Labor unions have long been a staple of the Democratic party, but the Medicare for All policy embraced by some 2020 candidates could hurt their chances of winning over union members next fall.

The conflict represents a shift in the Democratic party — one that the party will need to consider to retain a cohort that could be persuaded to vote for Donald Trump or stay home on Election Day.

The term Medicare for All is a catch-all for a single-payer healthcare system, in which the government or other public agency provides healthcare for all residents. Everyone is covered under the same plan, though individuals could still choose their own physicians. 

Several of the leading Democratic presidential candidates, including Bernie Sanders, Elizabeth Warren, and Kamala Harris, support some version of Medicare for All, though they differ on how far toward a true single-payer option it should go. 

Others, like Joe Biden and Amy Klobuchar, say the focus should be on improving coverage under the Affordable Care Act, rather than starting over with a single-payer system. This approach appeals more to unions.

“We don’t support the ‘Medicare for all’ structure. We certainly aren’t in support of a government-control, government-run system at the expense of those that currently have employer-provided, or union-negotiated, plans,” Harold Schaitberger, general president of the International Association of Firefighters, told the Washington Examiner. “For members of our union, it would be a significant disincentive.”

Implementing a plan like this would mean drastic shifts in the U.S. health insurance market and lead to a lot of uncertainty in the short-term, which is prompting those who like their current plans to push back against Medicare for All.

One benefit unions offer to workers is their ability to negotiate for high-quality, low-cost healthcare. The prospect of giving up that coverage makes unions reluctant to support a candidate that is in favor of Medicare for All.

While the number of workers in unions has decreased over time, they still remain a reliable part of the Democratic base and one that candidates will need to win in swing states like Ohio, Pennsylvania, and Wisconsin. 

“The members have a comfort level with private insurance, and to eliminate that would be a problem,” said Gary Steinbeck of AFL-CIO in Ohio. “It would definitely create a problem trying to get votes from labor folks.”

One compromise might be a healthcare system that expands the public option while allowing people to keep private insurance if they choose. This position was favorable to more than half of voters, according to a Morning Consult survey. 


Grassroots Pulse covers public policy and political issues aimed at engaging highly-active policy makers, donors, and grassroots leaders at the forefront of the political process in America today.

Image credit: Photo by Piron Guillaume on Unsplash