2020 elections

‘This is going to cause down-ballot damage’: Warren's $20 trillion health plan fails to quiet critics

The Massachusetts senator’s Medicare for All proposal is new ammunition for her rivals.

Elizabeth Warren

The most-vulnerable Democrat in Colorado’s state House, Bri Buentello, is dreading door-knocking in her rural district now that Elizabeth Warren dropped her massive “Medicare for All” plan into the presidential arena.

“This is going to cause down-ballot damage in swing districts and states if she’s the nominee,” Buentello says, describing how her Pueblo-area constituents — who voted overwhelmingly for Donald Trump in 2016 — were already echoing criticisms about a giant, one-size-fits-all big government run plan that cancels private health insurance and raises taxes.

The fear of blowback is indicative of the broad and largely negative response to Warren’s proposal from centrist, moderate and rural Democrats — many of whom, like Buentello, back Joe Biden in the primary. And it exposes the fault line between those who fret about winning voters in the center and the activist progressive base propelling Warren to the front of the Democratic pack.

The long-awaited plan to raise the $20.5 trillion she says is needed to pay for single-payer health care in America is Warren’s attempt to answer critics after weeks of questions from rival candidates about the cost of her proposal and the prospect of higher taxes. Warren promised, as she has in the past, that "not one penny in middle-class tax increases” is necessary to finance the effort.

Surveys show Medicare for All polls well with Democrats and has majority support overall. But leading politicians in the party believe the popularity won’t last.

In swing-state Ohio, Democratic Sen. Sherrod Brown, a liberal populist, has previously referred to Medicare for All as a “terrible mistake.” The influential culinary workers union in Nevada has also expressed misgivings. And the best-known Democrat from the blue state stronghold of California, House Speaker Nancy Pelosi, also let it be known Friday that she’s not on board.

"I'm not a big fan of Medicare for All," Pelosi told Bloomberg TV. "I welcome the debate. I think that we should have health care for all. I think the affordable care benefit is better than the Medicare benefit."

Throughout the presidential primary season, Medicare for All has been debated repeatedly by Democrats on stages where Warren has largely ducked specifics and the issue of tax increases.

What’s different now is that Warren is emerging as the frontrunner — and centrists and pragmatists in her party are starting to hit the panic button as Warren’s plan seems tailor-made to make enemies of doctors, hospitals, the insurance industry and some employers.

“Warren and the progressives are causing a real political problem for pro-growth, pro-business Democrats,” warned Scott Reed, a top consultant for the conservative-leaning Chamber of Commerce.

The chamber next week will discuss its political plans for responding to Medicare for All.

Progressives, however, dismissed those criticisms as business-backed fear-mongering as they cheered Warren for issuing a sober-minded and serious proposal.

"I’ve always felt that the scrutiny of Medicare for All and its cost is ridiculous, because none of the other plans are being asked this and it’s always being done without the context of what our current system costs,” Rep. Pramila Jayapal (D-Wash.), lead author of the House Medicare for All bill, said.

“Warren’s plan is good because it really challenges the naysayers,” she said. “Now, every candidate should have to explain why they want to keep a for-profit system in place that has no cost containment and doesn’t cover everybody.”

Over 100 House Democrats are co-sponsors of the bill.

Joe Biden, a top-tier presidential contender along with Warren, on Friday personally attacked the Massachusetts senator’s proposal and her math, saying the plan spends more than it takes in.

“She’s making it up,” Biden told PBS, saying Warren’s proposal spends more than it takes in. “We don’t have to go that route. All we have to do is go back [and] restore Obamacare.”

Warren gave no quarter in her response Friday.

“Democrats are not going to win by repeating Republican talking points and by dusting off the points of view of the giant insurance companies and the giant drug companies who don't want to see any change in the law that will bite into their profits,” she said.

“If anyone wants to defend keeping those high profits for insurance companies and those high profits for drug companies and not making the top 1 percent pay a fair share in taxes and not making corporations pay a fair share in taxes, then I think they're running in the wrong presidential primary.”

"You have to be kidding me," retorted Biden campaign manager Greg Schultz. "Warren was a Republican until she was 47 years old while Joe Biden has spent his life helping elect Democrats across the country and served with honor in the Senate and with President Obama."

Some progressives noted that Barack Obama himself said in September 2018 that Medicare for All was one of the "good, new ideas" Democrats were embracing.

Veterans of past political campaigns, remembering the beating their party took over Obamacare — which has finally become popular after Republicans attempted to repeal much of it — fear that Medicare for All raises too many questions, picks too many fights with special interests and won’t garner support where it counts the most in a presidential election: swing districts in the swing states needed to clinch the Electoral College.

“The fundamental challenge Senator Warren has in selling her plans across the country is that Medicare for All, while popular in largely urban coastal areas, does not share the same appeal in the middle of the country, particularly in the areas where people largely have health insurance and are mostly satisfied,” said Bill Burton, a former spokesman for President Obama’s campaign and the founder of a super PAC that supported his reelection, who also briefly worked for billionaire Howard Schultz's brief 2020 presidential campaign.

“When you look at the counties that President Obama and President Trump won, you see rates of health insurance in the 90-95% range, so she’s potentially solving a problem that many of these voters may not share these views on,” Burton said.

Burton has company among Obama alums , many of whom remember how Republicans weaponized Obamacare in the 2010 and 2014 midterms. Without Obama on the ticket defending his namesake healthcare plan, it was largely a millstone around the necks of Democrats.

“It played out with the Clinton health plan. It played out with the Affordable Care Act. Frankly, going all the way back to President Truman, it is consistently the case that health reforms are always popular at first, when they're more like bumper sticker slogans," said Larry Levitt, the senior vice president for health reform at the Kaiser Family Foundation. "As details get filled in and opponents really start to attack, plans never get more popular.”

The GOP is likely to echo the same criticisms of Obamacare — that it was a step toward socialism. But this time, a wholesale government takeover of health insurance would actually be a step toward socialism, which is still viewed more negatively than positively by Americans overall.

“You don’t win with a message of socialism in a swing state like Florida,” said Bill Nelson, a former Florida senator and Biden surrogate.

Another political problem underpins the debate: most of the Democrats running to unseat Republican incumbent senators don’t support her plan, and if they don’t win their races, then the GOP will remain in control of the Senate. So the plan wouldn’t pass anyway. And if the Democratic senators who oppose Medicare for All win their races, they’re unlikely to reverse their opposition and pass the plan.

The Democrat-controlled House could also pose a problem, said Rep. Ami Bera, a California Democrat who’s a doctor and is neutral in the primary.

“We need to put out proposals that can actually make it into law,” Bera said. “We should be proud as Democrats all of our candidates are talking about how to expand coverage, but I don’t see Medicare for All of getting anywhere close to 218 votes in the House and certainly not 60 votes in the Senate.”

John Hickenlooper, the Democratic frontrunner in the primary to take on Republican Sen. Cory Gardner of Colorado, made it clear he opposed Medicare for All when he was running for president earlier this year. The former governor took issue with Warren’s suggestion in one debate that he lacked the political will to fight for the policy.

“It comes down to that question of Americans being used to being able to make choices, to have the right to make a decision,” Hickenlooper said. “And I think proposing a public option that allows some form of Medicare that maybe is a combination of Medicare Advantage and Medicare, but people choose it, and if enough people choose it, it expands, the quality improves, the cost comes down, more people choose it, eventually, in 15 years, you could get there, but it would be an evolution, not a revolution.”

Hickenlooper’s former communications director in his presidential campaign, Peter Cunningham, said that he still believed Warren could pivot to supporting a so-called “public option” to provide a Medicare-like plan through Obamacare as a bridge toward eventually leading the country to a government-run healthcare system.

Ultimately, he said, Warren’s earnestness and credibility in “looking out for the little guy, for working people” will win over critics. But she has to work at it.

“Ultimately people don’t vote for plans. They don’t vote for policies. They vote on trust: ‘Do they understand my problems?’ And Warren does,” he said. “But she has this elitist patina about her that needs to be changed or countered. She wants to be more Oklahoma than Massachusetts, but she’s not.”

And that’s a problem that her plan might exacerbate in places like Colorado’s rural and suburban districts, said Rep. Buentello.

“This is an idea that’s dreamed up in big, urban rich states like Massachusetts and they expect them to go over well in places like Colorado and they don’t,” Buentello said. “The Denver suburbs won’t be in Democratic control forever, and this makes it harder for us to keep.”

Alice Miranda Ollstein contributed to this report.