WASHINGTON -- After spending most of 2017 defending the Affordable Care Act from GOP attacks, a growing number of Democrats believe the law's reliance on private insurance markets won't be enough and the party should focus instead on expanding popular government programs like Medicare and Medicaid.
The emerging strategy -- which is gaining traction among liberal policy experts, activists and Democratic politicians -- is less sweeping than the "single-payer" government-run system that Sen. Bernie Sanders, I-Vt., made a cornerstone of his 2016 presidential campaign.
Many Democrats still fear such a dramatic change would disrupt coverage for too many Americans, but they have also concluded that the current law's middle-ground approach to build on the private insurance market -- originally a Republican idea -- isn't providing enough Americans with adequate, affordable health coverage.
These Democrats see the expansion of existing public programs as a more pragmatic and politically viable way to help Americans struggling with rising costs and correct the shortcomings of the 2010 law, often called Obamacare.
"What is clear is that the Democratic Party as a whole is coming to the conclusion that stand-alone private market solutions to health care do not achieve affordability and coverage for all," said Chris Jennings, an influential Washington health policy adviser who worked for Presidents Bill Clinton and Barack Obama.
"But there is a recognition that you can't just snap your fingers and have political consensus. ... And one of the lessons learned from 2017 is that you better do your homework."
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Democrats are eager to avoid mistakes made by Republicans, who proved unprepared last year as they struggled unsuccessfully to fulfill their yearslong promise to repeal the current health law.
Developing a new health care agenda doesn't promise to be easy, as liberal activists and others in the progressive wing of the Democratic Party remain committed to the single-payer solution championed by Sanders and may resist more incremental steps.
At the same time, even more modest moves to build on Medicare or Medicaid will face opposition from hospitals, drugmakers and others in the industry who fear that government health plans would pressure them to accept lower prices.
And no one expects any Democratic plan to go anywhere as long as Congress remains in Republicans' hands and President Donald Trump holds a veto pen.