The new Democratic majority in the House will hold the first hearings on Medicare-for-All legislation, a longtime goal of the party’s left, after Speaker Nancy Pelosi lent her support for the process.

“It’s a huge step forward to have the speaker’s support,” said Rep. Pramila Jayapal (D-Wash.), who will be the House sponsor of the legislation, usually denoted as HR 676. “We have to push on the inside while continuing to build support for this on the outside.”

Some version of universal health care has been a Democratic goal for decades. The Expanded and Improved Medicare for All Act, first introduced in 2003 by then-Rep. John Conyers Jr. of Michigan, has become the vehicle for Democrats who want to bring single-payer, Canada-style health care to the United States.

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That legislation was typically sidelined, even when Democrats had power; in 2009 and 2010, when the House passed the Affordable Care Act, the “Medicare-for-All” package was not part of the discussion. But in his 2016 campaign for president, Sen. Bernie Sanders (I-Vt.) championed Medicare for All. The following year, for the first time, a majority of House Democrats co-sponsored HR 676.

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“I want to congratulate the House for holding hearings for the first time on Medicare for All,” Sanders told The Washington Post on Thursday. “I’m confident the results will show that Medicare for All is the way forward if we want to guarantee heath care to all people in a cost-effective way.”

Pelosi, who had been a co-sponsor, said throughout the 2018 campaign that Democrats were free to discuss many other health-care programs. She strongly suggested that a Democratic House would at least hold hearings on the far-reaching Jayapal bill; on Wednesday, Jayapal got Pelosi’s commitment to hearings in the Rules and Budget committees.

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The incoming chairmen of those committees, Reps. Jim McGovern (D-Mass.) and John Yarmuth (D-Ky.), support Medicare for All, and Yarmuth had told reporters last year that he would like to use his committee for hearings on how single-payer health care could work.

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“The American people deserve to know what the various options for Medicare for All would mean to them as health care consumers and taxpayers,” Yarmuth said.

Jayapal said supporters hope to release legislation in “the next couple of weeks” and hold hearings in a number of committees.

With Democrats locked out of power in the Senate and the White House, Jayapal said that supporters of universal health care were proceeding “one step at a time” and that getting the first real hearings on the bill — for years, it has been aspirational, and not even subject to a Congressional Budget Office score — would force a larger discussion.

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“This will ensure that Medicare for All is part of the 2020 Democratic presidential platforms,” said Jayapal.

Polling has found support for Medicare for All at anywhere from 58 to 70 percent, though critics point out that support dips depending on how the costs and changes to private insurance are described.

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Outside of Congress, supporters of ambitious liberal bills have viewed the new House warily. Later Thursday, the House is set to amend, but not eliminate, the “paygo” rule that requires any new spending to be offset with deficit reduction.

While Democratic leaders have pointed out that the spending rule is statutory and would remain active in the Senate no matter what the House does, a number of left-leaning Democrats have accused Pelosi of preemptively making it harder to pass major reforms. Jayapal, a co-chair of the Congressional Progressive Caucus who helped reshape the rule, said that those concerns were unfounded.

“The critical thing here is: Do we have a commitment to waive paygo on critical bills? I think we do,” she said. “I think we’ve not only got a commitment for that, but for hearings on those bills, and we’ve never had that before.”

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