WASHINGTON – Jake Johnson, a Democrat seeking to represent southern Minnesota in Congress, gingerly sidestepped a question at a town hall he hosted about whether he supported “Medicare for All.”
Johnson, a moderate who is trying to unseat Rep. Brad Finstad, R-1st District, said at that event in New Richland that he sympathized with those who are struggling to afford health insurance and pay for medical costs. He said he supported “a strong public option to the health insurers we have now.”
That meant Johnson would support allowing Americans to purchase a healthcare plan offered by the federal government that would compete with private insurers.
But that proposal — aimed at countering the increasing cost of health insurance coverage that is driving up the number of uninsured — has been rejected by Democratic socialists and progressives who have notched impressive victories in primaries this year and made their mark in Minnesota through the DFL endorsement process.
From 2019: At Houston debate, Klobuchar opposes Medicare-for-All plans
They pan the “public option” and other reforms proposed by Johnson and other party centrists as ineffective solutions that would continue to allow insurers and pharmaceuticals to unfairly profit from pain and illness.
So, the debate over healthcare in this election year has caused a fissure in the Democratic Party in Minnesota and across the nation.
Progressive activism has revived an effort to replace the nation’s patchwork of private insurers and government-run health plans like Medicaid and Medicare with one government-run program they are calling Medicare for All.
Sometimes a Democratic candidate’s position on healthcare reform is based, at least in part, on how well the party has done in their district.
The 1st Congressional District Johnson seeks to represent gave President Donald Trump 55% of the vote in 2025.
But in the neighboring 2nd Congressional District, former Vice President Kamala Harris won with 52% of the vote, and, unlike Johnson, the endorsed DFL candidate, Matt Little, is a vigorous proponent of Medicare for All.
Little said he is sensitive to the problems Americans have with the nation’s healthcare system because when his mother was gravely ill, she struggled for a year to have access to a specialist who could cure her.
“And we were lucky to have insurance,” said Little, a former state senator and former mayor of Lakeville.
Little said if he wins the 2nd District seat he would support a new bill, sponsored in the U.S. House by Rep. Pramila Jayapal, D-Wash., and in the U.S. Senate by Sen. Bernie Sanders, I-Vt., that would guarantee comprehensive healthcare to every U.S. resident as a human right, eliminating all premiums, deductibles and copayments.
The legislation would end the leading role of private insurers in providing most of the nation’s healthcare coverage, although they would be allowed to sell supplemental plans.
Proponents say the elimination of out-of-pocket health costs and premiums will offset higher federal income taxes for most working Americans and businesses that would pay for the plan.
It’s not a new idea. Sanders has been promoting Medicare for All for more than a decade and the idea of establishing a national, government-run healthcare system based on Medicare’s model has been around for a few decades. With little effect.
But Little, who like Sanders considers himself a progressive, said the time is ripe politically to once again try to establish a “single payer” system similar to those of other industrialized nations that most Republicans decry as low- quality “socialized” medicine.
“I think we are in a defining moment right now in the country,” he said, citing the Trump administration’s cuts to Medicaid and the GOP Congress’ failure to extend enhanced Affordable Care Act subsidies that helped many Americans, including about 90,000 Minnesotans, purchase health insurance.
He views the public option, the alternative moderates like Johnson are embracing as “just another handout to private insurance companies” and says other reforms under discussion in the Democratic Party are just “nibbling around the edges” of a national problem.
The public option was once going to be a part of the Affordable Care Act that former President Barack Obama breathed into life.
The ACA created state-based “marketplaces,” like MNsure, where those who lack employer-based individual plans can purchase coverage from a health insurer. Those who qualify can receive a subsidy to pay the premium and no one can be denied coverage because of an existing medical condition.
The initial plan was to establish a government-run option to the private insurer offerings on these ACA marketplaces. But heavy lobbying from health insurers and other politically powerful actors in the health field — and opposition by some centrist Democrats — killed the public option.
Minnesota Dems split over Medicare for All
Like Little, state Rep. Kaela Berg is running for the 2nd District congressional seat that is now held by Rep. Angie Craig, who is running for U.S. Senate.
Like Little, Berg is running as a progressive.
But unlike Little, Berg is flexible when it comes to proposed reforms to the nation’s healthcare system.
Berg said she supports the public option “and anything that gives people more health coverage.”
“It’s great to say Medicare for All and energize people,” Berg said. But she said that “we need to have (more) coverage now, whatever that looks like … while we continue to fight for Medicare for All.”
Berg is a flight attendant and union activist. And organized labor is split over Medicare for All, with some unions, including the United Auto Workers and the Association of Flight Attendants, supporting the idea and others strongly opposed because healthcare has been one of organized labor’s most potent bargaining chips.
The third Democrat running for Craig’s seat, state Sen. Matt Klein, is a physician, an internist who works for the Mayo Clinic.
He said he is a “firm believer that we need to get to universal healthcare” and if elected to Congress would “support whatever bill advances that.”
But he stopped short of backing Medicare for All, saying he would prefer the implementation of the public option.
The American Medical Association is firmly opposed to Medicare for All, saying it would limit patient choice and physician autonomy. The American Hospital Association and other powerful medical groups also strongly oppose the idea of a government-run, single payer plan.
Still, more than 100 U.S. House Democrats, including Reps. Ilhan Omar, D-5th District, and Betty McCollum, D-4th District, are co-sponsors of Jayapal’s Medicare for All bill and Sen. Tina Smith has co-sponsored Sanders’. But Rep. Kelly Morrison, D-3rd District, who like Klein is a physician, has not co-sponsored Medicare for All legislation.
A defining issue in U.S. Senate race
The Democrats running for retiring Sen. Tina Smith’s seat — Craig and Lt. Gov. Peggy Flanagan — are also split over how to achieve the goal of universal health coverage.
“This is not working,” Flanagan said of the nation’s healthcare system. “It is broken and I think people are ready (for Medicare for All).”
While noting the healthcare overhaul is impossible unless Democrats hold the White House and both chambers of Congress, Flanagan said defaulting to support of a public option for now with the hopes of working toward Medicare for All would not work.
“You should not start at the bottom because you are going to get even less,” she said.
Craig, meanwhile, last week introduced the Medicare-X Choice Act, which would create a public option in the nation’s Affordable Care Act exchanges.
Craig said the public option would “give the insurance companies some competition,” leading to lower premiums and better coverage for all.
From 2019: ‘Medicare for All’ can mean at least two different things
But proponents of Medicare for All, like Little, say a public option would draw the oldest and sickest Americans, benefiting private insurers who would enroll healthier, younger individuals, subsequently paying out fewer claims and increasing their profits.
Craig also said other reforms, including a bill she introduced that would hold health insurance companies accountable for above-average denial rates and legislation aimed at lowering the cost of prescription drugs, would also give Americans relief from the escalating cost of medical care.
Since Democrats are split over Medicare for All, there’s little chance a single-payer system will be established in the United States anytime soon.
But a Democratic takeover of the U.S. House and/or U.S. Senate could result in a rush of Democratic healthcare legislation and a vigorous debate over how to reverse the increase in uninsured Americans, even as any substantial change would have to wait for a Democratic president.
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