Democrats push single-payer healthcare at state level

By HPN Staff

Despite their minority status, Congressional Democrats haven’t given up on creating a single-payer healthcare system. But the political realities of the moment have forced a shift in strategy.

Instead of a top-down federal approach, a group of Democratic lawmakers is working with activist groups and legislators outside of Washington, D.C. to achieve their goal on a state-by-state basis.

The State-Based Universal Health Care Act, which has more than 30 co-sponsors in the U.S. House and Senate, would allow individual states to repurpose federal health spending for programs like Medicare and Medicaid towards new single-payer — or government-run — health care systems.

This approach “allows states to pave the way towards a system that is not driven by profit, but by people’s health,” said Democratic U.S. Senator Ed Markey of Massachusetts, one of the authors of the legislation.

Why it matters

The U.S. has a hybrid healthcare system, which mixes publicly financed health coverage — such as Medicare for seniors and Medicaid for low-income individuals — with privately funded insurance coverage.

In 2019, the Committee for a Responsible Federal Budget estimated a national single-payer system would cost roughly $3 trillion per year to implement, the equivalent of imposing a 32% payroll tax or doubling all federal income tax rates.

However, supporters of single-payer health care proposals argue that patients would still save money, because any required tax increases would be less than current spending on private insurance premiums, deductibles, coinsurance and other out-of-pocket expenses.

Within the Democratic coalition, there is significant support for abolishing private health plans and allowing publicly funded programs to take over the entire sector — a proposal known as single-payer or “Medicare for All” by its supporters.

But with the failure to move forward on the federal level, an umbrella organization called One Payer States now is supporting the efforts for a state-run program in Colorado, Washington and 21 other states.

In Colorado, for example, the legislature and governor recently approved a $400,000 study to develop “draft model legislation” by the end of 2026 for a state-based “universal health care system.”

In Washington state, activists are pushing a dual-track strategy, lobbying for single-payer legislation in the State Capitol while also preparing to gather signatures for a ballot measure that would deliver the same outcome. 

The bigger picture

The sheer cost of setting up a new single-payer system — and the tax increases necessary to pay for it — have been a major political hurdle at the state level.

The textbook example also took place in Colorado. In 2016, the “ColoradoCare” single-payer health care ballot measure would have raised taxes by $25 billion per year, and was defeated by a margin of 79% to 21%.

Accessing federal funding could limit the need for state-level tax increases and improve the political viability of future single-payer healthcare proposals.

“Our legislators worry about obtaining the federal dollars needed to provide universal health care through a single-payer [system],” said Kimberley Connors, executive director of Mass-Care, a coalition that campaigns for universal health care in Massachusetts.

Additional context

During his two unsuccessful campaigns for the Democratic presidential nomination in 2016 and 2020, Vermont U.S. Senator Bernie Sanders made single-payer healthcare a central demand of the party’s progressive wing.