LANSING, Mich. \u2014 Fifteen years working as an emergency room nurse has convinced Kim Bogan that the only way to fix the American healthcare system is to tear it down and start over.<\/p>\n
Her patients arriving for triage are sicker than ever. They can\u2019t afford many of the prescriptions they get in the ER. And sometimes when patients die, she wonders if she could have saved them had she not been caring for five or six other people at once.<\/p>\n
That\u2019s why she spent the past year shuttling between 12-hour shifts at this city\u2019s Sparrow Hospital and campaigning for Abdul El-Sayed, the Democrat who made \u201cMedicare for All\u201d a signature issue in his congressional campaign and is now a senator-elect.<\/p>\n
But she realizes that just because progressive candidates successfully campaigned on some form of the policy in states such as Texas, Iowa, Maine, and Michigan, it doesn\u2019t mean Medicare for All will be an easy sell. \u201cNobody expected that,\u201d Bogan said.<\/p>\n
Medicare for All typically refers to a government health program that would guarantee Americans coverage by replacing most or all private insurance. Critics are already pointing out that, even in a blue wave as massive as the 2026 midterms, the most vocal Medicare for All champions generally won by smaller margins<\/a> than more moderate Democrats.<\/p>\n \u201cWhatever else people voted for in this midterm election \u2014 anger about inflation, anger about corruption, anger about the Iran war \u2014 they by and large didn\u2019t vote to have the government take over health insurance,\u201d said Jonathan Oberlander<\/a>, a professor and healthcare reform expert at the University of North Carolina-Chapel Hill.<\/p>\n Still, supporters of universal healthcare see this moment as a once-in-a-generation opportunity because Americans are buckling under the weight of healthcare costs<\/a> and are hungry for change. Several states, including Oregon<\/a>, are already exploring what it would take to set up single-payer systems.<\/p>\n Kim Bogan, an emergency room nurse in Michigan, spent the past year campaigning for Abdul El-Sayed, because she believes \u201cMedicare for All\u201d is the best way to fix a broken healthcare system. The patients she sees coming into the ER have often put off getting care, even as their conditions deteriorated. (Kate Wells\/KFF Health News)<\/p>\n The affordability crisis \u201cdominated this election, and Medicare for All speaks to that,\u201d Oberlander said. Medicare for All supporters expect the policy agenda will gain major momentum heading into the 2028 Democratic presidential primaries, he said.<\/p>\n But more moderate Democrats may see the idea\u2019s growing popularity as a threat to gains they made in states such as Iowa, Kansas, and South Carolina. \u201cIf Democrats want to hold those seats, which were very difficult to win, they\u2019re probably not interested in passing Medicare for All,\u201d Oberlander said. \u201cThat\u2019s a huge political risk in red-leaning states. So just because Democrats have a majority doesn\u2019t mean it\u2019s a majority for Medicare for All.\u201d<\/p>\n Previous Medicare for All proposals would have required getting millions of people to willingly give up their existing coverage, fueling unprecedented opposition from the healthcare industry, said Michael Cannon<\/a>, a healthcare economist at the libertarian Cato Institute and a Medicare for All opponent.<\/p>\n \u201cIf Medicare for All actually had the price levels that Bernie Sanders and Abdul El-Sayed envision, the industry would tear it to shreds,\u201d he said.<\/p>\n And even as voters say they support Medicare for All<\/a> in greater numbers than in nearly a decade, support falters when they\u2019re presented with common arguments against it \u2014 like it could lead to higher taxes or delays in treatment \u2014 according to a recent KFF poll.<\/p>\n Jaime Bardenhagen said she feels a little guilty about the idea of getting her healthcare coverage from the government. A former nurse in rural Leelanau County in northern Michigan, Bardenhagen has Parkinson\u2019s and sialidosis, a rare genetic disease<\/a> that can cause seizures.<\/p>\n Yet she \u201cfeels bad\u201d about qualifying for disability benefits next year. Such programs were something she \u201cdidn\u2019t believe in\u201d while growing up on a farm, she said. You were supposed to work for what you needed, she said, not rely on government support. \u201cAnd I did work as hard as I could, for as long as I could.\u201d<\/p>\n But like millions of Americans, Bardenhagen and her husband saw their health insurance costs skyrocket this year, after enhanced Affordable Care Act subsidies expired.<\/p>\n Their monthly premiums went from $700 to $1,300, with a deductible of $7,500. They started putting off medical tests her doctor wanted, she said. \u201cWe couldn\u2019t afford that,\u201d she said.<\/p>\n Her husband voted for Donald Trump in 2016, Bardenhagen said. This time, he stayed home. Bardenhagen, a Democrat, also considered sitting out the midterms. \u201cI just don\u2019t trust either party anymore,\u201d she said.<\/p>\n Despite those misgivings, she says she supports Medicare for All. Her years as a nurse left her disillusioned with the current healthcare system, she said.<\/p>\n She felt the insurance companies, not doctors, were calling the shots, determining which prescriptions and procedures patients could receive. Wouldn\u2019t it be fairer, she figured, if \u201cgood people\u201d in government were making those calls? \u201cSo, absolutely, the government should take it over.\u201d<\/p>\n That takeover is Cannon\u2019s worst-case scenario. The libertarian economist said giving the federal government greater control over the healthcare system would only backfire. Patients would be left \u201cin even more vulnerable positions, because they would be relying for their access to healthcare on government spending that is just not sustainable.\u201d<\/p>\n Medicare for All supporters are naive to think the government could negotiate lower drug and healthcare prices by replacing private plans with a public one, he said. \u201cEveryone knows that the industry is going to end up running the show, and that has been the case since they passed Medicare,\u201d Cannon said.<\/p>\n For Bardenhagen, the message she wants Democrats to take from the midterms is simple: \u201cDo something,\u201d the former nurse said.<\/p>\n \u201cWith the election results, both parties are going to be under pressure to come up with solutions to address the current affordability crisis in healthcare,\u201d said Sara Collins<\/a>, a senior scholar at the Commonwealth Fund, a private foundation that supports healthcare research.<\/p>\n That could mean smaller, but still significant, bipartisan deals that might have seemed unthinkable before the midterms: things such as reinstating the enhanced Affordable Care Act subsidies that expired at the end of last year, or other measures with broad support, such as curbing insurance companies\u2019 use of prior authorizations, which requires patients to get insurers\u2019 approval before proceeding with a covered treatment.<\/p>\n \u201cThat\u2019s probably the lowest-hanging fruit for them, I\u2019d think,\u201d said Patricia Votava, a political strategist based in Sullivan\u2019s Island, South Carolina.<\/p>\n The pressure for healthcare reform is likely to grow, too, with Affordable Care Act premiums set to rise by double digits<\/a> again next year; employers passing on more of their growing insurance premium costs to workers; and massive cuts to Medicaid looming<\/a>, which are projected to leave 7.5 million more people uninsured by 2034.<\/p>\n On the whole, the midterm results could push Democrats\u2019 healthcare agenda further left, Oberlander said. Some Democrats could support a public option, a government-backed health plan people could opt into. Others in the party could coalesce around a version of Medicare for All that doesn\u2019t fully replace private insurance but serves as \u201cguaranteed baseline government health insurance,\u201d as El-Sayed described his current plan in the campaign<\/a>.<\/p>\n \u201cIf you like your insurance from your employer or from your union, that can still be there for you,\u201d he said.<\/p>\n Whatever they opt for, Democrats shouldn\u2019t expect voters to be willing to wait patiently for years of gradual change, Oberlander said. \u201cIf the window opens, you better jump right through.\u201d<\/p>\n South Carolina correspondent Lauren Sausser contributed to this report.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" LANSING, Mich. \u2014 Fifteen years working as an emergency room nurse has convinced Kim Bogan that the only way to fix the American healthcare system is to tear it down and start over. Her patients arriving for triage are sicker than ever. They can\u2019t afford many of the prescriptions they get in the ER. 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