For years, Republicans savaged Democrats for supporting the Patient Protection and Affordable Care Act, branding the 2010 law as a government takeover of health care.
Now, cast out of power in Washington and most state capitals, Democrats and activist leaders have embraced an actual government takeover of health care.
At rallies and in town-hall-style meetings, and in a collection of blue-state legislatures, liberal Democrats have pressed lawmakers, with growing impatience, to support the creation of a single-payer system in which the state or federal government would supplant private health insurance with a program of public coverage.
And in California on Thursday, the Democrat-controlled Senate approved a preliminary plan for enacting a single-payer system, the first serious attempt to do so in that state since then-Gov. Arnold Schwarzenegger, a Republican, vetoed legislation in 2006 and 2008.
[INTERACTIVE: Compare new health care bill with Affordable Care Act]
With Republicans in full control of the federal government, there is no prospect that Democrats can put in place a policy of government-guaranteed medicine on the national level in the near future. And fiscal and logistical obstacles may be insurmountable even in solidly liberal states such as California and New York.
Yet as Democrats regroup from their 2016 defeat, leaders say the party has shifted well to the left on the issue, setting the stage for a larger battle over the health care system in next year's congressional elections and the 2020 presidential race. Their liberal base, emboldened by forceful advocacy of government-backed health care last year by Sen. Bernie Sanders, I-Vt., is increasingly unsatisfied with the Affordable Care Act and is demanding more drastic changes to the private health insurance system.
In a sign of shifting sympathies, most U.S. House Democrats have endorsed a single-payer proposal. Party strategists say they expect that the 2020 presidential nominee will embrace a broader version of public health coverage than any Democratic standard-bearer has in decades.
RoseAnn DeMoro, executive director of the California Nurses Association and its parent union, National Nurses United, said the issue had reached a "boiling point" on the left.
Supporters of universal health care, including activists with DeMoro's union in California, repeatedly interrupted speakers at the California Democratic Party's convention in May, challenging party leaders to embrace socialized medicine. Demonstrators waving signs with single-payer slogans have become a regular feature at town hall-style meetings hosted by members of Congress.
But even in California, state Democratic Sen. Ricardo Lara, who helped write the bill, said the legislation would not clear the state Assembly without detailing how expanded coverage would be financed. The proposal lacks a complete funding plan.
The bill would mandate far more comprehensive access to health care, with no out-of-pocket costs, for all California residents at an estimated cost of $400 billion annually. Roughly half would come from existing public money spent on health care, but the rest would require new taxes. Gov. Jerry Brown, a Democrat who once campaigned for president supporting single-payer care, has questioned how the state can plausibly foot the bill.
There remains considerable skepticism among senior Democrats about a single-payer plan, and party strategists fear that proposing a potentially divisive health care agenda would offer Republicans a welcome diversion from their own wrangling over the Affordable Care Act.
At a briefing with reporters in May, the U.S. House minority leader, Rep. Nancy Pelosi, D-Calif., replied with a flat "no" when asked if Democrats should make single-payer a central theme in 2018. She said state-level action was more appropriate, though she said she supported the idea in concept.
A Section on 06/04/2017