The primary Medicare for All bill has more support in Congress now than it has ever before.
John Conyers' Medicare for All bill (HR 676), which he has introduced in each Congress since 2003, has seen a recent surge of new cosponsors -- 32 since March 8 and nine on April 3 alone. As of this writing there are 93 co-signers (and counting), representing more than 48 percent of the Democratic Caucus. This is the highest number of cosponsors ever, both in terms of members and as a percentage of the House Democratic Caucus. The count is up from just 62 cosigners -- 33 percent of Democrats -- in the last Congress, and an average of 37 percent since the bill was first introduced in 2003 (see chart).
disingenuously) maligning the policy to help keep Sen. Bernie Sanders from winning the Democratic Primary. Further, facing a large GOP majority, Democrats and activists have also been forced to "play defense" just to prevent Donald Trump and the GOP from kicking 24 million Americans off their insurance and doing away with essential benefits like mental health and emergency room visits. These, of course, are important benefits of the Affordable Care Act (ACA), which improved access to health insurance, but leaves about 30 million Americans uninsured. The ACA also can't control rapidly escalating health costs, a trend which has long been a central problem of our health system.
Indeed, the need for reform beyond the ACA is becoming increasingly clear. A Monmouth poll from February showed that 25 percent of Americans view health care as "the biggest concern facing their family right now." Health care was, by far, the most cited concern, dwarfing issues like immigration (3 percent) and terrorism (2 percent).
Public support for Medicare for All has been confirmed by pollsters for years. An April 6 poll from the Economist/YouGov showed 60 percent of the public support for the policy, including from a plurality of Republicans.
The latest increase in support for Medicare for All, according to advocates, activists and congressional staffers who spoke with Truthout, can also be attributed to several other factors, including the unintended consequences of the TrumpCare debacle and the work of activists pressuring Democrats from the left. The impactful rise of Bernie Sanders, who plans on introducing his own Medicare for All bill in the Senate, has also been key. Plus, the end of Hillary Clinton's campaign (and her role as the de facto head of the party), has led to more support for single payer, since she ran against the policy with such militancy -- and lost.
There is still a long way to go. Republicans have an iron grip on Congress. The Senate is, by design, a major obstacle to progress and democracy. Plus, the drug and insurance industries retain immense influence. But the growing momentum for this reform has organizers hopeful that we are at a turning point -- that a public universal healthcare system in the US may not be as far off as it once seemed. "I have been introducing the Medicare for All bill every session of Congress since 2003, and I'm the longest serving member of Congress," Conyers said in a statement. "I have never seen more enthusiasm and energy behind this issue than what I'm seeing today."
The Role of HR 676 in the Battle for Health Care Justice
It has been 14 years since Conyers first introduced HR 676, officially called the Expanded & Improved Medicare For All Act. The language is simple enough. "This bill establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care," and "only public or nonprofit institutions may participate."
In a global context, this is not a particularly radical idea. Similar systems exist all around the developed world -- they cover everyone and do it at about half the cost. While Conyers' bill has never been scored by the CBO [Congressional Budget Office], there have been many studies that show tremendous savings from HR 676 and single-payer health care in general. Support for the bill, however, was quite limited, especially at first. Only 38 House Democrats (18 percent) cosponsored it when it was introduced. Eventually it gained more supporters, peaking at 93 in 2010 but this was back when Democrats had just won large majorities in 2006 and 93 sponsors only represented 42 percent of the caucus.
That was the high water mark until now, with less than a third of Democrats signing on to the law in the last two Congresses (113th, 114th). In essence HR 676 has served mostly as an organizing tool, widely used by advocates to help educate the public. But now that it has gained the support of half the caucus, its status is elevated: The bill is now viewed by many lawmakers as a viable path to reform. And activists continue to push for more support.
"Our goal is to get to 110 by the end of the recess [April 25th]," said Dr. Carol Paris, the president of Physicians for a National Health Program (PNHP), in an interview with Truthout. "We think the enthusiasm and energy behind this bill reflect how much Americans care about this issue."
The TrumpCare Debacle Helps Single-Payer
As noted above, the new energy behind this bill is due to something of a perfect storm of factors. One of the most important, advocates say, is the impact of the debate over a Republican repeal of the ACA, or TrumpCare. The entire process was an abject failure for Republicans, of course. But it also added to the anxiety of millions of Americans who were rightly indignant to learn that the bill would jeopardize the insurance -- and indeed the lives -- of tens of millions of Americans, and rip Medicaid to shreds. A March 23 Quinnipiac poll showed a paltry 17 percent of Americans supported the GOP plan, and only 41 percent of Republicans.
"There is a fire [that] has been lit under a lot of people, especially since the collapse of the Trump bill," said Benjamin Day, executive director of single-payer advocacy group Healthcare-NOW, in an interview with Truthout.
As the debate over the GOP health reform plans took place, Democrats held numerous town halls, ostensibly with the noble goal of protecting the ACA. But, as Paris puts it, "voters weren't there just to talk about the Affordable Care Act." A Washington Post article about the GOP surrender on repeal observed that at town hall meetings "progressives in blue America celebrated -- then asked for more." Even getting Medicare for All mentioned in the dominant media is a victory, given their long record of ignoring the policy.
"At town hall meetings people continually asked Democrats about Medicare for All. I was at a meeting and as soon as it was mentioned the room erupted in applause," Paris said. "Some Democrats wanted to keep the debate narrow and only talk about protecting the ACA. But people weren't willing to let that stand."
The scare TrumpCare put into Americans also brought to light a phenomenon known as "loss aversion." The basics of this tendency, according to a March 24 New York Times article by Robert H. Frank, "is that the pain of losing something you already have is much greater than having gained it in the first place."
"In the end, the repeal effort's biggest hurdle may have been loss aversion, one of the most robust findings in behavioral science," Frank said in the article, which is headlined "What's Next After Obamacare, the Case for Medicare for All." With Americans increasingly protective over their health insurance, the prospects for single-payer, which would guarantee them insurance -- which the ACA fails to do -- becomes a comforting thought to a public that, according to a Pew poll from January, believes that "the government should be responsible for ensuring health care coverage for all Americans."
This is a reason why debate over cutting benefits in the ACA backfired on the GOP. The ACA has only gone up in popularity during the repeal effort. "The ACA has plenty of problems and is not universal. But, to its credit, if the ACA didn't do anything else, it gave many Americans a sense that universal health care is possible," Paris said.
Likewise, as Republicans debated the issue, the single-payer movement was benefiting. Advocates spoke of dramatic increases in the number of letters to the editor, web traffic and a pronounced uptick in social media interest. The Facebook page for PNHP, for instance, is now up above 50,000 members. Google Trends shows a dramatic spike in searches for "Medicare for All," and "single-payer," just as the GOP repeal bill was being debated in Congress (see image).
"People are getting pissed off, and the collapse of any alternative from the right is making Medicare for All a more obvious solution," Day said. In this context, it is noteworthy that 22 new cosponsors came out in favor of HR 676 soon after the GOP abandoned its own bill.
A Strategy Paying Off: Progressive Groups Pressuring Democrats
Another major reason for the new support for Medicare for All is the energetic activist base that has grown out of the Sanders campaign and in reaction to Trump's election. As Truthout recently reported, Democrats, to the chagrin of many in the establishment, have not been immune to pressure from activists. An important part of many organizations' strategies is to try and elect as many left-leaning progressives to positions of political power, from Congress all the way down to animal control officer. Some groups, such as WeWillReplaceYou.org, are threatening corporate Democrats with the prospect of a primary opponent if they aren't sufficiently strong on key issues.
Medicare for All is a key issue for many of these groups, which include Brand New Congress, Justice Democrats, National Nurses United, Progressive Democrats of America, Medicare4All, and the Labor for Single-Payer coalition featuring unions across the country. Our Revolution, the organization launched by Sanders following his campaign, has not made endorsements for the 2018 elections, but will almost assuredly emphasize support for single-payer in selecting candidates. "We support creating a federally administered single-payer health care program," the group clearly states on its page devoted to Medicare for All.
Brand New Congress, a group that aims to find progressive candidates for every seat in Congress that doesn't already have one, has been very active in trying to "pressure Democrats into backing Medicare for all," said cofounder Saikat Chakrabarti, in an interview with Truthout. They issued a petition citing the then "119 Democrats who are not supporting Medicare for All," not long before this latest spike in support. Since then they have been able to cross 26 names off that list.
In addition to petitions and letter-writing there have also been several national days of action, including one on Saturday, April 8. Events like this have been drawing crowds and soliciting actions since Trump's inauguration.
The Sanders Effect and the Coming Senate Legislation
Many of the organizations behind this effort were founded, and are largely made up of staffers and volunteers from the Sanders presidential campaign. And, there is no doubt that his campaign has been instrumental in educating and rallying the public behind this and other issues. Truthout has previously measured the considerable impact Sanders had on bringing attention to single-payer and in awakening class consciousness in many new people.
"I think his effect on the health care debate has been monumental," said Ken Zinn, political director of National Nurses United, in an interview with Truthout. "When you have a major candidate talk about it at every single stump speech, it opens minds." Zinn's organization was a staunch supporter of the Sander's candidacy for President and is rallying behind HR 676 and state-wide single-payer in California.
Sanders will introduce his own single-payer legislation in the Senate in the coming weeks. Rep. Peter Welch, the lone Vermont member of the House (and one of the cosponsors to HR 676), has said he will issue a sibling bill in the House. Advocates are eager to see the specifics of the Sanders bill, and to discover which senators, if any, will cosponsor. Sanders has been on an island in his single-payer support since joining the Senate in 2006, and when he introduced legislation in the Senate previously, he failed to win over a single cosponsor.
But advocates are confident that, armed with his massive popularity and the collective momentum for the issue, he will find cosponsors this time. Several newer members of the Senate were cosponsors of Conyers' bill when they were in the House. This includes Massachusetts Sen. Ed Markey who, Day speculates, is more likely to cosponsor Sander's bill than Sen. Elizabeth Warren is.
"I am very confident there will be cosponsors this time," Day said. It is a safe bet that progressives will take a long hard look at those names and pressure those who are not supportive to get on board.
Advocates have also been pleased to hear that Sanders is introducing, as Paris describes it, a "real Medicare for All bill," as earlier rumors suggested he might instead go with half measures like the "public option," or lowering the age restriction on Medicare to 55. The public option and the lowering of the Medicare age limit, according to Margaret Flowers, could both backfire if implemented. She argues they would remove sick patients from the risk pool for private plans, making the public plans appear to be less efficient. "We hear this is a strong plan and there is a lot of meat on the bone," Paris said of Sanders' new proposal.
Moving On: Democrats and Health Reform in Post-Clinton Era
As noted, Sen. Elizabeth Warren has never publicly supported single-payer. But advocates took notice when right after Trump's victory, she criticized the ACA. "Let's be honest: [The ACA's] not bold. It's not transformative," she said. "I'm OK taking half a loaf if our message was 'Here's half, now let's go get the rest.'"
This statement was unlike anything she uttered during the presidential campaign and may represent a significant pivot for Warren. "This [post-election] shift seems likely to unmuzzle single-payer supporters who closeted themselves during the ACA era," observed Steffie Woolhandler and David Himmelstein, of PNHP, about Warren's critique.
Warren's statement is one piece of evidence that because Clinton's campaign is over, Democrats may feel more liberated to back single-payer. If a member of Congress cosponsored single-payer legislation during the campaign, it may have been perceived as undermining Clinton's plan, which was anti-single-payer and singularly focused on the ACA.
"It was almost impossible to get cosponsors during the Democratic primary," Day said.
Clinton, however, is no longer a candidate and therefore no longer the head of the Democratic Party. Who is the head of the party? It depends on who you ask. Some might say Sen. Chuck Schumer or Rep. Nancy Pelosi, the minority leaders of the two congressional bodies. But Sanders is the most popular politician in the country, according to a Fox News poll in March, and there is a sense among some in DC that Sanders is now the de facto leader of the party. Obviously, if this proves to be true, the post-Clinton era will be a boon for single-payer.
Finishing the Job
Despite this progress, the fact remains that about half of the House Democrats have not cosponsored Medicare for All. Even in a blue state like Massachusetts, there are only three cosponsors out of nine house members.
Rep. William Keating, for instance, from the state's 9th congressional district, which (like every district in the state) supported Clinton in 2016, is one of the holdouts. Data from the Center of Responsive Politics reports that he got more than $39,000 from drug companies in 2016, which is $4,000 more than the average Democrat. But is this the only explanation? Keating's Massachusetts colleague Rep. Michael Capuano received $34,000 from pharmaceutical companies and he is, and has been in the past, a cosponsor of HR 676. Another Massachusetts Congressman, Joseph Kennedy III, is another kind of animal. He received about $180,000 in donations from Pharma, more than four times the average House member in either party.
Both Keating and Kennedy were contacted by Truthout and asked about HR 676. Keating said that "it seems increasingly clear Medicare for All is where we need to eventually end up," but did not indicate he would cosponsor HR 676, noting that "there is little common ground with Republicans in this current political climate," and he remains focused on protecting Obamacare. A staffer for Kennedy could only confirm that the congressman is "still reviewing the legislation." These are probably not the answers advocates want to hear. But the way things are going, those two members, along with all others who fail to cosponsor the Medicare for All bill, will be contacted by a lot more of their constituents in the coming months and years. And advocates committed to solving the health care crisis plan to keep calling until they get the right answer.