{"id":570287,"date":"2026-03-30T07:35:11","date_gmt":"2026-03-30T07:35:11","guid":{"rendered":"https:\/\/www.newsbeep.com\/ca\/570287\/"},"modified":"2026-03-30T07:35:11","modified_gmt":"2026-03-30T07:35:11","slug":"dems-quietly-start-their-next-big-health-care-effort","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ca\/570287\/","title":{"rendered":"Dems Quietly Start Their Next Big Health Care Effort"},"content":{"rendered":"

\"\"<\/a>(Composite by Hannah Yoest \/ Photos: Shutterstock)<\/p>\n

THERE ARE SIGNS that the debate about health care in America is about to get out of the rut it\u2019s been in for about fifteen years\u2014and that Democrats are preparing for the moment when it does.<\/p>\n

Ever since 2010, the most high-profile fights in Washington have been about the Affordable Care Act and Medicaid. Mainly that\u2019s because Donald Trump and the Republicans keep attacking those programs\u2014as they did last year when they enacted the largest-ever cuts to Medicaid<\/a>, then refused to extend lapsing \u201cObamacare\u201d subsidies<\/a> that had helped millions to get coverage, and reduced premiums for many millions more.<\/p>\n

Democrats are determined to reverse those two steps, somehow, and you can expect them to make that a rallying cry in their campaigns for November\u2019s midterm elections. But at least some Democrats don\u2019t want to stop there. On March 19, a dozen of the party\u2019s senators released an open letter<\/a> announcing their intention to develop policies that would address a broader topic: The underlying increase in health care costs that is affecting everybody, not just people who are uninsured, on Medicaid, or buying coverage at HealthCare.gov<\/a>.<\/p>\n

The roughly 170 million Americans who get coverage through their employers are now paying (directly and indirectly) an estimated $27,000 a year<\/a> on average for a family policy. \u201cThe American people need relief from rising premiums and deductibles that are forcing families into financial ruin,\u201d the Senate Democrats wrote in their letter. \u201cThey also want an insurance system that doesn\u2019t require them to jump through hoops and hack through red tape every time they need care.\u201d<\/p>\n

That may sound like a bunch of frothy boilerplate, given that the letter contained no specifics. But it\u2019s not just these Democratic lawmakers who say it\u2019s time to have a broader conversation, one that goes beyond undoing what Trump and the Republicans have just done. You hear the same thing from prominent analysts and advocates like Anthony Wright<\/a>, president of the pro-coverage, pro-consumer organization FamiliesUSA.<\/p>\n

\u201cI do think people recognize that, as we wage the fight to defend coverage and consumer protection and specific communities under attack, that we don\u2019t fall into a trap of defending the status quo that people thought rightly was broken,\u201d Wright told me in an interview. \u201cWe need to show that we have a plan, not just to repeal bad stuff, or even to rebuild\u2014but to reimagine what the health system should look like.\u201d<\/p>\n

That kind of reimagining can\u2019t happen right away. Trump and the Republicans seem incapable<\/a> of putting forward serious reform proposals, unless they involve hacking away at insurance coverage for people who need it. And the first chance Democrats might have to govern with a trifecta is nearly three years away. But it\u2019s with an eye to that possibility that Democrats and their allies are starting to plan now\u2014to make sure they are \u201cprepared to take action on these issues the next time Democrats have an opportunity,\u201d as the Senate Democrats put it in their letter.<\/p>\n

And there\u2019s an unmistakable parallel here, to a politically similar time when Democrats and their allies started laying the groundwork for future legislation. \u201cThis moment feels a bit like twenty years ago,\u201d Larry Levitt<\/a>, executive vice president for health policy at KFF, told me in an interview, \u201cwhen groups of policy experts, advocates, and politicians started to talk about health care ideas that ultimately coalesced into the passage of the Affordable Care Act.\u201d<\/p>\n

But the challenge is different this time, and in some ways more difficult. Reducing health care costs inevitably involves reducing the flow of money into somebody\u2019s pockets, which just as inevitably angers powerful constituencies and industry groups. Democrats aren\u2019t even close to having a consensus on what to do. And 2029 is a lot closer than it might seem.<\/p>\n

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ONE PERSON WHO KNOWS THIS all too well is Ron Wyden, the senator who organized the open letter and who hopes to lead discussions inside his caucus. He\u2019s been focusing on health care ever since the 1970s, when as a freshly minted college graduate he helped to establish Oregon\u2019s chapter of the Gray Panthers<\/a>, a grassroots organization to defend the interests of seniors.<\/p>\n

The unfailingly earnest Wyden will bring this up anytime you talk to him about health care. It\u2019s part of his wonky charm, if you\u2019ve gotten to know him as some of us have, and a point of information that is genuinely relevant. Helping elderly Americans get health care really has been a signature cause, going all the way back to 1981 when he first got to Congress.<\/p>\n

In fact, when I spoke to Wyden last week, he said he was still angry over testimony that Mehmet Oz gave a year ago, during hearings for his confirmation as administrator of Medicare and Medicaid. The celebrity doctor had refused to stand by a Biden-era rule<\/a> that raised the minimum staffing standards for nursing homes\u2014requiring more personnel and a nurse on duty 24\/7 by 2029\u2014instead arguing<\/a> that technology and telemedicine could take the place of extra staff.<\/p>\n

\u201cAre you kidding me,\u201d Wyden said in our interview, \u201can 85-year-old woman trying to go to the bathroom in a dark bedroom is somehow going to be able to be safe and get there by an algorithm?\u201d<\/p>\n

But Wyden has also put in the time to think about and propose policies for non-elderly Americans. In late 2006, shortly after Democrats won control of the House and Senate in that year\u2019s midterm election, he unveiled<\/a> what he called the \u201cHealthy Americans Act\u201d\u2014a detailed legislative proposal<\/a>, complete with a financing scheme and independent analysis<\/a> of its likely cost and impact.<\/p>\n

It was a watershed moment, because it signaled that mainstream Democrats were serious about trying to enact legislation to achieve or at least approach universal coverage. Democratic leaders had mostly abandoned that effort in the 1990s, after a failed reform effort by then-President Bill Clinton helped to fuel a political backlash that ended up giving Republicans full control of Congress for the first time in decades.<\/p>\n

Wyden\u2019s proposal didn\u2019t ultimately become the template for new reforms, partly because it envisioned everybody\u2014even people who already had employer insurance\u2014buying coverage on their own through newly regulated markets. That violated what most strategists believed was the single biggest lesson of the Clinton fiasco: Don\u2019t mess with employer insurance, because it will spook anybody who has it already.<\/p>\n

Another reason Wyden\u2019s proposal didn\u2019t go far was that he was not in charge of the Finance Committee, whose jurisdiction over taxes, Medicare, and Medicaid make it the single most critical committee for health care legislation. The chairman at the time was Montana Democrat Max Baucus, whose politics skewed more conservative<\/a> and whose close ties to industry lobbyists <\/a> enraged many of his fellow Democrats. Baucus\u2014whose relationship with Wyden was never great\u2014favored the less ambitious reform model that eventually became the Affordable Care Act, which left employer coverage in place.<\/p>\n

Wyden finally got his chance to legislate years later, as ranking minority member and then (after the 2020 elections) chairman of the Finance Committee. That\u2019s when he helped craft the Inflation Reduction Act\u2019s prescription drug price reforms<\/a>, including provisions that allow Medicare to negotiate with manufacturers over the prices of certain high-priced drugs, a longtime Democratic goal.<\/p>\n

\"\"<\/a>Sen. Ron Wyden (D-Ore.) during the confirmation hearing for Dr. Mehmet Oz on March 14, 2025. (Photo by Anna Moneymaker\/Getty Images)<\/p>\n

Wyden is in line to again become Finance chairman if Democrats retake the Senate in 2026, meaning that he would once more have the staff and jurisdiction to shape legislation. And he\u2019s already taking the initiative, in case the opportunity presents itself. The March 19 open letter outlines steps, including a series of conversations with both fellow senators and outsiders who have something to say, that Wyden hopes can lead to some kind of framework for legislation that the Finance Committee would formally release.<\/p>\n

\u201cSenate Finance Committee Democratic staff will develop policies that lower costs, make it simpler to get and use insurance, and rein in shameless profiteering by corporate insurance companies,\u201d the March 19 letter states, hinting at the directions Wyden and his colleagues want to go with policy.<\/p>\n

This letter is actually the second one Wyden and his colleagues have released. The first was about prescription drugs<\/a>. There are plans for a third, which will focus on long-term care. It\u2019s a lot to take on, which is why\u2014Wyden told me\u2014it\u2019s important the work gets started now.<\/p>\n

\u201cIt takes a lot of sweat equity if you want to get into major changes,\u201d he said.<\/p>\n

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WYDEN IS BY NO MEANS THE ONLY MEMBER of the Democratic caucus who is thinking big thoughts on health care, or who would be expected to play a key role in legislation should the party get a chance to govern. The list of others starts with Bernie Sanders<\/a>, the independent and self-described democratic socialist from Vermont, who has spent a political lifetime making the case for a single-payer, \u201cMedicare for All\u201d system.<\/p>\n

Should Democrats regain power, Sanders would be in line to take over the Health, Education, Labor and Pensions Committee\u2014which, despite its name, has traditionally played a junior role to the Finance Committee on health care issues because it has more limited jurisdiction. But Sanders\u2019s long history on health care, plus his position as leader of the party\u2019s progressive wing, means he would have to be part of any serious legislative effort.<\/p>\n

Sanders isn\u2019t on the open letter. But a few other high-profile progressive Democrats are (Elizabeth Warren of Massachusetts, Peter Welch of Vermont) as are some more conservative senators (Elissa Slotkin of Michigan, Mark Warner of Virginia). And it\u2019s not just on Capitol Hill where there\u2019s broad interest in thinking about the long term. There have been stirrings of activity in the world of think tanks and advocacy groups, too.<\/p>\n

\u201cThere are various interactive conversations in this world, including advocacy and think tanks, and they are just starting,\u201d said Wright, whose experience includes more than two decades spent helping to lead reform campaigns in California. \u201cI don\u2019t want to overstate how far they\u2019ve gone\u2014really just getting underway, a lot of it informal. But you can tell people are thinking ahead.\u201d<\/p>\n

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One reason such efforts led to legislation in the past, with the Affordable Care Act and with prescription drug reforms, is that Democrats were able to coalesce around some core ideas. Doing that now is going to require working through some contentious, complex questions, starting with one that dominated the 2020 presidential primaries\u2014i.e., the last time Democrats were the party out of power\u2014when the debate was about whether or not to endorse Sanders\u2019s version of Medicare for All.<\/p>\n

That debate is certainly worth having. Among other things, Medicare for All represents one way to deal with costs, since the early-stage proposals from Sanders and others generally envision the federal government controlling spending through a combination of budgets and price regulation, as countries abroad with national health systems do.<\/p>\n

But like all proposals it comes with tradeoffs. It would be taking money away<\/a> from at least some parts of the health care industry\u2014including hospitals\u2014and those affected sectors would argue (plausibly or not, depending on your point of view) that the change would lead to rationing. And that\u2019s to say nothing of the fact that\u2014like Wyden\u2019s old plan\u2014the purest schemes envision the new public insurance system replacing existing employer coverage.<\/p>\n

A healthy internal Democratic debate would consider that idea, just as it would consider other ideas for controlling costs\u2014including some that haven\u2019t yet gotten a ton of political attention. That might include, for example, going after costs with budgets and price controls but without requiring everybody to shift into a new public insurance plan. It could also include proposals that create a new public plan but that make enrollment purely voluntary<\/a>\u2014what\u2019s come to be known as a \u201cpublic option<\/a>.\u201d<\/p>\n

Yet another way to go would be to focus on a set of discrete, targeted reforms\u2014like expanding<\/a> the new prescription drug negotiating powers or resurrecting the once-popular idea<\/a> of a \u201cpatient\u2019s bill of rights<\/a>\u201d that restricted the ability of insurance companies to deny treatments. One advantage of this approach is that, depending on the specifics of the proposals, Democratic lawmakers might be able to pass narrower reforms more quickly. (Most likely, they\u2019d have to use the budget reconciliation process to avoid a Republican filibuster.) That could help build trust with voters for subsequent efforts.<\/p>\n

Of course, even the smaller, more targeted ideas would also come with tradeoffs. More aggressive drug price regulation, for example, could affect innovation. And deterring insurance company reviews could end up making it harder for them to control costs. That\u2019s the whole point of taking up these ideas now: To weigh those tradeoffs, figure out how to present the worthwhile ideas, and then build a consensus behind them.<\/p>\n

\u201cYou can\u2019t win health reform before the election, but you can lose it,\u201d said Wright. \u201cIf you don\u2019t set things up, then you won\u2019t be ready when the window opens.\u201d<\/p>\n

And the window is bound to open, probably in the next few years, because that\u2019s how it goes in American politics. Big debates about how to reform health care reliably start once the problems of the status quo have become impossible to ignore, and once the battle scars from previous debates have started to fade. Typically the cycle takes about two decades. And it\u2019s been almost exactly two decades since the start of the process that led to the Affordable Care Act.<\/p>\n

This doesn\u2019t mean the Affordable Care Act was a failure, as Republicans frequently claim. It simply means there is a lot more to do, because\u2014as Barack Obama tweeted<\/a> last week\u2014the law \u201cwas always meant to be a first step.\u201d<\/p>\n

And now, just maybe, it might be time for the next one.<\/p>\n

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