klobuchar, O'Rourke visit Wisconsin as 2020 race heats up Sherrod Brown pushes for Medicare buy-in proposal in place of 'Medicare for all' 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 BookerKlobuchar, O'Rourke visit Wisconsin as 2020 race heats up Sherrod Brown pushes for Medicare buy-in proposal in place of 'Medicare for all' Harris off to best start among Dems in race, say strategists, donors MORE (N.J), Kirsten GillibrandKirsten Elizabeth GillibrandSenate Dems introduce bill to prevent Trump from using disaster funds to build wall Klobuchar, O'Rourke visit Wisconsin as 2020 race heats up Sherrod Brown pushes for Medicare buy-in proposal in place of 'Medicare for all' MORE (N.Y.), Harris and Amy KlobucharAmy Jean KlobucharFemale Dems see double standard in Klobuchar accusations Klobuchar, O'Rourke visit Wisconsin as 2020 race heats up Harris off to best start among Dems in race, say strategists, donors 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 PelosiThe national emergency will haunt Republicans come election season On unilateral executive action, Mitch McConnell was right — in 2014 National emergency declaration — a legal fight Trump is likely 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.