The Path to Winning a Floor Vote for Medicare for All in Congress

Hundreds of activists stage a demonstration for Medicare for All at the Trump International Hotel and Tower in New York on Jan. 15, 2017.

While Medicare for All organizers mobilize for the imminent introduction of Medicare for All bills in the House and Senate, pushing to win a record number of co-sponsors, #ForceTheVote, a proposed tactic to force a floor vote in Congress on the health care plan, still dominates the Medicare for All organizing discussion online.

#ForceTheVote originated last December when a group of online activists suggested that progressive members of Congress withhold their votes for Nancy Pelosi’s reelection as speaker of the House until she agreed to put the Medicare for All bill on the floor for a vote. Pelosi was reelected to the position in January, but the debate didn’t stop there.

As an organizer, I think it’s important to look for and meet on common ground with progressive allies and not descend into an online debate club. But because #ForceTheVote, which was conceived primarily on Twitter and does not have the support of a single organization or union fighting for Medicare for All, has captured so much attention on the left, unpacking some of its problems is a great way to illustrate what kind of organizing will get us closer to passing Medicare for All — and, hopefully, will bring us closer to a shared theory of change.

At the heart of the argument to #ForceTheVote is the belief that a ceremonial vote on Medicare for All, even one that would not pass, would be useful in pressuring members of Congress who vote “no” on one of the most broadly supported policies in the nation. Advocates of #ForceTheVote maintain that this will provide considerable pressure over and above the House co-sponsor list, a public document that already tells you who is and isn’t on the bill.

Fundamentally, we disagree not on whether to hold electeds accountable, but how. The co-sponsor list actually holds plenty of power; it’s just not being used. I bring two case studies.

The first is a pressure tactic that was not ultimately effective on its own. Rep. Stephen Lynch, D-Mass., represents a solidly Democratic district; he was reelected with over 80 percent of the vote in 2020. Healthcare-NOW, the organization I work for, and the Boston chapter of the Democratic Socialists of America bird-dogged him on Medicare for All at a 2018 town hall and caught a great moment on video. When pressed on why he won’t support the bill, he said, “Your current insurance will go away” — to wild applause. The clip was retweeted by People for Bernie and other popular accounts and got almost 15,000 views on Twitter, broadcasting Lynch’s defiance on Medicare for All and his right-wing talking points.

“If you have insurance from your employer, that goes away.”

*Crowds erupts into cheers* #LynchTownHall pic.twitter.com/ZttMCyYoqX

— Boston DSA Healthcare Working Group (@BDSAHealthcare) August 22, 2019

Did Lynch support the bill after being “exposed”? Absolutely not. And if forced, he will vote against it with few repercussions. This is despite the fact that his constituents, and Democrats at large, are overwhelmingly Medicare for All supporters.

Here’s an open secret about our political process that explains how this can be: Legislators don’t care if their constituents “support” X or Y policy. They start to care if they know that you have the capacity to hold them accountable and that you intend to carry out a public pressure campaign in response. Of course, the power of constituents also competes with the pressure House members receive from the health care industry.

Lynch’s constituents might support Medicare for All, but until enough of those constituents have been mobilized into a local pressure campaign, he will happily carry on taking corporate donations from the industry (so far, $427,000 just from insurers over his career) and brazenly disparaging Medicare for All.

Related

What’s the Path Forward for Medicare for All?

A floor vote and the co-sponsor list are both powerful in the same way: latently. To actually wield this power requires persistent and strategic local activism. It’s this undervaluation and dismissal of local accountability that leads to the analysis behind #ForceTheVote: the notion that we just need to pull harder on the same lever of power that we already have through the national co-sponsor list. The adoption of this faulty analysis — without significant consultation of organizing groups already working on this issue — has not only led to the popularization of an ineffective tactic, but also has deepened existing misconceptions about our path to victory.

Here’s an example of that co-sponsor list in action: For almost all of the years that Joe Kennedy represented Massachusetts’ 4th Congressional District, he was not a co-sponsor of the Medicare for All bill. But when Healthcare-NOW formed a local in-district coalition that brought this to the public — a very specific public, his constituents — he finally started to feel the heat. Late in the campaign, activists spent an entire month canvassing outside supermarkets in his district, informing them that Kennedy was not a co-sponsor of the bill and asking them to call his office. When we finally got the in-person meeting that led to his co-sponsorship, he shared his distress over these calls, the vast majority of which came from his district. The power of his absence on that co-sponsorship list laid dormant until activists picked it up and used it against him.

House Speaker Nancy Pelosi and other Democratic lawmakers speak outside the White House in Washington, D.C., on Feb. 5, 2021.

#ForceTheVote lit a fuse on Twitter for two reasons. First, people are frustrated with corporate Democrats and maybe even more so with our stalled progress at fighting them; after a blitz of new co-sponsors in 2017 and 2018, the collective movement for Medicare for All has made much less progress over the last couple of years.

The unfortunate truth is that the next and last 114 votes we need to hit a majority in the House are going to be significantly harder to gain than the ones we already have, because the lawmakers are in many cases more powerful and closer to leadership and represent districts that don’t have established progressive infrastructure. The next and hardest phase to win Medicare for All will require serious in-district base- and coalition-building and the commitment of organizations to carry through campaigns that may run for months. And most supporters understand that it’s going to take more than “call and email your legislator” action; they just don’t know quite what that action will be.

An actual mass movement doesn’t look like everyone doing the same thing; rather, it means building power in your neighborhood, city, or state.

Which brings me to the second reason #ForceTheVote took off: People are hungry to get involved in Medicare for All organizing. Tagging progressive members of Congress on Twitter and demanding that they pressure Pelosi was an easy action in which everyone could participate. It had the feeling of a mass movement.

But an actual mass movement, counterintuitively, doesn’t look like everyone doing the same thing; rather, it means building power in your neighborhood, city, or state. If you’re building power effectively, it will look very different in Alabama’s 7th Congressional District than in California’s 12th Congressional District. You make a huge difference to the national movement by doing the kind of local-organizing and coalition-building work that creates deep and enduring accountability structures we can draw upon no matter who is in office.

Unfortunately, instead of funneling people into the organizations that are base-building locally, #ForceTheVote became a purity test that distracted from the less-glamorous work of organizing and perhaps even undermined it. Rather than consolidate our efforts, #ForceTheVote spawned a new organization that would do more “radical” Medicare for All work. Frustration that should have been directed at local Democratic parties and all the complicit institutions that uphold our for-profit health care system was instead turned on progressive organizers who didn’t endorse this overnight sensation of a tactic.

The House speaker vote has passed. I understand the desire to skip to Congress-wide endgame tactics; unfortunately, when you’re up against the wealthiest opposition any movement has ever faced, there are no shortcuts. But make no mistake: When we’re close to victory, we’re absolutely going to force the vote.