Lobbyists either helped draft or made extensive revisions to opinion columns published by three state lawmakers in a way that warned against the dangers of Medicare-for-all and other government involvement in health care, according to emails obtained by The Washington Post.
Montana Democratic state Rep. Kathy Kelker and Democratic State Sen. Jen Gross acknowledged in interviews that editorials they published separately about the single-payer health proposal included language provided by John MacDonald, a lobbyist and consultant in the state who disclosed in private emails that he worked for an unnamed client.
Gross said MacDonald contacted her on behalf of the Partnership for America's Health Care Future, a multimillion-dollar industry group founded in 2018 and funded by hospitals, private insurers, drug companies, and other private health-care firms.
Additionally, an aide to Ohio Republican state Sen. Steve Huffman confirmed in a brief interview that the lawmaker's op-ed criticizing Medicare-for-all was written with the help of Kathleen DeLand, an Ohio-based lobbyist.
None of the lawmakers' columns disclose that they were written with the help of a lobbyist.
The emails show how, even at the state and local levels, lobbyists are trying to bend public opinion away from an idea that has seized much of the debate during the current Democratic presidential primary. Two candidates, Sens. Elizabeth Warren of Massachusetts and Bernie Sanders of Vermont, have proposed a massive redesign of the health-care system that would place all Americans on a single government health insurer.
The documents were provided to The Post by the nonprofit advocacy group Medicare for All Now, which supports the single-payer system. The group obtained the documents through Freedom of Information Act requests.
The revelation comes amid a fierce debate among Democrats nationwide about the best way to address health-care concerns. Health care remains a top issue for many voters, and industry groups and moderate politicians have warned that the ideas pursued by Warren and Sanders could be viewed as too extreme and lead Democrats to lose in the 2020 election. But the ideas are also very popular among many Americans, and the health-care industry has taken notice.
The emails offer a glimpse into the industry mobilization against both single-payer and a "public option," a government-run insurer that would compete with private plans. A change could redirect trillions of dollars in spending, with insurers, hospitals and pharmaceutical companies all directly affected.
The Partnership for America's Health Care Future has spent more than $1 million on television advertisements since August warning against Medicare-for-all and other changes to the health-care system, according to Advertising Analytics, a firm that tracks TV spending. The group has recently expanded its operations to the state level, and has heavily targeted voters in early primary states and battleground states, according to Politico.
Neither of the consultants who helped write the op-eds would confirm or deny whether they had been hired by the Partnership for America's Health Care Future.
MacDonald, asked if he works for the organization, responded over the phone by saying: "Not directly. ... I probably need to talk to some other folks before I provide any details to you and see if I can have somebody call you back." MacDonald said in a subsequent interview that he could not provide additional information about his clients.
DeLand's emails to the Ohio lawmaker's staff include the acronym for the group in the subject line: "PAHCF op-ed - OH - Huffman.docx." DeLand did not return requests for comment about whether she had been hired by the group.
A spokesman for the Partnership for America's Health Care Future declined to confirm or deny whether the group had hired MacDonald or DeLand. In emails to reporters, the partnership linked to op-eds written by these state lawmakers, at one point citing them as evidence that "voices throughout the nation" oppose Medicare-for-all.
"It's no surprise that elected officials on both sides of the aisle, and many other voices throughout the nation, are expressing serious concerns about these one-size-fits-all proposals" such as Medicare-for-all, Lauren Crawford Shaver, the group's executive director, said in a statement.
Single-payer supporters say the lobbyists' role in crafting the op-eds bolsters their argument that their opponents are parroting talking points from industry groups that profit off the current health-care system.
"These secret emails blow open what I saw firsthand and revealed as a health insurance whistleblower: These companies and their lobbyists will stoop to whatever it takes, no matter how grotesque, to deny people the lifesaving coverage they need," said Wendell Potter, a former health insurance executive who is now president of Business for Medicare-for-all. "This is just the latest reason we need to reform this broken system where greedy corporations determine who can get medical treatment in America."
The emails raise troubling ethical implications about the undisclosed involvement of private interests in lawmakers' public statements, said Larry Noble, who served as general counsel for the Campaign Legal Center and the Federal Election Commission.
"It's disturbing," Noble said. "I think there's a certain ethical obligation to be upfront about who wrote the editorial."
The emails appear to show extensive outside involvement in the Montana lawmakers' op-eds. In a Microsoft Word document, MacDonald removed three paragraphs from a draft of Kelker's op-ed that pointed out that the United States "clearly spends significantly more on health care per capita than other developed nations." He also deleted a table from the lawmaker's original draft showing that the U.S. has higher health-care spending per capita than France, Germany, Norway and Switzerland.
The columns were published this summer in the Missoulian, a newspaper published in Missoula, and the Billings Gazette.
"I know most newspapers are going to have trouble formatting the graphic you provided and will likely ask us to hold off on that," MacDonald told Kelker in a June 12 email. "The client had trepidations that it might also come across to the 'less-discerning' reader that because foreign single-payer markets cost patients less, they are superior."
Instead, MacDonald wrote in the draft he sent back to Kelker that "extreme ends of the political spectrum" are offering health-care proposals while "what most Montanans and Americans would prefer lies somewhere in the middle." In his revisions, MacDonald also added a sentence that said, "Calls for a more government-controlled healthcare system are misguided as well."
In an interview, Kelker said it is common for state legislators to publish under their name op-eds that they did not write. "That's pretty normal," she said. "Actually, most of the time, for legislators, at least in Montana, [they] are written by someone else. You know, a helper-person, not necessarily a lobbyist. I normally write all of the text for my op-eds."
She added: "I suppose I'm fairly naive. . . . As a legislator, you learn to sort out who is a good guy, and who is not, in terms of the lobbyists, and [MacDonald] has always been really straight. I don't hang out or do anything with lobbyists much, but I really do trust him."
Gross, who acknowledged writing less than half of her op-eds, said that when she worked at Planned Parenthood, she frequently provided "templates" for young people who needed help drafting statements, adding that this practice occurs elsewhere as well. Gross also said she listened to MacDonald's description of the Partnership for America's Health Care Future and supported the group's message.
"Formally and informally, I have held the role of community/grassroots organizer for more than a decade. Providing letter-to-the-editor op-ed drafts/templates is a common practice in organizing work," Gross said in a text message.
Gross also pointed to low pay for Montana lawmakers and noted that they do not have staff members.
She added: "If I could do it over again, I would have spent more time on it and put it in my own words. But I was up against time constraints. ... If the angle is that a consultant wrote half of the op-ed that I had published in the Billings Gazette in July, so be it. I'm not embarrassed by that at all."
An aide to Ohio Sen. Huffman confirmed that their office worked with the consultant on Huffman's op-ed criticizing Medicare-for-all as "socialized medicine" and "not a workable solution." Asked whether that consultant had been hired by the Partnership for America's Health Care Future, the aide responded, "I believe so." Huffman's office declined additional requests for comment.
John Fortney, a spokesman for the Ohio Senate Majority Caucus, later said in a statement: "The legislative process is open to input from everyone, including experts from [the] medical community. Senator Huffman is an emergency room doctor and understands the serious problems and affordability of the left's misguided single payer agenda."
Both Kelker and Gross said they received criticism from constituents about the views expressed in their op-eds. The day after Kelker’s op-ed ran, however, she wrote MacDonald an email that said: “At church, I received many favorable comments -- mostly from Republicans!”