House progressives are set to introduce a revised single-payer “Medicare-for-all” bill during the last week of this month, as Republicans sharpen their criticism of the policy and Democratic presidential hopefuls face questions about whether they support it.

The House bill from Rep. Pramila Jayapal, D-Wash., will have at least 100 initial co-sponsors. It comes as Democrats are offering a range of bills to expand health insurance coverage, such as a proposal to allow adults between 50 and 64 to buy into Medicare that was unveiled Wednesday, and presidential candidates refine their positions on what “Medicare-for-all” should mean and the role private insurers would play.

That question could be one of the major policy questions of the 2020 Democratic primary and a key way of differentiating the most progressive Democrats from others seeking the nomination. Still, the eventual nominee will likely face opposition to his or her health care plan from Republicans who also want to exploit divisions within the party.

Top Republicans on the Energy and Commerce Committee called last week for hearings on the topic, while emphasizing that they oppose it and warning that the expected high cost of such a program could lead to benefit cuts.

“We’re going to pull the curtain back on ‘Medicare-for-all’ so the American people can actually assess it,” said Kevin Brady, R-Texas, the Ways and Means Committee ranking member, adding that he expects the panel to hold hearings on the issue.

The House bill is expected to mirror a 2017 proposal by Sen. Bernard Sanders, I-Vt., whose 2016 presidential campaign helped push “Medicare-for-all” to the forefront of Democratic politics. Sanders will likely reintroduce the measure in the coming weeks and is working with Jayapal’s office, said Josh Miller-Lewis, his press secretary, in an email.

At least two congressional committees, the Budget and Rules committees, are set to hold hearings on the issue in the coming months. The Rules Committee plans to go first, with a hearing possible during the last week of March, said Jayapal.

Democratic leaders of the Ways and Means and the Energy and Commerce committees suggest that they, too, could hold hearings but have not given firm commitments.

The intra-party divisions could complicate Democrats’ hope of keeping health care as a unifying issue and a central theme in the 2020 campaign, building on their capture of the House in 2018 by focusing on protections for pre-existing conditions and defending former President Barack Obama’s signature domestic policy achievement.

Polls show that Democrats want to further expand health insurance coverage, while Americans generally want lawmakers to lower health care costs.

“The most important thing for Democrats to do is outline a couple of core principles that they are for and what they mean by ‘Medicare-for-all,’” said Celinda Lake, president of Lake Research Partners, adding that candidates should focus on broad topics like covering all Americans, lowering costs and the ability to choose their own doctors. “It’s very, very important that we get some of those components and core values out.”

Not all Democrats favor establishing a single-payer system. Those who do typically support more incremental plans, too.

“At the end of the day, what people want is access to affordable health care for everyone,” said Mark Mellman, a Democratic strategist and president of the Mellman Group. “People are less concerned about the mechanism through which that’s provided and more concerned about the ultimate objective.”

Still, only a few weeks into the Democratic primary season, it’s unclear whether voters will prioritize support for a certain health plan over others.“In a sterile environment of polling, it’s one thing,” Mellman said. “In the real-life exchange in a campaign, it’s something potentially quite different and I don’t know if we really know the answer to that yet.”

What is clear is that Democrats face political risks, including potential frustration from voters wanting direct answers.

“In the 2018 election … it probably served a lot of politicians to not be very specific about what ‘Medicare-for-all’ meant,” said Caroline Pearson, a senior fellow at NORC at the University of Chicago. “It’s relatively unlikely that candidates will get through the 2020 election without having to be more specific about what the policy means to them.”

Candidates’ choices

Sen. Kamala Harris, D-Calif., has said her support of “Medicare-for-all” includes eliminating private insurance companies, although she also supports other types of plans.

“The idea is that everyone gets access to medical care, and you don’t have to go through the process of going through an insurance company, having them give you approval, going through the paperwork, all of the delay that may require,” she said on CNN. “Who of us has not had that situation, where you’ve got to wait for approval, and the doctor says, well, I don’t know if your insurance company is going to cover this? Let’s eliminate all of that. Let’s move on.”

Harris backed Sanders’ single-payer legislation last year, along with others who could or are seeking the nomination: Sens. Cory Booker, D-N.J.; Kirsten Gillibrand, D-N.Y.; Jeff Merkley, D-Ore.; and Elizabeth Warren, D-Mass. All, including Sanders, also support other plans that would expand health coverage but not end private insurance.

Warren said she supports moving toward making “Medicare available to everyone,” but said Democrats should first focus on protecting the 2010 health care law.

“There are a lot of different ways that we can deliver better access to health care at a lower cost. And we should be moving forward on all fronts,” she told CQ.

Sens. Sherrod Brown, D-Ohio, who could jump into the race, and Amy Klobuchar, D-Minn., who did so last weekend, backed other plans to expand coverage, such as allowing people to buy into public programs, but did not support the Sanders measure last year.

Former New York City Mayor Michael Bloomberg, who is exploring a run, said he opposes a single-payer system, suggesting it would not be feasible.

“You can have Medicare for all people that are uncovered … but to replace the entire private system where companies provide health care for their employees would bankrupt us for a very long time,” he said last month.

Progressives say Democrats should push for a complete overhaul of the insurance system and that lesser steps, like a buy-in or public option, don’t go far enough. Jayapal said those plans don’t control costs enough or ensure there’s a big enough pool of people to apply pressure to keep costs low.

“You will make little nibbles around the edges, but you’re not actually going to transform the system,” she said.

Polling shows that most people support expanding coverage through Medicare, but support for “Medicare-for-all” fell when people heard it could cause them to lose their insurance. A Kaiser Family Foundation poll released last month found that support for a national health plan fell from 56 percent to 37 percent when people were told it would eliminate private insurance.

Brad Woodhouse, the executive director of Protect Our Care, which defends the 2010 health law, said voters want immediate action to improve the health law before shifting to more ambitious goals.

“There’s a sequence here to have that conversation, and you know the first thing to do is to do the things that the American people want done immediately and then go from there,” he said.

The group has primarily focused on congressional races, and several of the Democrats that flipped red seats in the 2018 election campaigned on strengthening the 2010 law rather than overhauling the system.

But Lake said there’s a difference between a congressional candidate and someone aspiring for the White House, who needs to lay out a bolder vision.

“It’s very different for a president, and particularly different for a president in a Democratic primary,” Lake said. “People are looking for what’s the big picture change here, what’s the big next step we’re going to take.”

Frederick Isasi, executive director of the pro-consumer group Families USA, said candidates would get into some detail for their health policy plans during the campaign, but that many more difficult decisions would come when Congress begins its work. Capitol Hill politics will partially determine what can advance, but the president will want to fulfill campaign promises.

“It will be this very high-level framework,” he said. “What we saw with President Obama, once he was elected, that basic framework that he hammered out on the campaign trail, became the basic framework that negotiators had to adhere to.”