Midterm wave sets a course for ‘Medicare for All’ fight
Midterm wave sets a course for ‘Medicare for All’ fight
By Kate Wells for KFF Health News
Fifteen years working as an emergency room nurse has convinced Kim Bogan that the only way to fix the American healthcare system is to tear it down and start over.
Her patients arriving for triage are sicker than ever. They can’t afford many of the prescriptions they get in the ER. And sometimes when patients die, she wonders if she could have saved them had she not been caring for five or six other people at once.
That’s why she spent the past year shuttling between 12-hour shifts at this city’s Sparrow Hospital and campaigning for Abdul El-Sayed, the Democrat who made “Medicare for All” a signature issue in his congressional campaign and is now a senator-elect.
But she realizes that just because progressive candidates successfully campaigned on some form of the policy in states such as Texas, Iowa, Maine, and Michigan, it doesn’t mean Medicare for All will be an easy sell.
“Nobody expected that,” Bogan said.
Medicare for All typically refers to a government health program that would guarantee Americans coverage by replacing most or all private insurance. Critics are already pointing out that, even in a blue wave as massive as the 2026 midterms, the most vocal Medicare for All champions generally won by smaller margins than more moderate Democrats.
“Whatever else people voted for in this midterm election—anger about inflation, anger about corruption, anger about the Iran war—they by and large didn’t vote to have the government take over health insurance,” said Jonathan Oberlander, a professor and healthcare reform expert at the University of North Carolina-Chapel Hill.
Still, supporters of universal healthcare see this moment as a once-in-a-generation opportunity because Americans are buckling under the weight of healthcare costs and are hungry for change. Several states, including Oregon, are already exploring what it would take to set up single-payer systems.
The affordability crisis “dominated this election, and Medicare for All speaks to that,” Oberlander said. Medicare for All supporters expect the policy agenda will gain major momentum heading into the 2028 Democratic presidential primaries, he added.
But more moderate Democrats may see the idea’s growing popularity as a threat to gains they made in states such as Iowa, Kansas, and South Carolina.
“If Democrats want to hold those seats, which were very difficult to win, they’re probably not interested in passing Medicare for All,” Oberlander said. “That’s a huge political risk in red-leaning states. So just because Democrats have a majority doesn’t mean it’s a majority for Medicare for All.”
Previous Medicare for All proposals would have required getting millions of people to willingly give up their existing coverage, fueling unprecedented opposition from the healthcare industry, said Michael Cannon, a healthcare economist at the libertarian Cato Institute and a Medicare for All opponent.
“If Medicare for All actually had the price levels that Bernie Sanders and Abdul El-Sayed envision, the industry would tear it to shreds,” he said.
And even as voters say they support Medicare for All in greater numbers than in nearly a decade, support falters when they’re presented with common arguments against it—like it could lead to higher taxes or delays in treatment—according to a recent KFF poll.
Jaime Bardenhagen said she feels a little guilty about the idea of getting her healthcare coverage from the government. A former nurse in rural Leelanau County in northern Michigan, Bardenhagen has Parkinson’s and sialidosis, a rare genetic disease that can cause seizures.
Yet she “feels bad” about qualifying for disability benefits next year. Such programs were something she “didn’t believe in” while growing up on a farm, she said. You were supposed to work for what you needed, she said, not rely on government support. “And I did work as hard as I could, for as long as I could.”
But like millions of Americans, Bardenhagen and her husband saw their health insurance costs skyrocket this year, after enhanced Affordable Care Act subsidies expired.
Their monthly premiums went from $700 to $1,300, with a deductible of $7,500. They started putting off medical tests her doctor wanted, she said.
“We couldn’t afford that,” she said.
Her husband voted for President Donald Trump in 2016, Bardenhagen said. This time, he stayed home. Bardenhagen, a Democrat, also considered sitting out the midterms.
“I just don’t trust either party anymore,” she said.
Despite those misgivings, she says she supports Medicare for All. Her years as a nurse left her disillusioned with the current healthcare system, she said.
She felt the insurance companies, not doctors, were calling the shots, determining which prescriptions and procedures patients could receive. Wouldn’t it be fairer, she figured, if “good people” in government were making those calls? “So, absolutely, the government should take it over.”
That takeover is Cannon’s worst-case scenario. The libertarian economist said giving the federal government greater control over the healthcare system would only backfire. Patients would be left “in even more vulnerable positions, because they would be relying for their access to healthcare on government spending that is just not sustainable.”
Medicare for All supporters are naive to think the government could negotiate lower drug and healthcare prices by replacing private plans with a public one, he said.
“Everyone knows that the industry is going to end up running the show, and that has been the case since they passed Medicare,” Cannon said.
For Bardenhagen, the message she wants Democrats to take from the midterms is simple: “Do something,” the former nurse said.
“With the election results, both parties are going to be under pressure to come up with solutions to address the current affordability crisis in healthcare,” said Sara Collins, a senior scholar at the Commonwealth Fund, a private foundation that supports healthcare research.
That could mean smaller, but still significant, bipartisan deals that might have seemed unthinkable before the midterms: things such as reinstating the enhanced Affordable Care Act subsidies that expired at the end of last year, or other measures with broad support, such as curbing insurance companies’ use of prior authorizations, which requires patients to get insurers’ approval before proceeding with a covered treatment.
“That’s probably the lowest-hanging fruit for them, I’d think,” said Patricia Votava, a political strategist based in Sullivan’s Island, South Carolina.
The pressure for healthcare reform is likely to grow, too, with Affordable Care Act premiums set to rise by double digits again next year; employers passing on more of their growing insurance premium costs to workers; and massive cuts to Medicaid looming, which are projected to leave 7.5 million more people uninsured by 2034.
On the whole, the midterm results could push Democrats’ healthcare agenda further left, Oberlander said. Some Democrats could support a public option, a government-backed health plan people could opt into. Others in the party could coalesce around a version of Medicare for All that doesn’t fully replace private insurance but serves as “guaranteed baseline government health insurance,” as El-Sayed described his current plan in the campaign.
“If you like your insurance from your employer or from your union, that can still be there for you,” he said.
Whatever they opt for, Democrats shouldn’t expect voters to be willing to wait patiently for years of gradual change, Oberlander said. “If the window opens, you better jump right through.”
South Carolina correspondent Lauren Sausser contributed to this report.
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