by Sandy Eaton, RN, Dialogue & Initiative, August 2018
This year is pivotal for shifting the balance of forces in the United States away from the proponents of austerity, racism, war and fascism. People are coming together not only to resist Trump and the Republicans but to fight for economic and social survival. Health care in the U.S. is a raging cauldron of struggle to win justice as millions campaign for access, affordability, quality and equality. Single-payer financing is increasingly recognized as essential for a just healthcare system.
The drive toward “Building a Pathway to Victory” has begun and was the focus of this year’s national single-payer strategy conference. The Minnesota Nurses Association hosted this historic meeting in Minneapolis June 22–24. Initially funded by National Nurses United, this campaign seeks to make healthcare justice, including the enactment of expanded and improved Medicare for all, an essential ingredient in the 2018 and 2020 elections. Support for improved Medicare for all has already shown itself to be a winner in Democratic Party primaries across the country, North and South. Organizers have been hired to work in key presidential primary states. Regional meetings to launch this campaign have so far drawn hundreds more activists into the fray.
Single-payer universal health care was beyond the range of acceptable political discourse within the two-party system until the Bernie Sanders campaign of 2016, which offered a social-democratic platform in defiance of neoliberal marketplace dogma. Ironically, Donald Trump, supposedly the contrarian, has been pushing a domestic neoliberal agenda with all the stops pulled out. Finance capital is extending its tentacles ever further into what passes as the U.S. healthcare system. Make no mistake: we’re making a direct assault on a major funding stream of finance capital. We’re confronting and refuting its neoliberal practitioners and ideologues.
In January 2017, 500 activists assembled at AFSCME District Council 37 in New York City, convened by the Labor Campaign for Single Payer (LCSP) and Healthcare NOW!, the national umbrella of active single-payer organizations. (See the report in the 2017 D&I.) One week before the Trump inauguration, they came together under the theme of “going on offense while playing defense.” That strategy has been unfolding nicely.
Two-and-a-half attempts to “repeal and replace” the ACA failed due to Republican Congressional factionalism and massive grassroots opposition. Predictably, death by a thousand cuts was the alternative approach: cutting insurance-company subsidies, which a federal court in California ruled to be legal since states are supposedly filling the funding gap. The annual window for signing up for plans on the exchanges was shortened and outreach funds cut. The 2018 budget began the planned $1.5 trillion cut from Medicare and Medicaid. CHIP was allowed to sunset. The 28,000,000 lacking health insurance (CDC 2015) are being joined now by growing numbers falling through the widening cracks. Gallup reported that 12.3% are now uninsured, with the change greatest among Black and Latinex residents. Four million people are estimated to have lost coverage in the last two years.
The LCSP was founded in Saint Louis in January 2009, a week before Barack Obama’s first inauguration. Its first goal was putting the AFL-CIO back on track with the social insurance model of health care, something lost with McCarthyism, the Cold War and the development of Taft-Hartley and other union-sponsored health plans. Seventy unions submitted single-payer resolutions to the Pittsburgh AFL-CIO convention that September, and that effort proved successful. The Los Angeles AFL-CIO convention of 2013 continued that support, avoiding a blanket condemnation of the ACA that some demanded.
On October 24, 2017, the AFL-CIO passed Resolution 6, Making Health Care a Right. The Labor Campaign for Single Payer had a short window between assessing the final draft of Sanders’ Senate single-payer bill and the deadline for submitting convention resolutions. Nevertheless, the draft resolution was submitted by eighteen union bodies. Although the resultant resolution lacked the specific injunction to work for the Senate or House single-payer bill, it did call for active struggle for Medicare-for-all enactment. Both HR.676 and the Sanders bill, S.1804, are there for such active support, while defending a role for union health plans and maintaining the fightback.
With ever-growing inequality, communities with disproportionate numbers of well-heeled privately-insured people are far less likely to lose necessary facilities and services. Where the dollar value of individuals is least, insured with public programs with lower reimbursements, working-class communities, particularly communities of color, are far more likely to experience medical redlining, losing community hospitals, community health centers and such family-centered services as maternity, pediatrics and mental health. Single-payer financing will not automatically end this disparity between the haves and the have-nots, but it will provide a matrix wherein the struggle for equality will be strengthened. The struggle against racism and elitism will still need to be central.
The Maine People’s Alliance and allies won a ballot question last Fall to force Medicaid expansion, which Tea Party Governor Paul LePage is fighting tooth and nail. Movements in other states are working to win the ACA’s Medicaid expansion through the ballot box as well. Healthcare expansion is becoming an explosive election issue as November approaches. Virginia is enacting the expansion, but with the cruel work requirement attached.
Early drafts of Bernie Sanders’s Senate Medicare for All bill included co-pays and other undesirable features. His staff was pressured not to include any concessions to neoliberal influence and the resultant bill complied. Senator Bernie Sanders introduced the Medicare-for-All Act of 2017, S.1804, on September 13, 2017 with sixteen cosponsors, including likely presidential candidates. John Conyers’ HR.676, the Expanded & Improved Medicare for All Act, now has 122 cosponsors. Minnesota Representative Keith Ellison, former co-chair of the Congressional Progressive Caucus, has taken over lead sponsorship of the House Medicare for All Act after John Conyers’s resignation. A single-payer caucus will be reemerging in the House following the expected shift in November.
Representative Pramila Jayapal of Washington is also preparing to introduce the “State Based Universal Healthcare Act” based on a version introduced by now-retired Representative Jim McDermott in 2016. The bill would make it easier for states to implement a single-payer-style state health plan by explicitly authorizing ACA Section 1332 waivers and adding an ERISA waiver, while allowing states to consolidate all federal funding streams from Medicare, Medicaid, CHIP, TriCare and the federal employee health benefits fund into a single stream, provided that the state establishes a universal healthcare system that covers everyone at levels higher than the current levels mandated by the various federal programs. Unlike the earlier McDermott version, this plan would avoid “race to the bottom” problems by making these waivers only available for universal healthcare programs.
Some Corporate Democrats have proposed a Medicare X, a variation of the so-called public option, the DP equivalent of Republicans’ high-risk pool. On April 18, Democratic Senators Jeff Merkley of Oregon and Chris Murphy of Connecticut introduced the Choose Medicare Act. The bill closely follows the recommendations made by Jacob Hacker and the Center for American Progress (CAP). Both Hacker and the CAP were leading advocates of the public option during the debates that led to the passage of the Affordable Care Act in 2010. Senator Diane Feinstein of California is now running for reelection on a pledge to support lowering the age of Medicare eligibility to fifty five. These efforts, including an offer to allow Medicare to negotiate drug prices with the drug cartel (something prohibited both under the Bush Medicare Part D and the Obama ACA), would look like steps forward if it weren’t for the fact that it’s single-payer universal health care that’s the growing demand and rallying point of the opposition to the current marketplace madness and wave of cutbacks.
In addition to vastly heightened activity on the national scene, state health-reform movements are burgeoning. Encouraged by the provision of the Affordable Care Act that permitted states to experiment with expanded coverage starting in 2017, Vermont enacted a path to Green Mountain Care, signed into law by Democratic Governor Peter Shumlin, who had run for election in 2010 as the single-payer champion and reelected in November 2014, only to pull the rug out from under this initiative that December, thoroughly infuriating the activists of the Vermont Workers Center and the members of the union coalition committed to healthcare justice, those who had built a vibrant grassroots single-payer movement starting in 2008.
In Colorado, a state senator and physician grew frustrated with the inability to get progressive healthcare reforms through the legislature, initiated a binding ballot question to get it enacted. Although both the Right and the Left used the short-hand term “single payer” to describe its content, the retention of some copays weakened its appeal. The building trades unions actively opposed it, arguing that its benefits would be less than those currently offered its members through their multi-employer plans. Without the backing of the Colorado AFL-CIO and the Democratic Party, it went down in flames in November 2016.
Activists in Washington are now pursuing a statewide single-payer ballot question. Without a strong enough organizational and funding base, many fear it will go the way of similar prior ballot attempts in California and Colorado.
Rightly or wrongly, such losses are used by defenders of the status quo to try to blunt independent initiatives. Wonks and politicians opposed to single payer have been making the rounds.
The New York Health Act (A4738/S4840) passed the Assembly in 2015, 2016 and 2017. Support in the Senate is back to thirty-one cosponsors, with thirty two votes needed to pass. Unfortunately, Republican leadership in the Senate refuses to bring the bill to a vote and advance it to Governor Andrew Cuomo’s desk. Even though Cuomo now claims to support single payer, allies in the Senate may spare him the pain of actually having to enact it or the embarrassment of vetoing it.
In California, the single-payer bill SB.562 passed the Senate but was taken off the table by Assembly Speaker Anthony Rendon, who claimed it was unfinished. The Campaign for a Healthy California argues that the missing pieces were to be added while it was going through the appropriate Assembly committees. The fight-back has been intense, with canvassing and confrontation ongoing. Two of the Democratic Party’s four gubernatorial candidates this year support single payer, including the leading candidate, Lieutenant Governor Gavin Newsom. Observers feel that Governor Jerry Brown, like New York Governor Cuomo, does not want a single-payer bill to cross his desk.
Health care is now 17.8% of the GDP. Healthcare workers are largely women and people of color, and have become a major force fighting for healthcare justice. So now we have PDA, DSA, Our Revolution, the AFL-CIO, and such independent unions as NEA, SEIU, UE and ILWU on record in support, many seeing single payer universal health care as a top-tier priority. CCDS has joined this list. Unleashing the rank-and-file and grassroots activists is essential to realize the potential promised by all the resolutions that have been passed. The “Building a Pathway to Victory” campaign offers the hope of our doing just that!
Addendum: This report was submitted for publication in June 2018. So fast have events been moving that some specifics discussed here are already outdated.