Single-payer health care is increasingly popular among American voters. Poll numbers fluctuate depending on how the question is asked, but findings consistently show majority support for a single-payer program like Medicare for All. One 2018 poll showed support was as high as an astonishing 70 percent. But as the Democratic primary wears on, those numbers have been slipping: A Kaiser Family Foundation survey from the very end of November found that Medicare for All had just the slimmest of majority support, at 51 percent.

While Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts have proposed their own single-payer health-care plans, other Democratic presidential candidates like former vice president Joe Biden and South Bend, Indiana mayor Pete Buttigieg have come out strongly against any policies that would undermine private health insurance companies. Meanwhile, Democratic strategists and insiders have told New York Times reporters that they think strong social programs like universal health care will hurt the party in the long run. And just a month ago, House Speaker Nancy Pelosi told Bloomberg News, "I’m not a big fan of Medicare for all."

State-level lawmakers are also jumping into the debate. Democratic and Republican legislators have been publishing op-eds suggesting either very mild adjustments to U.S. health care, or attacking single-payer outright. And, it turns out, some of them are relying on feedback from the heath-care industry.

The Washington Post obtained private e-mails of multiple lawmakers, showing that they ran their op-eds by health-care industry lobbyists before publishing them. Montana representative Kathy Kelker and state senator Jen Gross, both Democrats, included language from John MacDonald, a lobbyist who reached out on behalf of Partnership for America’s Health Care Future, an industry group founded in 2018 and funded by hospitals, private insurers, drug companies and other private health-care firms. Among other edits, MacDonald apparently deleted a table from one of the op-eds showing that Americans spend more per capita on health care than France, Germany, Norway, and Switzerland.

Kelker and Gross both told the Post that they weren't aware that MacDonald was a lobbyist, and that they've received some push back from their constituents over the op-eds. But after Kelker's op-ed ran, she emailed MacDonald, writing, "At church, I received many favorable comments—mostly from Republicans!"

An aide to Ohio state senator Steve Huffman, a Republican, also confirmed that Huffman's recent op-ed attacking Medicare for All was written with help from Ohio-based lobbyist Kathleen DeLand. DeLand would neither confirm nor deny to the Post that she also worked for Partnership for America’s Health Care Future, but her e-mails to Huffman's staff included the group's acronym in the subject line: "PAHCF op-ed - OH - Huffman[3]. docx." The Partnership linked to these op-eds in e-mails to reporters, citing them as evidence that "voices throughout the nation" oppose Medicare for All.

In a story from November, Politico detailed the rise of the Partnership from a coalition of groups representing the insurance and pharmaceutical industries to a multi-million dollar juggernaut aiming to oppose any major expansion of government-financed health care in D.C. and across the country. The organization promotes the talking points that a single-payer heath-care system would empower "bureaucrats" to force Americans into a "one-size-fits-all" plan, taking away their "choice" and "control." According to the Kaiser Family Foundation, 156 million Americans, or 49 percent of the country's population, rely on employer-provided insurance, so how much "control" they have over their health care is debatable.