Where do Texas Democrats Stand on Single-Payer Health Care?

Half of the state’s congressional Dems have not signed on to Medicare for All legislation.


U.S. Representatives Joaquin Castro, Beto O’Rourke, Lloyd Doggett (left to right)  United States Congress/Wikimedia Commons

About 4.5 million Texans would get coverage under the single-payer health care legislation that’s gaining traction in Congress. Texas, with the highest uninsured rate in the country nearly twice the national rate has a lot of catching up to do. But many Democrats still see single-payer health care as a risky political move, especially as Republicans continue attempts to dismantle the Affordable Care Act. Only six of the 11 Texas Democrats in Congress have signed on as co-sponsors.

The legislation won’t pass anytime soon. But growing support, in part thanks to Senator Bernie Sanders’ campaign, is a big shift. For Texas Democrats who are on board, single-payer health care is a way to bridge the insurance gap with other states and sidestep Texas Republicans’ decision to decline Medicaid expansion and otherwise limit health care access. But others are more wary.

The current legislation, dubbed “Medicare for All,” is the latest version of universal health care, paid for by the government. Six Texas Democrats are currently co-sponsors of the Medicare for All bill introduced by Michigan Representative John Conyers Jr. in January: Representatives Sheila Jackson Lee, Al Green and Gene Green, all representing Houston; Marc Veasey, of Fort Worth; Vicente Gonzalez, of McAllen; and Filemon Vela, of Brownsville. A majority of House Democrats are signed on to Conyers’ bill, while about a third of Democrats in the Senate support the Sanders proposal.

Five Texas Democrats have not signed on to the Medicare for All legislation. The Observer checked in with each to see where they stand.

Beto O’Rourke (El Paso)

Representative Beto O’Rourke calls Sanders the “absolute champion” of single-payer health care in the U.S., and his presidential campaign “transformational.” “It was the catalyst for the conversation this country has needed to have for a long time,” O’Rourke told the Observer.

The El Paso Democrat is hoping the promise of health care for all could help him win over Ted Cruz’s Senate seat in 2018. O’Rourke supports universal coverage and sees a single-payer approach as the “only clear path” to get there. He’s not signed on to the House bill, even though he likes its goal, because he disagrees with the requirement that providers be public institutions or nonprofits. “If you like the way Medicare works today, I don’t know why you wouldn’t use the same model in what is being called a Medicare for All bill. Instead, Conyer’s bill changes that model fundamentally, takes a big chunk of potential providers out of the mix and starts out with some entrenched opposition,” O’Rourke told the Observer. “I think we can do better.”

O’Rourke likes what he’s read of Sanders’ bill, but disagrees with having no copays for anyone and no premiums for low-income families he’d prefer everyone pay in to some extent. But O’Rourke said something better than the status quo is needed, whether it’s a version of Conyers’ bill, Sanders’ bill or one he’s drafting himself.

Single-payer legislation would also elevate Texas from its perennial status as a state with alarmingly high uninsured rates, he said: “With true universal health care in the U.S., we would have a national standard of care that applies to everyone in every state, and states wouldn’t have the ability to opt out of providing coverage for their residents.”

Lloyd Doggett (Austin)

When Representative Lloyd Doggett was asked about his position on single-payer health care at a Medicaid town hall this summer, the crowd roared with applause at his mention of Medicare for All. It quieted quickly as he continued: “The question is what is the best strategy for right now…”

The longtime Austin progressive said he favors Medicare for All over the Affordable Care Act, but that now is not the time for Democrats to push for the change. The Medicare for All proposal is unrealistic, he said, because efforts to pass a public option or lower the Medicare age of eligibility were unsuccessful several years ago, when Democrats had a stronger footing in Congress. Doggett also said he thinks the measure is risky, since it could divide Democrats’ fragile opposition to the GOP’s ACA repeal efforts.

“It’s not that it’s a bad idea or a bad concept, it’s a better concept,” Doggett said at the town hall. “But there’s the question of how we hold together this very tenuous coalition and keep the focus on what the deficiencies are in their bill, rather than beginning a whole new dialogue about government takeover of health care.”

Joaquin Castro (San Antonio)

“I completely support universal health care coverage and look forward to discussions of how we can achieve that goal, including consideration of Medicare for all, a public option, and other proposals,” Representative Joaquin Castro said in a statement. His office did not respond to multiple inquiries about why he isn’t signed on as a co-sponsor.

Henry Cuellar (Laredo)

“I have been a longtime supporter of innovative public health care initiatives such as the Children’s Health Insurance Program (CHIP) and Obamacare. I think it’s a good thing to bring all ideas to the table when it comes to health care. However, my priority is fixing the problems that we have with our current system before we look at different alternatives,” Representative Henry Cuellar said in a statement. “Obamacare has been proven to work on a state level and I believe that with the right tweaks, it will provide the right combination of coverage, access, and affordability nationally.” A Blue Dog Democrat, Cuellar has pushed for running more conservative Democratic candidates in moderate districts in 2018.

Eddie Bernice Johnson (Dallas)
Representative Eddie Bernice Johnson said she is “studying” the House Medicare for All bill and that “it is past time to explore all options that could improve Medicare and provide its benefits to all Americans.” She said in a statement that the bill “would establish a privately delivered, publicly financed universal health care system in the United States,” but the bill says participating providers must be public institutions or nonprofits. Johnson’s office didn’t respond to a request for further comment from the Observer.

Correction: The original version of this story listed Waco as Representative Eddie Bernice Johnson’s hometown. In fact, it is Dallas. The story has been corrected.

Cat Cardenas contributed to this report.