While Democrats passed the ACA and remain its strongest supporters, not all Democrats and progressive constituents believe the ACA’s approach was the best way to reform the healthcare system. During the 2020 election, Medicare-for-All

(M4A) plans received unprecedented attention. A number of 2020 election polls found support for a national health plan called Medicare for All ranged from 56% to 70%. Nevertheless, the level of support dropped significantly when specific consequences were highlighted. For example, support dropped to 37% if private insurance companies were eliminated or taxes were increased, 32% if it endangered the current Medicare program, and 26% if testing and treatment delays occurred.

Ten different M4A plans were proposed in 2019, making it even more difficult to gauge public opinion accurately. The approaches included a true single-payer system for everyone, a national health plan with an opt-out option, a new public option to compete in the ACA marketplace, a Medicare buy-in option for elderly who did not qualify for the current program, and a Medicaid buy-in option for individuals purchasing insurance through an ACA marketplace. Of course, with all of these options, the details about the cost, financing, eligibility, benefits, changes to current programs, role of the federal government, and role of private insurance varied depending on the proposal.

If the experience of the ACA has made anything clear, it is that finding support for plans that promise comprehensive, affordable coverage is not too difficult, but maintaining that support is much more challenging once details are released and changes to the current system occur. M4A is a part of the national conversation in a way that even its supporters could not have imagined a decade ago. That being said, passing the ACA was a herculean task when the Democrats were mostly aligned. Having the Democrats divided over M4A versus ACA, let alone which M4A plan to support, makes it highly unlikely that an M4A plan will become reality in the near future.