A new initiative from Senate Democrats signals a reboot of the party's health care platform that takes aim at insurers' "corporate greed."

Why it matters: The world has changed since 2016 (and 2020 and 2024), and there's growing awareness within the party that Democrats need new ideas that speak to voters' increased frustration with health care affordability.

Driving the news: A dozen Senate Democrats led by Finance Committee Ranking Member Ron Wyden of Oregon yesterday launched an effort to develop private insurance options for when they regain power in Washington, calling the existing system "fundamentally broken."

• The changes will "lower costs, make it simpler to get and use insurance, and rein in shameless profiteering by corporate insurance companies," according to the letter announcing the effort.
• Though it nods at exploring "Medicare-type choices for health care," it also takes aim at insurer practices they say "delay or deny access to care" and are "gaming" rules that are supposed to limit insurers' profits.
• Signers include Democrats across the ideological spectrum, from Sen. Mark Warner (D-Va.) to Sen. Elizabeth Warren (D-Mass.).

The big picture: Democrats have already made it clear they'll hammer Republicans on health care costs heading into the midterms this fall and blame them for rising premiums and coverage losses.

• That messaging will point to the Republican-led Congress' refusal to extend enhanced Affordable Care Act subsidies and deep cuts to federal Medicaid spending.
• But Wyden's initiative — which followed a similar letter on prescription drug prices — is one of the first signs of the party beginning to answer the question of what it will do if given political control in Washington.
• Having a unifying agenda could potentially take the wind out of another divisive "Medicare for All" debate during the 2028 primary.

My thought bubble: Democrats have always loved to talk about health care. And yes, that includes health care affordability.

• But the letter includes some big shifts in how they talk about it — with phrases like "vertical integration" that will be familiar to readers of this newsletter but haven't exactly headlined past primary debates.
• Those fights have tended to hit on populist themes like whether private health care should exist at all, and the extent to which government-run insurance options should be expanded.
• While Democrats have long focused on lowering what working-class and lower-income people pay for health insurance, they've been relatively quiet about how to address what's driving up health care costs, outside of prescription drugs.

What they're saying: "Health plans' top priority is connecting Americans with high-quality care and shielding them from the high and rising prices set by brand drugmakers, consolidated hospitals and PE-backed providers," said Chris Bond, a spokesperson for America's Health Insurance Plans.

• "We welcome any opportunity to discuss common-sense solutions to improve outcomes, expand access and lower costs for everyone."

In the years since Bernie Sanders mainstreamed Medicare for All, health insurance and the underlying cost of care have continued to get more expensive.

• Health care companies have also consolidated through horizontal mergers and, particularly in the case of insurers, vertical integration.
• The medical system is dominated by enormous companies that control hundreds of billions of dollars in revenue and group payers, providers and pharmacies all under the same roof.
• Health coverage has also become more frustrating, with prior authorization and claims denials now firmly topics on policymakers' radar.

"Since the ACA there's been a ton of consolidation in the health insurance industry and continued consolidation in the hospital industry, so that's driving up costs and I think the public is frustrated by it," said the Center for American Progress' Topher Spiro.

• "What people are frustrated about are rising deductibles, rising premiums, prior authorization — it's all sort of starting to come to a head and boil over, and so there's just a lot of pent-up anger out there," he added.

State of play: Here's what caught my attention about how the senators are trying to meet the moment:

1. The platform explicitly addresses employer insurance.

• The Affordable Care Act targeted people who didn't have access to employer health care, which has largely been left untouched by both parties.
• But leaving workplace insurance alone may no longer be sustainable.
• "There are millions and millions more who have employer insurance who are also being crushed by health care costs, and we need to have policies that deliver immediate relief for them as well," Spiro said.

2. It's more about cost containment than coverage expansion.

• Democrats have spent the last couple of decades working on getting to universal coverage in the U.S., and have tried to make health care more affordable primarily through offering government subsidies or expanding access to government-funded care.
• Through the frame of "tak[ing] on corporate greed," they're now broadly talking about tackling the underlying cost of care.
• Democrats now want to be seen as "equally committed to cost and complexity reduction as we are coverage expansion," said Democratic consultant Chris Jennings.

3. The kind of language it uses is pretty bad news for insurers.

• It reminds me a lot of how they've talked about the pharmaceutical industry.
• "There is a more intense and explicit frustration about perceived increased insurer abuses and reduced accountability," Jennings said.
• Perhaps even more importantly, it means that "Big Insurance" is now firmly in the crosshairs of both political parties — an undesirable place to be.

What I'm watching: Whether the ideas of overhauling private insurance and undoing what Republicans have done eventually tamp down talk of eliminating private insurance altogether.

• "Because there's so much cleanup work to be done — the Medicaid issue, the expansion of the subsidies, etc. ... the thought of doing a whole Medicare for All plan I just think is ... other issues are going to take over," said Wendell Primus, former House Speaker Nancy Pelosi's longtime health adviser.

The bottom line: Scrapping private insurance entirely may be far-fetched.

• But "as candidates seek the nomination, there will be the inevitable debate between a vision for Medicare for All versus some other bold vision of reform," Jennings said.
• "What won't fly will be some incremental vision that does not credibly address the frustration that voters are now expressing."