By Amanda Michelle Gomez
Think Progress, April 1, 2019
Medicare for All has attracted widespread support in the Democratic Party. But the ambitious overhaul of the nation’s health care system faces a major threat: big spending by health care and insurance interests determined to preserve the status quo.
A ThinkProgress analysis found that those industries, part of a coalition called the Partnership for America’s Health Care Future, donated nearly $1.2 million in the 2017-2018 election cycle to Democratic members of four key House committees that could determine the fate of Medicare for All.
Asked at a recent press conference about the greatest hurdle facing her bill, the most far-reaching Medicare for All proposal out there, Rep. Pramila Jayapal (D-WA) replied, “the money, money, money, ain’t it funny of the industry groups that are going to fight us every step of the way.”
The Jayapal bill, H.R.1384, would radically transform the health care system by abolishing virtually all private insurance and moving everyone into one government-run program.
Sen. Bernie Sanders (I-VT), a 2020 Democratic presidential candidate who popularized the idea during the last presidential campaign, shares her concern.
“This is not going to be an easy fight,” he said in a conference call after the midterms. “You’re taking on the drug companies, you are taking on the insurance companies, and these people have unlimited amounts of money — unlimited. They buy and sell politicians every single day.”
Jayapal and Sanders have reason to be worried.
Last summer, leading pharmaceutical, insurance, and hospital interests formed the Partnership for America’s Health Care Future to curb favor for Medicare for All in the Democratic Party. And they’ve been donating a lot to get their views across.
ThinkProgress analyzed political action committee (PAC) contributions to Democratic members on four key House committees — Ways and Means, Energy and Commerce, Budget, and Rules — on the website Political Money Line as of March 2019.
House Energy and Commerce Committee Chairman Rep. Frank Pallone (D-NJ), who has declined to hold any Medicare for All hearings, received $56,000 from partnership members — the most of any chairman of those committees. Notably, he received thousands more than committee chairmen who promised to hold Medicare for All hearings, jump-starting conversations about the future of health reform. Pallone did not respond to a request for comment.
But even co-sponsors of the Jayapal bill have received donations from partnership members. Rep. Jimmy Gomez (D-CA), who is a co-sponsor, received $66,769 — more than any other member on the four committees.
The partnership has been waging a quiet war to shape the national conversation around single-payer health care and to ensure Medicare for All isn’t part of the Democratic Party platform in 2020. The coalition intends to do this by “engaging stakeholders…including key committees and staff on the Hill,” as the coalition put it in documents obtained by the Intercept. In other words, the partnership will try to meet with and influence congressional lawmakers responsible for health reform. The coalition does not lobby directly, but it does have “a diverse set of members who do lobby, raising concerns about Medicare for All proposals,” a spokesperson for the partnership, who wished to remain anonymous, told ThinkProgress.
The Federation of American Hospitals, America’s Health Insurance Plans, and the Pharmaceutical Research and Manufacturers of America created the coalition last June. By August, when the Hill first reported the coalition’s formation, the partnership had 16 organizations. Today, nearly 30 organizations belong.
Of the partnership’s early members, 11 operate a PAC that donated more than $7.5 million to congressional candidates during the midterm elections, when the Medicare for All rallying cry was prevalent. House Speaker Nancy Pelosi (D-CA) received $27,500 from partnership members, but that’s far less than the $60,000 her Republican counterpart, House Minority Leader Kevin McCarthy (R-CA), received.
Republicans aren’t interested in Medicare for All; in fact, the Trump administration is more concerned with repealing Obamacare, a goal laid bare when it supported a federal judge’s decision to declare the entire health law unconstitutional last week. But many Democrats are open to the idea of Medicare for All, so are more susceptible to persuasion.
The 11 PAC members of the partnership are the National Association Of Insurance And Financial Advisors (NAIFA), the Council Of Insurance Agents & Brokers, the American Medical Association, the American College Of Radiology Association, the National Association Of Health Underwriters, the Blue Cross Blue Shield Association, the Federation Of American Hospitals, the National Retail Federation, the Pharmaceutical Research and Manufacturers of America (PhRMA), America’s Health Insurance Plans, and the Association For Accessible Medicines.
“Like most Americans, we are concerned with Medicare for All-style proposals that would scrap our current health care system and start from scratch with a one-size-fits-all program run by the government, and we strongly believe that approach would cause more harm than good for patients throughout our country,” said Lauren Crawford Shaver, executive director of the Partnership for America’s Future, who also served in Hillary Clinton’s 2016 presidential campaign and as a health advisor in the Obama administration.
The statement to ThinkProgress echoes the group’s past talking points — but in reality, the partnership isn’t against only single-payer health care. It’s against any proposal to expand access to federal health programs like Medicare and Medicaid. For example, earlier this year, the partnership opposed a modest bill that would allow people to buy into Medicare beginning at age 50.
PhRMA and NAIFA were the only partnership members to respond to ThinkProgress, but neither spokesperson would comment on PAC contributions.
“We believe that the current health care system must be improved to help patients achieve affordable and accessible health care that fits their unique health needs. We joined this coalition to contribute to policy conversations that look to deliver affordability, expand options, improve access and foster innovation,” PhRMA spokesperson Holly Campbell said in a statement.
“NAIFA routinely meets with Members of Congress on a variety of issues including health reform,” said NAIFA spokesperson Sheila Owens in an email.
“NAIFA strongly supports the employment-based private sector health insurance system which provides quality health insurance coverage to millions of individuals and businesses in the small and large group markets. We believe any expansion of government programs should be narrowly limited to those persons who are not appropriate candidates for private coverage, and it should expressly authorize the use and compensation of agents in placing insureds in such coverage,” she added.
With Republicans controlling the White House and the Senate, Medicare for All is unlikely to become law any time soon. But activists who support it stress that this moment is about starting the national conversation on where the country should go next on health care reform. The House committees on Energy and Commerce, Ways and Means, Budget, and Rules will oversee any reform legislation, which is why members of the partnership have given contributions to these lawmakers.
“We know for a fact that corporate opposition to Medicare for All has deep pockets and they wouldn’t be giving this money to Congress if they didn’t think it would have its desired effect… it should raise people’s skepticism about the motivations of leaders,” said Dr. Adam Gaffney, the president of the single-payer advocacy group Physicians for a National Health Program.
“It’s sort of like when people talk about pharmaceutical companies giving money or gifts to physicians — they wouldn’t be doing it if it didn’t matter.”
Rep. Richard Neal (D-MA), the chairman of the other critical House committee, Ways and Means, received slightly less than Pallone, $54,500.
Meanwhile, the chairmen of the Budget and Rules committees, Reps. John Yarmuth (D-KY) and James McGovern (D-MA), received $5,000 and $3,500 respectively.
The House Budget Committee has six members who received no contributions from partnership members — the most of any of the four committees — including Jayapal, Reps. Ro Khanna (D-CA), Sheila Jackson Lee (D-TX), Steven Horsford (D-NV), David Price (D-NC), and Ilhan Omar (D-MN). The NAIFA PAC sent $2,000 to the Khanna campaign, but the campaign did not accept it. “We just pledged to be completely PAC free,” said Khanna’s campaign manager, Cooper Teboe. Horsford and Price aren’t cosponsors of the Jayapal bill.
Two members of the Rules Committee, Reps. Alcee Hastings (D-FL) and Jamie Raskin (D-MD), received no contributions from partnership members. Only one member of Energy and Commerce and one of Ways and Means — Reps. John Sarbanes (D-MD) and Steven Horsford (D-NV), respectively — received no money from these special interests. The Energy and Commerce and Ways and Means committees are usually comprised of more seasoned lawmakers who are also more likely to receive more industry money.
Two of the four committees (Budget and Rules) have announced plans to hold hearings on single-payer health care — but there’s a catch.
Jayapal told The Washington Post in January that she secured Pelosi’s commitment to hold the first-ever hearings about Medicare for All legislation in those two committees. But a Budget Committee spokesperson told ThinkProgress that the chairman, Yarmuth, would hold a hearing on “various approaches” to making coverage more accessible. “It will not be a hearing on any specific proposal,” said a spokesperson who asked to remain anonymous.
The Rules Committee is the only panel that has committed to a hearing focused on Jayapal’s Medicare for All legislation, though a committee spokesperson who asked to remain anonymous said no date has been set yet.
Neal, chairman of House Ways and Means, is open to holding a hearing on the issue but nothing’s scheduled yet, said committee spokesperson Erin Hatch.
The Energy and Commerce Committee, meanwhile, will be “focused on legislation that will reverse the Trump administration’s sabotage of our health-care system, protect people with pre-existing conditions, and make health care and prescription drugs more affordable,” a committee spokesperson who asked to remain anonymous said. The partnership has reportedly been encouraging lawmakers to focus on shoring up the Affordable Care Act, or Obamacare, instead of adopting single-payer health care.
The partnership denies that campaign contributions will stand in the way of Medicare for All. Shaver, the executive director, asserted that the obstacles to passage are the plan’s cost and a lack of public support. (In reality, support fluctuates based on how the argument around Medicare for All is framed). She added that the midterm elections weren’t a referendum on Medicare for All, but on Obamacare.
“It would be worth going back to Rep. Jayapal and asking her to explain why she thinks so many members of her own party – especially her own House Democratic Caucus colleagues – are not with her on this,” said Shaver.
Supporters of Medicare for All counter that health care industries always have fought proposals to change the status quo.
“The corporate opposition is unquestionably the biggest obstacle ahead of us — that’s been the case throughout the history of the fight for universal health care in America and this stage is not different,” said Gaffney, of Physicians for a National Health Program.
“But look back at history and you see grassroots movements succeeding when they are able to change the conversation around an issue,” he said. “We’ve already seen that — look at where we’ve come in the last two years.”
Medicare for All supporters have also been trying to meet with lawmakers to build support for the Jayapal bill. Activists with the Center for Popular Democracy, for example, tried to meet with lawmakers on the first day the new Congress convened, but typically just left information packets at the front desk. Even so, they’re optimistic.
“Health insurance companies, the pharmaceutical industry, and other corporate players make billions of dollars off of America’s illness — and they want to keep it that way,” said Jennifer Flynn Walker, director of mobilization and advocacy at the Center for Popular Democracy, an advocacy group that promotes progressive policies.
“Corporations prioritize profits over people, which keeps health care out of reach for millions,” she said. “We will win because the time has come for a change. We are organized in a way that we never have been before.”
Josh Israel, Ryan Koronowski, and Diana Ofosu contributed to this story.