Above photo: Backbone Campaign.
NOTE: The report below is helpful for understanding opposition to National Improved Medicare for All. We would not characterize the Senate bill introduced by Senator Sanders as a strong bill. It has serious flaws, such as containing Accountable Care Organizations, which shift the risk of the costs of care onto doctors and lead to restrictions of care and discrimination, unproven payment schemes and a long, complicated transition, among other flaws. This review of the weaknesses of the previous Sanders bill pertains to the new one, as very little has changed except that coverage of longterm care services (not residential costs) was added. – Margaret Flowers
With Democrats in control of the U.S. House of Representatives, a significant number of U.S. senators co-sponsoring the strongest Medicare for All legislation ever introduced in the Senate, and powerful polling in support of the proposal, single-payer health care is at the center of the public debate like never before.
Between the first quarter of 2018 and the first quarter of 2019, lobbying on Medicare for All increased dramatically, almost entirely due to a surge in lobbying activity by organizations that oppose it. This indicates that opponents of Medicare for All are newly scared about its rising prospects.
The diverse and powerful array of trade groups, conservative activist organizations, GOP-linked establishment groups and health care industry interests launching an all-out advertising blitz against Medicare for All further reinforces this reality.
- The number of organizations hiring lobbyists to work on Medicare for All increased from nine in the first quarter of 2018 to 61 in the first quarter of 2019 – a nearly sevenfold increase.
- The number of individual federal lobbyists working on Medicare for All increased from 29 in the first quarter of 2018 to 270 in the first quarter of 2019 – a ninefold increase.
- Six of the seven organizations hiring the most lobbyists to work on Medicare for All in the first quarter of 2019 belong to the Partnership for America’s Health Care Future, a new coalition dedicated to opposing single-payer health care proposals.
- Nine of the 10 organizations hiring the most lobbyists on Medicare for All oppose it.
- Some of the most visible opposition to Medicare for All comes from major players in American conservatism, including the U.S. Chamber of Commerce, the Koch network, and GOP strategist and money-wrangler Karl Rove.
Introduction
The debate over Medicare for All has reached a fever pitch. For decades, single-payer health care was considered a quixotic, fringe proposal.[1]However, the tide appears to be turning.
At present, 14 senators have co-sponsored[2] the Medicare for All Act of 2019 introduced in the U.S. Senate by Sen. Bernie Sanders (I-Vt.). The Medicare for All bill under consideration in the U.S. House of Representatives has 112 Democratic co-sponsors. Single-payer legislation at the state level is being considered in at least 18 states,[3] and Public Citizen is part of a national partnership seeking to pass Medicare for All resolutions in local communities.
The rising enthusiasm for Medicare for All has prompted industry to increase its lobbying against the proposal dramatically. Between the first quarter of 2018 and the first quarter of 2019, the number of organizations hiring lobbyists whose lobbying disclosure forms indicated that they worked on Medicare for All increased by nearly seven times, and the overall number of lobbyists hired increased ninefold. The increase in Medicare for All lobbying is almost entirely driven by organizations that oppose it.
The ramp up of lobbying against single-payer proposals is validation that powerful health care interests see Medicare for All as a legitimate threat.
The Spike in Lobbying on Medicare for All
The number of organizations hiring lobbyists to work on Medicare for All rose sharply over the one-year period between the first quarters of 2018 and 2019.
This likely is at least partially due to the 2018 midterm elections. Lobbying on the issue increased greatly heading into 2018’s third and fourth quarters. We found an even larger spike in the first quarter of 2019. This may be because the election resulted in a newly minted Democratic House majority, including many new arrivals who ran on expanding access to health care, and Medicare for All, specifically.[4] [See Figures 1 and 2]
SOURCE: U.S. HOUSE OF REPRESENTATIVES LOBBYING DISCLOSURE DATABASE
We found that the organizations that have hired the most lobbyists to lobby on Medicare for All overwhelmingly oppose the proposal. Of the 10 organizations hiring the most lobbyists, nine outright oppose Medicare for All. [See Table 1]
TABLE 1: GROUPS HIRING THE MOST LOBBYISTS ON MEDICARE FOR ALL IN Q1 2019
| Rank | Organization | Number of Lobbyists Hired | Stance on Single-Payer |
| 1 | Pharmaceutical Research and Manufacturers of America | 27 | Oppose[5] |
| 2 | Chamber of Commerce of the U.S.A. | 26 | Oppose[6] |
| 3 | American Medical Association | 21 | Oppose[7] |
| 4 | Biotechnology Innovation Organization | 18 | Oppose[8] |
| 5 | AHIP | 15 | Oppose[9] |
| 6 | Federation of American Hospitals | 14 | Oppose[10] |
| 7 | Blue Cross Blue Shield Association | 11 | Oppose[11] |
| 8 | National Association of Manufacturers | 11 | Oppose[12] |
| 9 | American Nurses Association | 10 | Undecided[13] |
| 10 | American College of Surgeons | 9 | Oppose[14] |
SOURCE: U.S. HOUSE OF REPRESENTATIVES LOBBYING DISCLOSURE DATABASE
The new entrants represent the biggest names and industries in health care. These include representatives of insurance companies, including Allstate, Blue Cross Blue Shield (including state-specific associations), and the Kaiser Foundation Health Plans; the pharmaceutical industry, including the Pharmaceutical Research and Manufacturers of America (PhRMA), the Biotechnology Innovation Organization, and GlaxoSmithKline; and hospitals, including the Federation of American Hospitals, the American Hospital Association, and the Hospital Corporation of America. [See Appendices I and II]
Corporate Giants, Conservative Advocacy Groups Enter the Fray
While the data indicate a substantial rise in lobbying against Medicare for All through 2019’s first quarter, there is reason to expect that this trend will only continue. In particular, it is notable that some of the most resourced and powerful forces in American politics – the U.S. Chamber of Commerce (Chamber) and the Koch brothers’ network of politically active nonprofits and conservative libertarian donors – have now thrown their hats into the ring. Furthermore, establishment GOP-linked groups like Karl Rove’s One Nation and coalitions of health care interests have launched initiatives against Medicare for All.
The U.S. Chamber of Commerce
This January, during the annual State of American Business Address, Chamber CEO Thomas J. Donohue promised that the Chamber was dedicated to using “all of our resources” toward lobbying against single-payer health care.[15] As the largest lobbying group in the country,[16] those resources are certain to be vast. As shown in Table 1, the Chamber devoted the second-highest number of lobbyists to opposing Medicare for All in the first quarter of 2019.
The Coalition Against Socialized Medicine
Then there are the Koch brothers, known for their massive web[17] of connections with conservative and libertarian advocacy groups. In characteristic fashion, the Kochs’ efforts to oppose Medicare for All have been shadowy and diffuse across many organizations. The Coalition Against Socialized Medicine (CASM) has made it a core mission to defeat Medicare for All proposals.[18] The Coalition consists of[19] the Koch-founded Freedom Works, as well as other groups the Kochs have funded,[20] like Heritage Action for America and the Club for Growth, and groups with close ties to the Kochs like the American Conservative Union,[21] Citizens Against Government Waste[22] and the National Taxpayers Union.[23]
CASM has been waging a propaganda campaign against Medicare for All, using the term “socialism” as a boogeyman to stir up fears of single-payer health care. Matt Schlapp, chairman of the American Conservative Union, has claimed that Medicare for All would “subject all American patients to the types of ineffective socialized medicine systems that have plagued European and socialist countries for decades.”[24] The United States could benefit by catching the plague that Schlapp described. Those European countries achieve better health results that we do in the United States and spend much less on their health care.[25]
One Nation
Establishment GOP-linked groups have begun to take aim at Medicare for All. One Nation, an advocacy group founded by Karl Rove and his colleagues “as a conduit for anonymous, political money,” in the words of the Center for Responsive Politics,[26] has now taken aim at Medicare for All. The organization has ties to the GOP establishment. Its president is Steven Law – former chief of staff to Senate Majority Leader Mitch McConnell (R-Ky.) and current president of the Senate Leadership Fund,[27] a super PAC that is essentially operated by the GOP Senate leadership.
One Nation debuted in 2015 with a $2 million ad campaign promoting what it called a “congressional consensus on Medicare”[28] that aimed to replace the Affordable Care Act.[29] Now, One Nation is waging a $4 million advertising campaign against single-payer health care meant to air around Democratic presidential primary debates.[30]
Partnership for America’s Health Care Future
Finally, there’s the Partnership for America’s Health Care Future (PAHCF), a coalition of well-funded groups in health care industries including the Federation of American Hospitals, the American Medical Association, the Biotechnology Innovation Organization, Pharmaceutical Research and Manufacturers of America (PhRMA), America’s Health Insurance Plans (AHIP), and the Blue Cross Blue Shield Association.[31] PAHCF has unleashed what The New York Times calls “a daily fusillade of digital advertising, videos and Twitter posts”[32] deriding Medicare for All as excessively expensive and bureaucratized.
While PAHCF had not yet begun lobbying as of 2019’s first quarter, the lobbying firm Forbes-Tate did register as a new client for the Partnership, listing five of its staffers who are expected to act as lobbyists on its behalf.[33] Disclosure forms from the remaining periods of 2019 may indicate that these Forbes-Tate lobbyists have indeed begun to lobby for PAHCF, and/or that PAHCF has begun to conduct in-house lobbying. Regardless, the member organizations’ individual lobbying is already massive; six of the top seven hirers of lobbyists on Medicare for All, as listed in Table 1Table 1, are member organizations – and all are opposed to the policy.
In an op-ed[34] for Buzzfeed in May, U.S. Sen. Bernie Sanders (I-Vt.) accused PAHCF of being a “front group” of industry actors with a financial interest in maintaining the status quo using “deceptive ads” in order “to try to persuade legislators to oppose Medicare for All, or divide us and confuse us with weaker proposals.” The senator went on to enumerate the massive financial resources these groups have spent on lobbying and executive compensation, around $1.7 billion for the 65 highest health care CEOs,[35] and around $440 million for the top 25 highest-paid CEOs in the pharmaceutical industry.[36] Clearly, PAHCF’s member organizations reap massive profits from private health care, and they do not intend to give up those profits.
Conclusion
The dramatic increase in lobbying against Medicare for all shows that its opponents view it as a politically viable threat. Those who profit from our broken health system are putting up the most money.
It remains to be seen how successful these efforts will be. While the trade groups, conservative activist organizations and for-profit industry interests that oppose Medicare for All wield a great deal of power and resources, the majority of the public supports Medicare for All.[37]
The results of the 2018 election and the energetic ongoing efforts to adopt local Medicare for All resolutions show that the people power demanding this policy is growing rapidly. Further, recent hearings in the House of Representatives indicate that our policymakers are listening to the fact that health care is the number one issue for voters.[38] The momentum is so powerful that even the health care sector’s most well-funded lobbying organizations may be unable to stop it. The only thing that’s certain is that they’ll make every effort to do so.
Methodology
The data for this report were gathered via the U.S. House of Representatives’ federal lobbying disclosure database. Using the search-terms “single-payer,” “Medicare for All,” the relevant House and Senate legislation, and all permutations of those terms by grammar and punctuation, groups were identified as having deployed lobbyists to work on “single-payer” / “Medicare for All” as an issue (often in addition to other issues). Only those lobbyists whose names were listed in the section of lobbying disclosure forms including one of those search terms as a lobbying issue were counted.
APPENDIX I: REPORTED FEDERAL LOBBYING ON SINGLE-PAYER / MEDICARE FOR ALL, QUARTER 1, 2018
| Year | Quarter | Client | Number of lobbyists |
| 2018 | 1 | AHIP | 13 |
| 2018 | 1 | National Association of Manufacturers | 4 |
| 2018 | 1 | American Postal Workers Union, AFL-CIO | 3 |
| 2018 | 1 | Public Citizen | 2 |
| 2018 | 1 | P Street Project, Inc. | 2 |
| 2018 | 1 | American Chiropractic Association | 2 |
| 2018 | 1 | Social Security Works | 1 |
| 2018 | 1 | National Nurses United | 1 |
| 2018 | 1 | International Longshore & Warehouse Union | 1 |
APPENDIX II: REPORTED FEDERAL LOBBYING ON SINGLE-PAYER / MEDICARE FOR ALL, QUARTER 1, 2019
| Year | Quarter | Client | Number of lobbyists |
| 2019 | 1 | Pharmaceutical Research and Manufacturers of America | 27 |
| 2019 | 1 | Chamber of Commerce of the U.S.A. | 26 |
| 2019 | 1 | American Medical Association | 21 |
| 2019 | 1 | Biotechnology Innovation Organization | 18 |
| 2019 | 1 | AHIP | 15 |
| 2019 | 1 | Federation of American Hospitals | 14 |
| 2019 | 1 | Blue Cross Blue Shield Association | 11 |
| 2019 | 1 | National Association of Manufacturers | 11 |
| 2019 | 1 | American Nurses Association | 10 |
| 2019 | 1 | American College of Surgeons | 9 |
| 2019 | 1 | American College of Surgeons Professional Association | 9 |
| 2019 | 1 | American Society of Anesthesiologists | 8 |
| 2019 | 1 | National Treasury Employees Union | 6 |
| 2019 | 1 | National Community Pharmacists Association | 6 |
| 2019 | 1 | GlaxoSmithKline Inc. | 6 |
| 2019 | 1 | Fred Hutchinson Cancer Research Center | 5 |
| 2019 | 1 | Ascension Health | 5 |
| 2019 | 1 | Allstate Insurance Company | 4 |
| 2019 | 1 | Kaiser Foundation Health Plan Inc | 4 |
| 2019 | 1 | Public Citizen | 4 |
| 2019 | 1 | American Hospital Association | 4 |
| 2019 | 1 | Bristol-Myers Squibb Company | 3 |
| 2019 | 1 | HCA Hospital Corporation of America | 3 |
| 2019 | 1 | Retail Industry Leaders Association | 3 |
| 2019 | 1 | Planned Parenthood Federation of America, Inc. | 3 |
| 2019 | 1 | American Federation of Teachers | 3 |
| 2019 | 1 | Amalgamated Transit Union | 2 |
| 2019 | 1 | Alliance for Retired Americans | 2 |
| 2019 | 1 | Families USA Foundation | 2 |
| 2019 | 1 | AFL-CIO | 2 |
| 2019 | 1 | Bluecross Blueshield of Tennessee | 2 |
| 2019 | 1 | Highmark, Inc. | 2 |
| 2019 | 1 | Public Policy Management Group | 2 |
| 2019 | 1 | International Association of Machinists and Aerospace Workers | 2 |
| 2019 | 1 | The Hospital & Healthsystem Association Of Pennsylvania | 2 |
| 2019 | 1 | National Retail Federation | 2 |
| 2019 | 1 | SCL Health System | 2 |
| 2019 | 1 | Texas Hospital Association | 1 |
| 2019 | 1 | National Small Business Association | 1 |
| 2019 | 1 | School Employees Retirement System of Ohio | 1 |
| 2019 | 1 | Social Security Works | 1 |
| 2019 | 1 | Horizon Blue Cross Blue Shield of New Jersey | 1 |
| 2019 | 1 | Tenet Healthcare Corporation | 1 |
| 2019 | 1 | UAW Retiree Medical Benefits Trust | 1 |
| 2019 | 1 | Utility Workers Union of America | 1 |
| 2019 | 1 | Accenture Federal Services LLC | 1 |
| 2019 | 1 | American Chiropractic Association | 1 |
| 2019 | 1 | Amgen USA Inc. | 1 |
| 2019 | 1 | 60 Plus Association | 1 |
| 2019 | 1 | National Nurses United | 1 |
| 2019 | 1 | National Association of Pediatric Nurse Practitioners | 1 |
| 2019 | 1 | National Association of Letter Carriers | 1 |
| 2019 | 1 | Blue Cross and Blue Shield of Florida, Inc. | 1 |
| 2019 | 1 | Blue Cross and Blue Shield of Kansas, Inc. | 1 |
| 2019 | 1 | MVP Health Plan, Inc. | 1 |
| 2019 | 1 | Massachusetts Medical Society | 1 |
| 2019 | 1 | California Hospital Association | 1 |
| 2019 | 1 | International Longshore & Warehouse Union | 1 |
| 2019 | 1 | Independence Blue Cross, LLC | 1 |
| 2019 | 1 | Virginia Hospital & Healthcare Association | 1 |
| 2019 | 1 | National Right to Life Committee | 1 |
[1] Mary Ellen McIntire, How ‘Medicare for All’ went from pipe dream to mainstream, Roll Call (March 26, 2019), http://bit.ly/2Zyz5yr.
[2] S.1129 – Medicare for All Act of 2019 (introduced April 10, 2019), http://bit.ly/31Q71IL.
[3] State Single Payer Legislation, Healthcare-Now! (viewed on June 21, 2019), http://bit.ly/2IXISYd.
[4] Nicole Gaudiano and Maureen Groppe, Democrats back Medicare for all in about half of House races they’re contesting, USA Today (Oct. 23, 2018), http://bit.ly/2XwHCEC.
[5] Karl Evers-Hillstrom, Big Pharma, insurers, hospitals team up to kill Medicare for All, Open Secrets News (March 7, 2019), http://bit.ly/2KyzptE.
[6] U.S. Chamber Letter to the Senate Opposing Medicare for All and Medicare Buy-In Proposals, U.S. Chamber of Commerce (March 18, 2019), https://uscham.com/2FpxxPB.
[7] Bruce Japsen, AMA: Build On The ACA Rather Than Pursue Medicare For All, Forbes (June 11, 2019), http://bit.ly/2IwqZRt.
[8] Thomas Neuburger, Medicare For All—The Democratic Party Audition for 2020, Common Dreams (Jan. 22, 2019), http://bit.ly/31JGBIF.
[9] AHIP Submits Statement for House Hearing on Single-Payer Health Care, AHIP (May 22, 2019), http://bit.ly/2Y5mWkf.
[10] Chip Kahn, FAH Leader Reacts to CBO Report on Single-Payer, Federation of American Hospitals (May 1, 2019), http://bit.ly/2KuwYYZ.
[11] Stephanie Goldberg, Why Blue Cross sees red in Medicare expansion push, Crain’s Chicago Business (March 1, 2019), http://bit.ly/2Kst9Ud.
[12] Competing to Win: Health Care in Focus, National Association of Manufacturers (May 2019), http://bit.ly/31KmDxw.
[13] Bruce Japsen, ANA Nurses Not Ready To Follow Union On Medicare For All, Forbes (March 10, 2019), http://bit.ly/2XbtyBq.
[14] Shefali Luthra, Once Its Greatest Foes, Some Doctors Are Now Embracing Single-Payer, Kaiser Health News (Aug. 7, 2018), http://bit.ly/2MZZofy.
[15] Craig Sandler, New Year, New Congress—Same Old Chamber, Chamber Watch (January 10, 2019), http://bit.ly/2IHb18g.
[16] Political Spending, Chamber Watch (viewed on June 21, 2019), http://bit.ly/2Y7FIaS.
[17] The Koch Government: How the Koch Brothers Agenda Has Infiltrated the Trump Administration, Public Citizen (Nov. 30, 2019), http://bit.ly/2ZDPGAR.
[18] Adam Cancryn, Establishment looks to crush liberals on Medicare for All, Politico (Dec. 10, 2018), https://politi.co/2L7RVsq.
[19] Dan Diamond, Conservatives launch anti-‘Medicare for All’ coalition, Politico (June 6, 2019), https://politi.co/2ZGTtO1.
[20] A Maze of Money, Open Secrets (viewed on June 21, 2019), http://bit.ly/2ZDPP7n.
[21] American Conservative Union, SourceWatch (viewed on June 21, 2019), http://bit.ly/2RsIF33.
[22] Citizens Against Government Waste, SourceWatch (viewed on June 21, 2019), http://bit.ly/2RtiqJI.
[23] National Taxpayers Union, SourceWatch (viewed on June 21, 2019), http://bit.ly/2RtitFo .
[24] Alex Pappas, Conservative groups form coalition to ‘aggressively’ oppose socialized medicine in US, Fox News (June 7, 2019), https://fxn.ws/2ZArejW.
[25] Eagan Kemp, The Case for Medicare for All, Public Citizen (Feb. 4, 2019), http://bit.ly/2NcxXPA.
[26] Robert Maguire, Rove’s ‘new’ group isn’t new, and that could be the point, OpenSecrets News (May 26, 2015), http://bit.ly/2N29T1O.
[27] One Nation, SourceWatch (viewed on June 21, 2019), http://bit.ly/2WW3vJd.
[28] One Nation Launches With Ad Blitz Promoting Congressional Consensus on Medicare, One Nation (May 12, 2019), http://bit.ly/2IYnSk1.
[29] One Nation advertisement, Politico (May 2015), http://bit.ly/2KwMEuW.
[30] Alex Roarty, GOP group launches ad blitz attacking single-payer health care ahead of first Democratic debates, McClatchy (June 20, 2019), http://bit.ly/2WXgTgn.
[31] Our Mission, Partnership for America’s Health Care Future (viewed on June 21, 2019), http://bit.ly/2RpicDq.
[32] Robert Pear, Health Care and Insurance Industries Mobilize to Kill ‘Medicare for All,’ The New York Times (Feb. 23, 2019), nyti.ms/2ZMTfVG.
[33] Forbes-Tate registration to lobby on behalf of Partnership for America’s Health Care Future, filed with the secretary of the Senate (effective date April 1, 2019), http://bit.ly/2IXR7DO.
[34] Bernie Sanders, Medicare For All’s Moment Is Here. Don’t Back Down, BuzzFeed (May 2, 2019), http://bit.ly/2J15LtE.
[35] Sam Baker, Top health care CEOs made $1.7 billion last year, Axios (July 26, 2018), http://bit.ly/2KvrAVH.
[36] Highest-Paid Pharmaceutical CEOs, The Wall Street Journal (June 21, 2019), http://bit.ly/31RzLBd.
[37] Carl M. Cannon, Poll: ‘Medicare for All’ Support Is High – But ComplicatedReal Clear Politics (May 15, 2019), https://bit.ly/2JlEt44.
[38] Stephanie Armour, American Voters Have a Simple Health-Care Message for 2020: Just Fix It! The Wall Street Journal (June 2, 2019), https://on.wsj.com/2WYvJbk.