LANSING, Mich.: After 15 years as an emergency room nurse, Kim Bogan believes the American healthcare system is beyond repair and needs to be rebuilt from the ground up. She says patients arriving at triage are sicker than ever, many cannot pay for prescriptions they receive in the ER, and she sometimes wonders whether patients who died might have survived if she had not been juggling care for five or six others at once.
That conviction led Bogan to spend the past year moving between 12-hour shifts at Sparrow Hospital in Lansing and campaigning for the Democrat who made Medicare for All a centerpiece of his congressional run and is now a senator-elect. Still, Bogan concedes that progressive wins in states such as Texas, Iowa, Maine, and Michigan do not guarantee an easy path for the policy. "Nobody expected that," she said.
Medicare for All generally describes a government health program that would guarantee coverage by replacing most or all private insurance. Skeptics note that even in a massive Democratic wave, the most outspoken champions of the idea typically won by narrower margins than more moderate candidates.
"Whatever else people voted for in this midterm election, anger about inflation, anger about corruption, anger about the Iran war, they by and large didn't vote to have the government take over health insurance," said Jonathan Oberlander, a professor and healthcare reform expert at the University of North Carolina at Chapel Hill.
Supporters of universal coverage nonetheless view the moment as a once-in-a-generation opening, arguing that Americans are buckling under healthcare costs and eager for change. Several states, including Oregon, are already examining what it would take to build single-payer systems. Oberlander said Medicare for All advocates expect the issue to gain major momentum heading into the 2028 Democratic presidential primaries.
Moderate Democrats, however, may see the idea as a threat to hard-won seats in places like Iowa, Kansas, and South Carolina. "If Democrats want to hold those seats, which were very difficult to win, they're probably not interested in passing Medicare for All," Oberlander said. "That's a huge political risk in red-leaning states. So just because Democrats have a majority doesn't mean it's a majority for Medicare for All."
Past proposals would have required millions of people to give up existing coverage, drawing fierce industry opposition, said Michael Cannon, a healthcare economist at the libertarian Cato Institute. "If Medicare for All actually had the price levels that Bernie Sanders and Abdul El-Sayed envision, the industry would tear it to shreds," he said. A recent KFF poll found that while public support for the concept is at its highest in nearly a decade, it weakens when people hear common counterarguments, such as higher taxes or treatment delays.
For Jaime Bardenhagen, a former nurse in rural Leelanau County in northern Michigan who has Parkinson's disease and sialidosis, a rare genetic condition, the issue is personal. After enhanced Affordable Care Act subsidies expired, she and her husband saw their monthly premiums jump from $700 to $1,300, with a $7,500 deductible, and they began postponing medical tests. Her years in nursing left her convinced insurers, not doctors, were calling the shots. "So, absolutely, the government should take it over," she said, adding that her message to Democrats is simple: "Do something."
Cannon argues the opposite, saying greater federal control would leave patients "in even more vulnerable positions" because they would depend on government spending that is not sustainable. "Everyone knows that the industry is going to end up running the show, and that has been the case since they passed Medicare," he said.
Sara Collins, a senior scholar at the Commonwealth Fund, said both parties will face pressure to respond to the affordability crisis, possibly through bipartisan steps such as restoring the expired enhanced ACA subsidies or curbing insurers' use of prior authorizations. The urgency is likely to grow, with ACA premiums projected to rise by double digits next year, employers shifting more costs onto workers, and Medicaid cuts projected to leave 7.5 million more people uninsured by 2034. Oberlander said the results could push Democrats left, whether toward a public option or a version of Medicare for All that acts as guaranteed baseline coverage while letting people keep employer or union plans. His advice: "If the window opens, you better jump right through."
