Revive the Call for Medicare for All

For more than a decade, Republicans have waged a propaganda war against the Affordable Care Act. From the earliest debates around the law in 2009, Republicans have falsely portrayed the legislation as a “government takeover” that would open the door to a dystopian tyranny replete with sinister bureaucratic “death panels” deciding who would live and who would die. The truth, of course, ran very much in the other direction. The liberal reform kept private insurance at the center of U.S. health care, and was modeled on Republican proposals developed as “market-based” alternatives to a single-payer system. 

But if the earliest GOP efforts succeeded in scaring Americans with socialist bogeymen made from straw, a decade later it is clear that red-baiting has failed to turn the broader public against the law. Now that Americans have experienced some of its benefits, nearly seven in 10 Americans view Obamacare favorably, up from four in 10 back in 2015. Belief in the infamous “death panels,” meanwhile, has dropped sharply, from roughly 40% to fewer than 10%. 

Despite this sea change in public opinion, Republicans have revived their efforts to repeal the law amid the current dispute over the ACA tax credits that are set to expire at the end of the year. 

But this time Republicans have adopted a different line of attack. Instead of shouting about “death panels” and “tyranny,” they have redirected their attacks toward what President Donald Trump recently described on social media as the “money-sucking Insurance Companies.” This move reflects a strategy of casting the ACA as a corporatist giveaway that serves insurers more than patients. Trump has led the way in these efforts, using the issue of ACA tax credits to posture as a champion of the people who will take (in all caps) “the ‘fat cat’ insurance companies out of the corrupt system of health care” and redirect the premium subsidies “directly to the people.” 

Republicans in Congress have wasted little time adopting their own faux populism in opposition to the enhanced ACA tax credits, which enjoy nearly 80% support from Americans and a majority of self-identified Republicans. 

“We must stop taxpayer money from going to insurance companies and instead give it directly to Americans in HSA-style accounts and let them buy the health care they want,” declared Sen. Rick Scott, R-Fla., who promised that this would “increase competition & drive down costs.” On the Senate floor, Lindsey Graham, R-S.C., echoed this proposal while doubling down on Trump’s rant against insurance companies. With oversized graphs displaying record profits and exorbitant compensation packages for insurance executives, Graham denounced big insurers like UnitedHealthcare for “making out literally like bandits under Obamacare.” “It’s never been affordable [and] the only people winning from this are health care insurance companies and CEOs.” 

Republican proposals, while vague, largely center on the idea of redirecting subsidies to tax-advantaged health savings accounts (HSAs) that are mostly used by healthy upper-income individuals with high-deductible plans. It is unclear whether Graham and his Republican colleagues want individuals to go uninsured and rely on HSA savings for health emergencies (hence bypassing “Democrat-supported insurance companies”) or to simply downgrade to cheaper plans with higher deductibles and out-of-pocket costs. Either way, the Republican “plan” would lead to an explosion of uninsured and underinsured people and primarily benefit the healthy and affluent over the sick and poor, effectively restoring the system that existed before the Affordable Care Act. 

Fifteen years after the passage of Obamacare, Republicans are still incapable of presenting a feasible alternative to fixing America’s broken health care system. Yet it would be a mistake for Democrats to dismiss the new Republican critique out of hand. It is, after all,  demonstrably true that insurance companies have done very well under the ACA. As an analysis from The Lever showed last year, America’s biggest health insurers have earned more than $371 billion in profits since the law was passed in 2010, with more than 40% of these profits going to UnitedHealth Group, which saw its annual profit soar by 400% thanks in part to its high denial rates. 

It is also true that the ACA has largely failed to bring down costs. While there is evidence that Obamacare slowed the rate at which costs have increased, spending on health care has continued to spiral out of control. In some ways, subsidies have masked the rising costs that have helped to fatten the margins of insurance companies and other corporations. If the tax credits expire at the end of December, these costs will quickly become apparent to millions of enrollees who can expect to see their premiums double, triple or even quadruple. (As enrollment for 2026 gets underway, many have already been hit with shocking sticker prices to keep their current plans, with monthly premiums rising by 114% on average).

These rising costs will hit at a time when health care is among the leading drivers of the nation’s deepening affordability crisis. Indeed, almost all Americans can expect to face steep hikes in health care costs next year, with the average price for employer health plans expected to rise by 6.5% per employee in 2026 — the highest spike in 15 years — which most employers plan to pass on to their workers in the form of higher deductibles and out-of-pocket costs. 

The primary critique of the ACA from the left is that it does little to curb the profits (or power) of the insurance companies, and in fact, bolsters them. While conservatives spent the first decade after its passage decrying Obamacare as socialist, progressives and leftists have long complained that it was not socialist enough. While progressives can acknowledge that the ACA has done good — reducing the number of uninsured Americans, protecting those with preexisting conditions and introducing other incremental changes — there is no denying that it did little to check the pernicious influence of the major insurers and the other giant corporations that dominate our health care system. The only remotely “socialist” idea in the initial plan — a “public option”—  was quickly scrapped by Democrats in response to GOP accusations of a “government takeover.” Had it been included, a public option would have almost certainly helped to reduce premiums and costs more than the ACA ultimately has. 

Unlike Republicans, critics on the left have always presented a clear and viable alternative: Medicare for All. A single-payer health care system would dramatically reduce costs and prevent anyone from going bankrupt because they get sick. It would also, to borrow the words of Trump, “[take] the ‘fat cat’ insurance companies out of the corrupt system of health care.” 

With Republicans spotlighting the greed, corruption and inefficiency of U.S. health care, progressive Democrats have an opening to take Medicare for All off the back burner and renew the push for a comprehensive overhaul. The fact that Republicans are calling out insurance companies for their profiteering shows how much the national mood has changed since the passage of the ACA. With Republicans unable to offer anything but a return to an intolerable status quo ante, Democrats should make the case for moving beyond the broken status quo. 

As health care costs continue to spiral and insurance companies book record profits, anger with the health care system will only grow. So too will the common-sense appeal of Medicare for All or comparable plans that polls show a majority of Americans already support. The U.S. spends nearly twice as much on health care per person as its developed peers, yet ranks well behind them in long-term health outcomes. The glaring difference is that almost all of these countries have what Republicans would describe as socialized medicine. Unsurprisingly, studies consistently show that introducing a single-payer system in America would reduce overall costs and make health care affordable again, in part by eliminating the administrative waste and profits that currently go to shareholders. 

The standoff in Washington over Obamacare presents an opportunity. If the enhanced ACA subsidies expire in January, Republican leaders will attempt to dodge the blame by claiming to be standing up to insurers. But the real losers will know who they are: the millions of working-class Americans forced to choose between their health insurance and other essential expenses. The immediate cause of this crisis will be the Republicans’ refusal to extend subsidies, but the root cause will lie in America’s broken health care system. A decade and a half after Obama signed the ACA into law, the case for a major overhaul has never been clearer or more compelling.