NNU's Jasmine Ruddy on the Labor History Behind Medicare for All

Jasmine Ruddy, Director of Medicare for All and Community Campaigns for National Nurses United, joined the America's Work Force Union Podcast as part of the Labor 132 series to trace the century-long role of organized labor in the fight for national health insurance in the United States.

From the first push tied to the Social Security Act of 1935 through Harry Truman's 1945 national healthcare proposal, the AFL-CIO's declaration of government health insurance as its top legislative priority in 1957, Walter Reuther's central role in marshaling labor support and the ultimate passage of Medicare and Medicaid in July 1965, Ruddy described labor as a core driver of every major healthcare reform win in American history.

Ruddy also updated listeners on the current status of the Medicare for All campaign. There are two pieces of legislation, introduced concurrently in the House and Senate. More than half of House Democrats have signed on as co-sponsors, and a coalition of over 335 organizations, including major unions, has declared its support.

• The fight for national health insurance in the United States dates to the 1920s and 1930s, when it was first tied to the Social Security Act of 1935 before being stripped out due to fierce opposition from the American Medical Association, which claimed national health insurance would undermine American values. The effort was also tied to fears of communism — themes Ruddy said persist in the opposition's messaging today. A 1950 AMA-backed electoral campaign defeated 80 percent of all pro-national health insurance legislators, illustrating the political cost of the issue before organized labor made it a central priority.
• The AFL-CIO's 1957 declaration that government health insurance was its number one legislative priority was the critical turning point in the effort that eventually produced Medicare and Medicaid in 1965. Walter Reuther, longtime UAW president and AFL-CIO co-founder, was central to marshaling the labor coalition that pushed the legislation across the finish line, including forcefully pushing back against the AMA's propaganda campaign, which enlisted Ronald Reagan to record a speech warning that Medicare would be the end of freedom in the United States.
• The U.S. House Medicare for All bill, H.R.3069, sponsored by U.S. Representatives Pramila Jayapal and Debbie Dingell, currently has more than half of House Democrats as co-sponsors. U.S. Sen. Bernie Sanders introduced the Senate version, S.1506. It has 17 co-sponsors. The NNU-led open letter to Congress has been signed by more than 335 organizations, including NNU, the UAW, UE, IFPTE, APWU, the Association of Flight Attendants-CWA and others. It reflects growing recognition across the labor movement that employer-sponsored insurance is not working for union members and that a universal program is the only durable solution, Ruddy said.

Labor Has Always Been at the Center of Healthcare Reform

Jasmine Ruddy opened her remarks by providing a framework that reorients the way most people think about Medicare's origins. The creation of Medicare and Medicaid in 1965 was not a standalone political achievement. It was the culmination of more than four decades of organized labor fighting for national health insurance in the United States. It was a fight that started and failed multiple times before ultimately succeeding after the AFL-CIO made it its top priority.

The 1930s and 1940s: First Attempts and First Defeats

The push for national health insurance in the United States first gained momentum in the 1920s and 1930s. When the Social Security Act was being drafted in 1935, the original drafts included a form of government health insurance for seniors tied to Social Security benefits. The American Medical Association opposed it vigorously, arguing it would undermine American values of individualism and self-reliance, and invoked fears of communism that Ruddy said echo in the opposition's rhetoric to this day. The health insurance component was stripped from the Social Security Act before passage.

In 1945, President Harry Truman became the first president to publicly support a national healthcare program. The opposition pattern repeated itself. The AMA and its allies mounted a fierce campaign against the proposal, using similar fearmongering. Truman backed away. In the 1950 midterm elections, the AMA and its allies ran a targeted electoral campaign that defeated 80 percent of legislators who had supported national health insurance. The political cost of the issue was made clear.

The 1957 Turning Point

Ruddy identified 1957 as the moment that changed the trajectory of the fight. The AFL-CIO's executive council formally declared government health insurance its number one legislative priority. Walter Reuther, then president of the UAW and a co-founder of the AFL-CIO, was a central figure in that commitment and in the years of organizing that followed.

The AMA, recognizing the shift in political momentum, continued its opposition. It recruited Ronald Reagan, then a movie star and corporate spokesperson, to record a speech warning that Medicare would be the end of freedom in the United States. Reuther responded to the AMA's campaign, describing it as more useful as fertilizer than a political argument.

Labor's organizing muscle and political pressure, combined with the election of John F. Kennedy in 1960, began moving the legislation closer to reality. When Kennedy was assassinated, and Lyndon B. Johnson assumed the presidency, he immediately declared healthcare a top legislative priority. On July 30, 1965 — 61 years before the current campaign's July 30 day of action — Medicare and Medicaid were signed into law.

Medicare covers Americans 65 and older. Medicaid covers low-income Americans. Neither was the national health insurance program that labor had been fighting for since the 1930s. But both were the direct result of labor's sustained 30-plus-year campaign, and both remain the most significant expansions of government-provided healthcare coverage in American history.

Where Employer-Sponsored Insurance Came From — and Why It Is Failing

Ruddy noted that during the period when national health insurance repeatedly failed to pass, employer-sponsored health insurance grew as a substitute. The model became embedded in the American economy and in union contracts. Walter Reuther himself negotiated some of the most significant employer-sponsored health benefits in the country for UAW members. But Ruddy described the current state of that system as a racket that no longer works for labor or American workers.

Insurance company bureaucrats, not doctors and nurses, make the real decisions about what care patients can receive. Networks determine which providers are accessible. Out-of-pocket costs — premiums, deductibles, copays — all create financial barriers to care for people who technically have coverage. The Affordable Care Act extended coverage to millions, but its subsidies have been eroded, and the Big Beautiful Bill's cuts have further accelerated that erosion. Ruddy said Medicare for All is not a radical departure from American values but an expansion of a program that Americans already love and trust. It would also remove the insurance industry from the equation entirely, eliminate out-of-pocket costs and put healthcare decisions back in the hands of doctors and nurses, she added.

Where the Campaign Stands

Two companion Medicare for All bills, one in the House and the other in the Senate, have been introduced. The House bill is sponsored by U.S. Reps. Pramila Jayapal and Debbie Dingell. The Senate bill is sponsored by U.S. Sen. Bernie Sanders. Both bills are hundreds of pages long and, if passed, would implement a Medicare-for-All system. Slightly more than half of House Democrats are now co-sponsors of the House bill. The Senate bill has 17 co-sponsors. The NNU's open letter to Congress, signed by more than 335 organizations this summer, reflects the breadth of the coalition's support. It includes the NNU, the UAW, UE, IFPTE, APWU, the Association of Flight Attendants and others. The AFT and SEIU have also formally expressed support in recent years.

The path forward, Ruddy said, is to build majority support in Congress and ensure the entire Democratic caucus hears clearly from its base. Support for Medicare for All among Democratic voters is near 90 percent, she said.

Listeners who want to get involved or learn more can visit medicareforall.org. More information on National Nurses United is available at nationalnursesunited.org.

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