The Partnership for America’s Health Care Future does not publish a donor list. It is not required to. The 501(c)(4) social welfare designation it operates under was designed for civic leagues and community organizations. It has become, over decades of legal interpretation and political practice, the preferred legal structure for large-scale corporate political spending that does not want to be traced.
What this means in practice is that a coalition spending tens of millions of dollars to shape healthcare policy — the policy that determines whether 30 million uninsured Americans get coverage, whether patients can afford their prescriptions, whether hospital prices can be regulated — does so without the public knowing who is paying for it. The donors know. The lobbyists know. The politicians being lobbied know. The people whose healthcare is being decided do not.
This article documents what is known about PAHCF’s funding. It is not a complete picture. The 501(c)(4) structure guarantees a complete picture will never be available. What follows is what investigative reporting, tax filings, and corporate disclosures have managed to surface — the floor, not the ceiling.
What the Tax Returns Show
PAHCF files Form 990 tax returns as a nonprofit organization. These returns disclose total revenue, total spending, and broad categories of expenditure. They do not disclose individual donors. What they reveal about the scale of the operation is significant.
According to tax returns analyzed by The Lever and Jacobin, PAHCF spent $60 million in the 2019 to 2020 period — the two years when Medicare for All had its greatest legislative momentum and when Democratic presidential candidates were debating the policy on national television. The coalition reported receiving six contributions of $5 million each, and more than a dozen seven-figure gifts overall during this period. The sources of those contributions are not identified in the filings.
In 2019, when PAHCF concentrated most of its fire on the federal Medicare for All legislation, the vast majority of its $20 million in spending went toward what it reported as attempts to influence public opinion. It reported only $60,000 in formal federal lobbying expenditures that year — a figure that reflects the narrow legal definition of lobbying rather than the full scope of its political activity. Advertising campaigns, media relations, surrogate recruitment, polling, and candidate positioning do not count as lobbying under federal disclosure rules. PAHCF spent heavily on all of them.
The Donors Who Became Visible
Investigative reporting by The Intercept identified two major corporate donors whose contributions became visible through corporate disclosures and state filing requirements that PAHCF’s federal 501(c)(4) status does not override.
CVS Health contributed $5 million to PAHCF — the largest known single contribution to the coalition. CVS Health owns Aetna, one of the largest health insurance companies in the country, and operates thousands of pharmacies and walk-in clinics. The company’s financial interest in preventing Medicare for All is direct and substantial: a single-payer system would eliminate the private insurance market that Aetna depends on and restructure the pharmaceutical distribution system that CVS’s pharmacy business operates within. The $5 million contribution was not disclosed by PAHCF. It became visible because CVS’s own corporate filings, subject to different disclosure requirements, referenced the contribution.
Tenet Healthcare, the nation’s third-largest investor-owned hospital operator, contributed more than $2.1 million to PAHCF, including $1.5 million in the first half of 2020 alone. Tenet’s incorporation records are listed in PAHCF’s own organizational documents, with a Federation of American Hospitals lobbyist named as one of PAHCF’s authorized representatives. The Federation of American Hospitals is the trade group that represents Tenet and other investor-owned hospital chains. The connection between Tenet’s financial contribution and its institutional representation in the coalition’s governance is documented in the coalition’s own records.
These two donors became visible because of the particular disclosure requirements that applied to their corporate filings — not because PAHCF disclosed them. Every other contribution of comparable or greater size remains unknown.
The Member Organization Spending Behind the Coalition
PAHCF’s direct spending is one measure of the financial power behind the coalition. The lobbying expenditures of its member organizations are another, and they dwarf what flows through PAHCF itself.
In 2018 alone, the member organizations of the Partnership for America’s Health Care Future spent a combined $143 million on lobbying, according to data from the Center for Responsive Politics. That figure includes nearly $28 million from PhRMA, $23 million from Blue Cross Blue Shield, and substantial amounts from the American Hospital Association, the Federation of American Hospitals, and America’s Health Insurance Plans. These expenditures cover the member organizations’ own federal lobbying activity — separate from what they contributed to PAHCF and separate from PAHCF’s own political spending.
The $143 million is the organized interests side’s routine annual operating cost for maintaining Congressional relationships, monitoring regulatory activity, and shaping the legislative environment — not a special campaign expenditure. It is what they spend in a year when they are not running an emergency anti-reform operation. When Medicare for All gained momentum and PAHCF was activated, the coalition’s spending layered on top of this baseline.
The total financial picture is: $143 million in member organization lobbying in a single year, plus $60 million in PAHCF direct spending over two years, plus undisclosed contributions from CVS, Tenet, and an unknown number of additional corporate donors, plus the individual lobbying expenditures of member organizations at the state level. No single figure captures the full investment. That is also by design.
What the Money Bought
The $60 million in documented PAHCF spending went toward a specific set of operational activities documented across tax returns, state lobbying disclosures, and investigative reporting.
Advertising at scale. Between 2018 and 2021, PAHCF ran 1,675 paid advertisements on Facebook and Instagram that received between 32 and 40 million views, according to a peer-reviewed study published in PLOS Global Public Health in July 2025. The campaign targeted specific demographic groups — mothers with children and seniors — with messaging designed to generate fear about what Medicare for All would mean for their existing coverage. Television advertising ran in Democratic primary states including South Carolina. In August 2019 alone, PAHCF spent more than $200,000 on television ads, with additional hundreds of thousands on Google and Facebook during the same period.
Democratic Party infrastructure. The American Prospect reported that PAHCF paid nearly $760,000 to Bully Pulpit Interactive, a communications and digital marketing firm that had worked with the Democratic National Committee and the Democratic Senatorial Campaign Committee. PAHCF paid approximately $185,000 to Anzalone Liszt Grove Research, a polling firm working simultaneously with Biden’s presidential campaign and the Democratic Congressional Campaign Committee. PAHCF paid $140,000 to Blue Engine Message and Media, a firm founded by former Obama campaign staffers. The people running the campaign against Medicare for All were the same Democratic Party infrastructure firms running Democratic campaigns.
State-level lobbying operations. PAHCF Action, the coalition’s state arm, deployed resources wherever public option or single-payer legislation surfaced at the state level. In Colorado in 2021, PAHCF spent more on lobbying than any organization since 2011 — possibly ever — resulting in the removal of the actual public option component from state legislation. In Connecticut in the first half of 2021, PAHCF contributed to more than $600,000 in dark money spending against public option legislation, with five health insurance companies threatening to leave the state if the bill passed.
Ghostwritten opposition. The Washington Post reported in December 2019 that PAHCF lobbyists drafted op-eds for state legislators in Montana and Ohio that were published under the legislators’ names without disclosing the lobbyists’ involvement. PAHCF then cited these op-eds as evidence that “voices throughout the nation” opposed Medicare for All — manufacturing the appearance of organic opposition and then using that manufactured opposition as sourced evidence in its public communications.
The Contrast the Numbers Make
In the first quarter of 2025, Representative Alexandria Ocasio-Cortez raised $9.6 million from 266,000 individual donors. The average contribution was $21. Senator Bernie Sanders raised $11.5 million in the same period.
These are not comparable funding structures. CVS Health writing a $5 million check to a dark money coalition is a corporate investment in a policy outcome. 266,000 people contributing $21 each is a different kind of political power — one that is harder to sustain institutionally but that rests on a different foundation.
The organized interests side has a structural advantage that money alone does not fully capture: permanence. PAHCF was not built for a single election cycle. The $143 million in annual member lobbying spending does not stop between election cycles, between administrations, or between moments of peak public attention. The civic side’s fundraising surges when the political environment activates people and recedes when it doesn’t. The organized interests side runs continuous operations regardless of the cycle.
That is what $60 million in two years, layered on top of $143 million in annual baseline lobbying, actually buys: not just advertising and lobbyists, but the capacity to be present and operating when the civic side is not. The gap between those two operating models is what this series is documenting.
What Cannot Be Known
The honest boundary of this article is that it documents what investigative reporting has managed to surface from a funding structure specifically designed to prevent surfacing. CVS and Tenet became visible because of disclosure requirements that applied to their own corporate filings — not because PAHCF disclosed them. Every other contribution of equivalent or greater size remains unknown.
Six contributions of $5 million each were reported in PAHCF’s tax returns without donor identification. More than a dozen additional seven-figure gifts were reported without identification. The total funding behind the coalition’s $60 million in 2019-2020 spending is documented as a number without names attached to it.
This is not a gap in the reporting. It is the legal architecture functioning as designed. The 501(c)(4) structure exists to enable exactly this — large-scale political spending by concentrated interests without the accountability that public disclosure would create. Understanding that the structure is functioning as intended, rather than being exploited in some unanticipated way, is part of understanding what PAHCF is and why reforming the campaign finance system is not separable from reforming healthcare policy.
How America’s Plan Addresses This
The funding asymmetry documented in this article is not closeable through fundraising. The civic side will not out-spend CVS Health. The organized interests side has a structural financial advantage that is durable and compounding.
What is potentially closeable is the connective infrastructure asymmetry. The organized interests side’s financial power is effective because it operates through permanent institutional infrastructure — established relationships, preserved institutional memory, continuous presence in the spaces where policy gets made. That infrastructure is what converts dollars into policy outcomes.
The civic side has the one asset the organized interests side cannot manufacture: the experiential knowledge and lived accountability of the people bearing the cost of the problem. Patients who have been denied prior authorization. Workers rationing medication. Families spending down savings for care. That knowledge does not exist in any PAHCF database. It exists in the people who lived it.
America’s Plan is designed to aggregate that knowledge, connect the people who hold it, preserve what civic campaigns learn so it compounds rather than dissipates, and build the kind of continuous organized presence that converts episodic civic energy into something the double principal arrangement cannot absorb and dismiss. The platform is early-stage. What the funding record documented in this article makes clear is what the civic side is building against — and why the infrastructure has to outlast any single campaign, any single election cycle, and any single moment of public attention.
Sources: The Intercept — CVS Health Quietly Made Massive Donation to Dark-Money Group Fighting Access to Care (April 2021); The Intercept — For-Profit Hospital Industry Is Leading Fight Against Medicare for All (October 2019); The Lever — Where Did the Public Option Go? (August 2022); Jacobin — The Establishment Is Gearing Up Against Even a Public Option (December 2020); American Prospect — Top Democratic Consultants Working for Anti-Medicare for All Campaign (November 2019); OpenSecrets — Big Pharma, Insurers, Hospitals Team Up to Kill Medicare for All (March 2019); OpenSecrets — Healthcare Giants Attack 2020 Democrats’ Healthcare Plans with Iowa Ad Blitz (August 2019); PLOS Global Public Health — Generating Opposition to Universal Health Care Policies in the United States (July 2025); ProPublica Nonprofit Explorer — Partnership for America’s Health Care Future Form 990; FEC filings — AOC and Sanders Q1 2025 fundraising.
The complete PAHCF Series
01 — What It Is and Why It Exists
02 — Who Funds It and What the Money Buys
03 — The Federal Strategy
06 — The Tobacco Playbook
The Organized Interests Playbook: A Structural Analysis of PAHCF
This article was researched and drafted with AI assistance under human review. See our full AI and editorial practices.