AMHERST — Just before taking the stage before thousands at the University of Massachusetts Amherst’s commencement Friday, health care was on U.S. Sen. Elizabeth Warren’s mind.

With Republicans holding a firm grip on both houses of Congress and the presidency, the GOP is poised to completely rewrite health care policy in the United States, and Democrats may have very little say in the matter.

It is in that context that Warren, D-Massachusetts, sat down for a one-on-one interview with the Gazette Friday to talk about how Democrats may move forward on health care reform.

As the state whose health care reform more than a decade ago eventually became a model for the Affordable Care Act, Massachusetts has previously played a unique role in defining the health care conversation nationwide.

“Massachusetts did this in 2006 and there were two important features of it,” said Warren, a short time before giving the commencement address.

“One is we did it bipartisan,” she said, with Republican and Democratic support. “The second is, we recognized we didn’t get it right the first time out,” and improved it with tweaks along the way.

“That’s what it takes to get health care coverage across this country,” she said. 

That, however, stands in sharp contrast to what is currently happening in Congress, Warren said.

Last week, Republicans in the House narrowly passed a bill to repeal and replace much of the Affordable Care Act. That bill, known as the American Health Care Act, has now landed in the Senate, where it faces an uncertain future as Republicans there signal that they will work on their own health care bill.

“Right now the Republicans have just simply set up a committee, they have locked the door, Democrats cannot come in, and they’re going to come out and tell us what they plan to do with health care,” Warren said. 

Democrats have been united in opposing whatever results come from those efforts, with House Democrats going so far as to sing, “Na na na na, hey, hey, hey, goodbye” to their Republicans counterparts when the American Health Care Act passed. 

As for their own proposals, however, the Democratic Party appears split between its progressive wing, lead in large part by Warren and Sen. Bernie Sanders, I-Vermont, and more centrist, establishment Democrats.

“We have announced our values,” Warren said. “We’re trying to get more health care coverage at lower cost, and we’ll take any way that we can do that.”

Single-payer to get a look

Warren said that means looking hard at proposals for single-payer health care — a system in which citizens pay the government to cover health care costs instead of individually buying insurance from private companies. 

That system could be set up in a number of different ways, Warren said. 

She mentioned organizing single-payer systems at the regional or state level, where legislation has already been introduced in places like California. Also on the table is “Medicare for all,” like the universal single-payer plan that Sanders has floated.

“The core is saying, ‘We have made a change in America from where we were 10 years ago,’” she said. “And that is, we’ve come to understand, to believe, that health care is a basic human right.

“I think having made that difference, we are now ready to take on the much bigger issue of how do we deliver the best health care to everyone at the lowest possible cost,” Warren said. “And I think that’s going to push us in the direction of single payer.”

Warren isn’t alone in calling for universal or near-universal health care under a government-run system. 

A 2016 Gallup poll found that the majority of Americans support replacing the Affordable Care Act with a federally funded system, and a recent Morning Consult/Politico poll found that a plurality of voters back single-payer health care.

Short-term measures

Warren said there are also more short-term measures that could improve access to health care and lower costs for Americans.

“One piece we could do right now is we could lower the cost of drugs, we could do it by importing drugs from Canada,” Warren said, referencing a bill she and Sanders have put forward to that effect.

“If the goal is to give more health care coverage at lower cost, I’m in, Democrats are in,” she said.

With Republicans in control in Washington, however, Democrats will first have to deal with whatever comes from Senate and House Republicans, Warren said.

“I am really worried, and I’m worried because the original House bill knocked 24 million off health care coverage, raised costs for middle class families,” she said, referring to the American Health Care Act. “Why? So they could produce a tax break for a handful of millionaires and billionaires.”

Warren said she has no doubt that Republicans will change that bill in the Senate, but because Democrats have been locked out of the process, she said she has no idea what those changes might be.

What’s more, Republicans can push their own health care bill through the Senate without any Democratic support if they run it through a legislative process known as reconciliation, which requires only 51 votes and would bar the possibility of a Democratic filibuster.

“We don’t have the votes, we are in the minority,” Warren said. “Whether or not we pick up enough Republicans to block it really is going to depend on people all across this country getting engaged: going to all those town halls, and making all those phone calls, and sending all those emails and text messages.”

The struggle will continue for Democrats, who have not only lost control in Washington, but have in recent years lost the majority of statehouses and governorships across the country.

After giving the UMass commencement speech, Warren headed to a town hall meeting in Ware.

Dusty Christensen can be reached at dchristensen@gazettenet.com.

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