House Minority Leader Nancy Pelosi (AP)

Democratic House leader Nancy Pelosi repeated over and over in the run-up to Nov. 6 that the midterm election wasn't about President Donald Trump.

It was about health care.

All of the Democratic Party's young, rising leaders -- and thus much of the old guard as well -- are embracing some form of universal health insurance.

So what happens now that the Dems retook the U.S. House majority but remain in the minority in the U.S. Senate?

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Sen. Bernie Sanders (AP)

Possibly nothing. And possibly something small but nevertheless meaningful.

Progressives like Vermont Sen. Bernie Sanders and 29-year-old New York Rep.-elect Alexandria Ocasio-Cortez are calling for a government-run single-payer health insurance program like what's common in Europe.

But as long as Republicans hold significant levers of power -- and, needless to say, they have the White House as well as the Senate -- that's not going to happen.

The GOP believes the free market is the best thing for health insurance. (We're as far away from a true, free-market health-insurance system as we are from single-payer, but at the moment that's neither here nor there.)

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Alexandria Ocasio-Cortez (AP)

What progressives want

The phrase on every progressive politician's lips is: "Medicare for All" -- that is, making the U.S. government health-insurance program for Americans 65 and older available to everyone.

Here's what Ocasio-Cortez has on her campaign website:

"Improved and Expanded Medicare for All is the ethical, logical and affordable path to ensuring no person goes without dignified healthcare. Medicare for All will reduce the existing costs of healthcare (and make Medicare cheaper, too!) by allowing all people in the U.S. to buy into a universal healthcare system."

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Bernie Sanders (AP)

On his website, Sanders states: "Health care must be recognized as a right, not a privilege. Every man, woman and child in our country should be able to access the health care they need regardless of their income."

NPR has pointed out that while Sanders calls his plan "Medicare for All," "that's more of a handy slogan than reality, as this plan would greatly expand Medicare and overhaul it -- for example, it would greatly expand the type of coverage offered and also eliminate deductibles, copays and premiums. Private insurance companies are also currently a part of the Medicare system. That wouldn't be the case under Sanders' plan."

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Medicare.gov

As NPR mentioned, the current Medicare program is far from the free, universal health care that many European countries offer to their citizens. The "full cost of the standard Medicare Part B premium in 2016 was $483.20 per month," The Senior Citizens League stated last year, "and most new enrollees [after subsidies] paid a $120.80 monthly premium." There are also various, and sometimes onerous, out-of-pocket expenses.

Which is why Sanders is seeking not just to expand Medicare to every American but also "overhaul it."

Sanders' plan would immediately make Medicare available for everyone who's reached their 55th birthday. In subsequent years the age eligibility would drop until everyone was covered by it.

This would mean higher taxes for everyone, especially wealthy Americans, but Sanders insists there also would be big savings thanks to the new, unified, single-payer, government-run system.

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Alexandria Ocasio-Cortez (AP)

What progressives -- and everyone else -- might get

Democrats in Congress hope to pull the 2010 Affordable Care Act -- aka, Obamacare -- out of its downward spiral. Republicans have spent the past two years chipping away at the law, making it less and less viable. Now Democrats hope to "stabilize" it through new legislation, and they hope to do so in a way that will attract enough Republican support in the Senate to pass.

One guide to what that stabilization might be is 2018's "Undo Sabotage and Expand Affordability of Health Insurance Act of 2018," from Democratic lawmakers Richard Neal, Frank Pallone and Bobby Scott.

The "sabotage" referred to in the title is, in part, the Trump Administration's attempts to draw younger, healthier Americans out of the core Obamacare markets, thus sending those group plans into freefall. The bill, which so far has gone nowhere in Congress, states that it would "prevent junk plans and continue protections for consumers with preexisting conditions."

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GOP Senate Majority Leader Mitch McConnell (AP)

The bill seeks to both expand federal subsidies for Americans using Affordable Care Act plans and aid Obamacare insurers struggling with a lot of high-cost enrollees.

"Undoing sabotage and bringing stabilization to the ACA markets, that's something we should really be thinking about," a House Democratic aide recently told Vox's Dylan Scott. "It depends on what kind of mood the Republicans are in. Maybe they'll say that actually, now that the tables are turned, we should probably sit down."

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Medicare enrollment stock photo (Viacheslave Iakobchuk)

A new law such as the "Undo Sabotage" bill would help protect Americans with preexisting conditions and make insurance more affordable for some lower-income people. But, to be clear, it would be a long way from "Medicare for All."

Writes Scott: "The Pallone-Neal-Scott bill might be a nice starting point -- no Democrat really disagrees about whether they should help the law work better in the short term -- but it still lacks any truly ambitious provisions. It is just about as narrowly tailored as an Obamacare stabilization bill offered by Democrats could be, a fact that aides and activists will privately concede."

The bill, Scott points out, "doesn't even include a Medicare or Medicaid buy-in."

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Dreamstime

A more conservative approach than Sanders' Medicare-for-all plan would be one that opened the Medicare program to Americans starting at the age of, say, 50. "Some policy experts," The Senior Citizens League has reported, "say that removing these older people from the market for younger workers would lower costs, and proponents of the idea argue that people age 50 to 64 would not cost as much to insure under Medicare."

Right now, House Democrats are not talking about such a proposal. As mentioned, progressives are enthusiastic about "Medicare for All" -- that is, single-payer universal health insurance. Even with Republicans holding onto the Senate, Dems are loath to talk about lesser gradations of that goal.

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President Donald Trump (Bloomberg)

The takeaway: Democrats taking over the majority in the U.S. House of Representatives almost certainly will not result in major changes in how Americans get their health insurance or how much they pay for it. But it might -- might -- mean that Obamacare gets propped up, making its plans a little more affordable and useful to those who enroll in them.

And this much is certain: Whatever happens, it's guaranteed that health insurance will be a major issue for the 2020 election, probably even more so than it was in 2018.

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-- Douglas Perry