Many unions are counting on the possibility that Bernie Sanders’s “Medicare for all” plan would get watered down so that it doesn’t eliminate private insurance, allowing them to keep the role of collectively bargaining for health benefits for members.
That’s not a likely scenario likely under the plan the top Democratic presidential contender is currently touting on the campaign trail, which would gut private insurance in favor of enrolling everyone in a government plan. But unions are banking that Sanders’s current plan won’t be the same as what would eventually emerge from Congress.
“There has never been anything that has gone through Congress without any kind of edits or changes or amendments or compromises,” said an official for the 3 million-member National Education Association. “The details on it depend on what Congress looks like or the environment looks like and a whole bunch of things that are impossible to predict.”
The NEA is one of many unions that have simultaneously said they like the goal of universal coverage under Sander’s plan but want to preserve a role for private health insurance coverage. Bargaining for health coverage is a key advantage that unions provide for their members and a critical enticement they use to recruit and retain members.
Sanders’s “Medicare for all” plan, therefore, presents a particular problem for unions because it would phase out private coverage over four years, preventing unions from bargaining for plans for their workers.
“Providing better health benefits is one of the main things unions claim to try and sell themselves to workers,” said F. Vincent Vernuccio, a labor lawyer and a senior policy fellow at the Mackinac Center, a right-of-center think tank. “For a movement that is already struggling to retain members, they don’t want to lose that.”
Union membership currently stands at 10.3% of the workforce, the lowest level recorded since the Labor Department began tracking the figure in 1983. The rise in popularity of state right-to-work laws and the Supreme Court’s 2018 Janus v. AFSCME decision make it easier for workers to opt out of membership even when their workplace is organized.
Some unions see “Medicare for all” as a serious threat. The Culinary Workers Union in Nevada issued a blistering attack on the Vermont senator prior to the state’s caucuses by stating, in a flier, he would “end culinary healthcare.” The attack was cited by Sanders’s rivals during a Democratic presidential debate in Las Vegas Wednesday.
Other unions have been trying to push Sanders’s plan back toward allowing private coverage since it was introduced. In a letter to Sanders last year, the NEA Director of Government Relations Marc Egan told the senator his plan must include “the ability to obtain benefits above any established floor or limit and preserving the existing tax exclusion.” The NEA source said the senator had responded and addressed their concerns but did not say precisely how.
Sanders’s “Medicare for all” would ban any private insurance that “duplicates” the extensive coverage under the legislation. However, his bill also states, “Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, including additional benefits that an employer may provide to employees or their dependents, or to former employees or their dependents.”
In theory, that condition could cover benefits obtained through collective bargaining, but it is hard to see what extra coverage that could be obtained through this loophole, noted Felix Reichling, a senior economist for Penn Wharton Budget Model who has studied Sanders’s plan. “The Sanders plan is so comprehensive that there is no reason to have additional coverage,” he said.
“Medicare for all” therefore puts union leaders in a bind. They don’t want to be seen as attacking a proposal to provide universal health coverage. Many support the idea. A common labor point is that universal government health coverage can actually help collective bargaining because the unions wouldn’t have to negotiate for basic health coverage themselves and could, therefore, press for other benefits. But they do want to be able to provide members better benefits than they could get otherwise.
“We believe in bargaining good healthcare into our contracts,” said United Autoworkers spokesman Brian Rothenberg. “We also believe universal healthcare is important to keep costs down, and ultimately, those high costs impact us at the bargaining table.” He declined to characterize UAW’s position on “Medicare for all” beyond that.
American Federation of Teachers President Randi Weingarten wrote in a September opinion piece for Politico that it was a “false choice” that “Medicare for all” was in conflict with private coverage. “A broader public plan and employer-sponsored private insurance can coexist while still making universal coverage mandatory if we expand our sense of what’s possible,” Weingarten wrote. She argued that employer-based insurance could be allowed provided that it “met or exceeded the standards set by the Medicare plan.” An AFT spokesperson said the article still reflected Weingarten’s thinking. Sanders rivals Pete Buttigieg and Joe Biden have proposed forms of a “public option,” that is, a government-run insurance plan that would compete with but not necessarily supplant private plans.
Sanders, however, hasn’t indicated that he thinks in those terms. He responded to criticism of his “Medicare for all” during a Democratic debate Wednesday by promising to protect the level of coverage the union workers got but not the actual plans. “Let me be very clear to my good friends in the Culinary Workers Union, a great union. I will never sign a bill that will reduce the healthcare benefits they have. We will only expand it for them, for every union in America, and for the working class of this country,” he said.
The following day, Weingarten said in a tweet that Sanders shares the union’s values and “significant support within our membership.”
