The first congressional hearing on a "Medicare-for-all" bill in at least a decade took place Tuesday, but without the usual phalanx of T-shirted supporters -- or even the presidential candidates -- who have been pushing the bill.
That's because the hearing took place not at one of three major committees that oversee health policy in the House, but in the ornate -- and comparatively miniature -- hearing room of the House Rules Committee. That panel's primary role is to set the terms for House floor debates, and its hearing room can seat about 50 people in the audience, compared with hundreds in the larger rooms of the Capitol complex's office buildings. Also, members of the public cannot easily access the room on the third floor of the Capitol as they can the House office buildings across the street.
That arrangement was no accident -- the Rules Committee is often called the "Speaker's Committee" because it is so closely aligned with the speaker's goals and is more heavily populated with members of the majority party than the usual committee breakdowns. House Speaker Nancy Pelosi has said repeatedly she does not want to push Medicare-for-all -- a plan popular among progressive Democrats to move the country to government health care system -- while Republicans control the Senate and the White House.
So, this hearing was the fulfillment of a promise she made to some of the more left-leaning members of her caucus when she courted them to support her candidacy for speaker. Another hearing, this one by the House Budget Committee -- also not among the committees that would normally handle major health legislation, is expected to follow soon.
Those usual panels -- Ways and Means, Energy and Commerce, and Education and Labor -- are busy working on health legislation, including bills to address prescription drug prices and "surprise" medical bills, but not currently on a Medicare-for-all bill.
Rep. Michael Burgess (R-Texas) pointed out that anomaly. "I don't want to say this hearing isn't normal, but normally, health care policy would come ... through the authorizing committees," he said in a gibe to the House Democratic leadership. Burgess is also a member of one of those committees: Energy and Commerce.
Pelosi did make a cameo at the Rules hearing, escorting activist Ady Barkan, who has the neurodegenerative disease amyotrophic lateral sclerosis, or ALS, and was the star witness for the proponents of Medicare-for-all. Barkan, an outspoken critic of Republicans' efforts to repeal and replace the Affordable Care Act in 2017, testified Tuesday by computer-generated voice, since his disease has progressed to the point he can no longer speak easily.
Still, despite the unusual venue, backers of universal health care hope the hearing marks the beginning of a journey to a new national health system.
"This is a historic moment," Rules Chairman Jim McGovern (D-Mass.) said, surveying the standing-room-only crowd. "I don't think we can squeeze anyone else in here." McGovern said he is a strong supporter of the Medicare-for-all bill introduced by Reps. Pramila Jayapal (D-Calif.) and Debbie Dingell (D-Mich.), which has more than 100 co-sponsors.
For all the political machinations and sometimes overheated rhetoric about a major overhaul of the U.S. health system, the hearing itself was remarkably unremarkable -- with witnesses both for and against the idea of the federal government providing health coverage to all Americans calmly discussing the pros and cons.
"The ugly truth is this: Health care is not treated as a human right in the United States of America," Barkan told the committee. "This fact is outrageous. And it is far past time that we change it."
Republicans were also eager to talk about Medicare-for-all -- so they could bash it.
"This bill is an extraordinary bill," said Rep. Tom Cole (R-Okla.), the panel's ranking member. "It would completely change America's health care system. And not for the better."
And while the most enthusiastic backers of the bill were not in the hearing room, they were not far away.
More than 300 members of the California Nurses Association/National Nurses United, one of the unions that has been pushing Medicare-for-all for years, watched the hearing from an overflow room in the Cannon House Office Building and visited offices to try to gin up support, said co-President Malinda Markowitz.
Markowitz said she was optimistic about the path forward for the measure. "We're going to continue to go to legislators that aren't supporting this and let them know we're not letting them off the hook," she said.
Republicans want the debate to continue in Congress, too. They hope they can stoke fear of a government takeover of health care that will work to their advantage in the next election.
The top Republicans on the House Ways and Means Committee on Tuesday wrote to Chairman Richard Neal (D-Mass.) urging him to schedule a hearing on the bill. "A public accounting of H.R. 1384 is necessary to inform the working families and seniors we represent to the risks of their health coverage under this proposal," said ranking Republican on the full committee, Rep. Kevin Brady (Texas), and the health subcommittee, Rep. Devin Nunes (Calif.).
That is apparently fine with Neal. In a brief interview Tuesday, he said his committee "likely would" hold a hearing in the current Congress. "I think we should have a full-throttle debate" about Medicare-for-all, he said.