How Did Medicare for All Candidates Fare in the Midterms?

This year, a majority of House Democratic candidates endorsed Medicare for All, according to the union National Nurses United. If you had told me in 2014, or even 2016, that this would happen, I would have frowned at you, walked away, and possibly tried to contact someone who cares about you out of concern for your mental health. This was pretty damn huge.

There are plenty of caveats to that astounding figure. Saying you’ll support Medicare for All is a different thing than actually doing so at a time when Democrats control Congress and could feasibly pursue that policy agenda. Some of these candidates might end up supporting less-than-radical alternatives like Medicare Extra when push comes to shove. And a lot of these candidates were running in safe seats. But there are still lessons to be drawn from how these candidates fared in 2018 and which Democrats are still absent from the list.

For this analysis, we took the National Nurses United’s list of House candidates who said they support Medicare for All, a list the union said is comprised of candidates who “explicitly support Medicare for all, as based on their responses to NNU candidate questionnaires, website issue postings, news reporting, or if an incumbent whether they are a current co-sponsor of HR 676, the House Medicare for All bill.” Using numbers from Ballotpedia and The New York Times, we looked at whether the candidate won or lost on Election Day, but also at what percentage of the vote they received, and how that share of the vote compared with the Democratic candidate running for the office in 2016. We also used the Cook Political Report’s list of battleground states to look at what happened in the races that actually had some potential to change hands.

One note: There are still a couple of races that might still change—Gina Ortiz-Jones in Texas hasn’t conceded, and California still has millions of ballots to count, somehow; since I started this story, Democrat Josh Harder (CA-10) has overtaken Jeff Denham, and Katie Porter (CA-45) still has a shot at beating Republican Mimi Walters. We also excluded Pennsylvania candidates when looking at vote share changes over 2016 because the state redrew its districts this year, so it wouldn’t be a fair comparison.

Overall, 57 percent of candidates who endorsed Medicare for All won their races. The vast majority of candidates who supported Medicare for All were running in safe seats, which makes sense, because the majority of seats in the House of Representatives are safe seats. You might expect a candidate like Democratic Rep. Nita Lowey, NY-17, who got 87.7 percent of the vote this year and ran unopposed in 2016, to endorse Medicare for All. But plenty of candidates running in deep red districts endorsed it, too. Kathy Ellis, a social worker, ran against Rep. Jason Ellis in Missouri’s Eighth District, where she received 25 percent of the vote. She supported Medicare for All. If you’re running against a guy who routinely gets 75 percent of the vote, why not come out strong for a humane healthcare policy?

A rising blue tide would lift all boats, but Medicare for All didn’t stop the wave from reaching those districts.

That makes that top-line figure—the 57 percent of Democrats who endorsed Medicare for All winning their races—a little less useful. It’s not particularly instructive for Democrats to heavily invest in districts where they routinely get crushed; “It might hurt us in districts where Col. Racist Gout-haver wins with 78 percent of the vote every year” really shouldn’t be a genuine concern for Democrats when it comes to weighing whether to back Medicare for All.

But even those candidates who backed single-payer in deep red districts did better at the polls this year than in 2016. Only five races out of 45 where Democrats who supported Medicare for All got less than 40 percent of the vote—safe Republican seats, in other words—saw a lower percentage of votes for the Democrat than in 2016. In Idaho’s Second District, the Democrat got 39.4 percent this year as opposed to 29.4 percent in 2016. Their vote totals went up by an average of 3.3 percent, or 7.4 percent if you include candidates who ran in districts where there was’t even a Democratic candidate in 2016. That doesn’t mean those districts will necessarily flip blue in 2020, but it does indicate that supporting single-payer didn’t obliterate them. A rising blue tide would lift all boats, but Medicare for All didn’t stop the wave from reaching those districts.

What’s most interesting are those candidates who supported Medicare for All in the closest races—and those who did not. Of the 117 races on Cook’s list of battleground states, only 33 involved a candidate who endorsed Medicare for All. Only seven candidates in the 30 races Cook labeled as toss-ups endorsed Medicare for All; of those candidates, two won, three lost and two races are still undecided, but only one reduced the vote share over 2016. Harley Rouda, who supports Medicare for All, increased the Democratic share of the vote by 10 percent to beat Dana Rohrabacher, per current totals. Incredibly, a district that previously looked at Dana Rohrabacher and said yes, I want him, now wants a guy who supports single-payer instead.

Democrats on the fence should take note of the fact that very few candidates who endorsed single-payer suffered crushing losses.

In those battleground races, just one Democratic candidate who endorsed Medicare for All received a lower percent of the vote than the Democrat did in 2016: That was Joe Radinovich, who was running for Rep. Rick Nolan’s vacated seat in Minnesota’s Eighth. Four Democrats who flipped a seat held by Republicans endorsed Medicare for All: Rouda, Katie Hill, Mike Levin, and Kim Schrier (Schrier is on the National Nurses United list, but her commitment to Medicare for All is questionable). We may yet add Harder and Porter to that list, too. And all single-payer-supporting Democrats who ran in districts deemed to be leaning or likely Republican increased the Democratic vote percentage over 2016 by an average of 6.6 percent, even when they lost. Nate McMurray, who lost in NY-27, got 48.3 percent of the vote; in 2016, the Democratic candidate received only 32.8 percent of the vote. Tedra Cobb, who lost against Republican Rep. Elise Stefanik in NY-21, increased the Democratic share of the vote 11 percent.

It’s interesting, though, that so many Democrats running in close races this year didn’t support Medicare for All, even in districts deemed Lean or Likely Democratic by Cook. Of 12 Likely Democratic races, only three Democrats endorsed Medicare for All. In 16 Lean Democratic races, only two Democrats did. In most of what Cook’s Dave Wasserman describes as “high-income suburban Clinton districts” with Republican representatives, like CO-06 and IL-06, the Democrats won—but didn’t support Medicare for All. (Democratic candidate Sean Casten in IL-06 supports a Medicare buy-in.)

So it seems that, even as Medicare for All becomes a mainstream policy among Democrats, its biggest holdouts remain Democrats in swing districts, where they likely fear the wrath of rich suburban independent voters. It’s impossible to say whether Medicare for All definitively helped or hurt candidates without controlling for all the other factors in the race, which is far beyond my powers of statistical analysis. Democrats did better overall this year; it’s to be expected that most candidates would improve their vote total over 2016. But Democrats on the fence should take note of the fact that very few candidates who endorsed single-payer suffered crushing losses—all but one in close races increased their vote share. It doesn’t seem like there’s much to fear from endorsing single-payer. After all, people love it.