In the fall of 2019, two Montana Democratic state legislators published opinion columns in local newspapers expressing concern about Medicare for All. State Representative Kathy Kelker’s piece ran in the Billings Gazette. State Senator Jen Gross published a separate column. Both were Democrats. Both raised substantive objections to single-payer healthcare. Both columns read as the considered views of elected officials who had thought carefully about the policy and reached independent conclusions.
Neither column was independently written.
Both legislators later acknowledged in interviews with the Washington Post that the columns included language provided by a lobbyist and consultant named John MacDonald, who had disclosed in private emails that he was working for an unnamed client. Senator Gross told the Post that MacDonald had contacted her on behalf of the Partnership for America’s Health Care Future.
In Ohio, an aide to Republican state Senator Steve Huffman confirmed that an Ohio-based lobbyist named Kathleen DeLand had helped write his op-ed criticizing Medicare for All. The subject line of DeLand’s emails to Huffman’s staff read: “PAHCF op-ed – OH – Huffman[3].docx.”
None of these op-eds disclosed the lobbyists’ involvement. All of them were published as the independent views of elected officials.
PAHCF then cited these op-eds in its own communications as evidence that “voices throughout the nation” independently opposed Medicare for All.
The Circular Operation
What the ghostwriting story documents is not simply that a lobbying coalition paid people to write columns. It documents a specific and self-reinforcing operation: manufacture the appearance of organic opposition, deploy that manufactured opposition as evidence of grassroots concern, and use that evidence to shape media coverage, candidate positioning, and legislative calculations.
The operation works because each stage appears credible in isolation. A state legislator publishing an opinion column about healthcare policy is not unusual. A coalition citing that column as evidence of widespread elected official concern is not unusual. What is not visible — what the operation is designed to keep invisible — is that the same organization produced both the column and the citation of the column as independent evidence.
This is not a minor tactical detail. It is the core of what PAHCF described internally as its “earned media” strategy. Paid advertising is identifiable as paid advertising. A former Democratic Senate Majority Leader expressing concern about single-payer is not. A Montana Democratic state representative publishing a column in the Billings Gazette is not. The earned media strategy converts purchased political activity into the appearance of organic political sentiment — and then uses that appearance as evidence in its own campaign.
The Washington Post investigation that broke this story was initiated because the nonprofit advocacy group Medicare for All Now obtained PAHCF lobbyist emails through Freedom of Information Act requests filed with state government offices. The emails revealed what the published columns concealed. Without that FOIA effort, the manufactured opposition would have remained invisible as such — functioning exactly as designed.
What the Editing Reveals
The lobbyist’s involvement in the Montana columns was not limited to providing draft language. John MacDonald also edited the legislators’ own contributions to the columns in ways that illuminate the strategic intent behind the operation.
In Representative Kelker’s draft, MacDonald excised three paragraphs that conceded the United States spends more on healthcare per capita than other developed nations. Those paragraphs were accurate. They were supported by documented data. They were also inconvenient for a column arguing against Medicare for All, because the per capita spending comparison is one of the strongest factual arguments for why the current system needs structural reform.
The lobbyist did not simply provide language. He removed accurate information that complicated the coalition’s messaging. The column that was published was not Kelker’s considered view with lobbyist assistance — it was a lobbyist’s argument with Kelker’s name attached, edited to remove the facts that would have undermined the argument.
Kelker and Gross both said in interviews that they believed their columns reflected their genuine concerns about single-payer healthcare. The question the editing raises is not whether their concerns were genuine. It is whether the columns, as published, accurately represented those concerns — or whether they represented a lobbyist’s version of those concerns, stripped of the factual context that might have complicated them.
The Scope Beyond Montana and Ohio
The three legislators identified in the Washington Post investigation — Kelker, Gross, and Huffman — were not presented as an exhaustive list. They were the cases that became visible because Medicare for All Now obtained the relevant emails through FOIA requests filed with state offices. FOIA requests work only on government records. The lobbyists’ communications with their own employers, with PAHCF, and with other potential surrogates are not subject to FOIA and were not obtained.
The internal PAHCF planning documents obtained by The Intercept in 2018 described the surrogate operation as a planned bureau — a structured program with identified targets across multiple states, not an ad hoc arrangement. The three documented cases are the cases where the documentation became available. The scope of the operation is unknown.
What is known is that PAHCF’s communications cited “voices throughout the nation” opposing Medicare for All — a framing that implies organic, distributed opposition rather than a coordinated production operation. The emails with “PAHCF op-ed – OH – Huffman[3].docx” in the subject line document what that framing was constructed from, in at least some of the cases it covered.
The Media Amplification Stage
The ghostwriting operation did not stop at publication. PAHCF actively circulated the op-eds it had helped produce as evidence of independent opposition in its communications with reporters and in its public statements.
When asked about the strategy, PAHCF Executive Director Lauren Crawford Shaver issued a statement saying: “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.”
The statement cited the existence of the op-eds as evidence of organic concern. The op-eds had been produced by the coalition making that statement. The citation of manufactured evidence as organic evidence is the final stage of the circular operation — and it was delivered to reporters covering the story after the Washington Post had already documented the production process.
The willingness to continue citing the manufactured evidence after its manufacture had been documented publicly is not incidental. It reflects the operational logic of the strategy: the manufactured opposition has already done its work in the media environment, in the candidate positioning landscape, and in the legislative calculations of the period during which it appeared to be organic. The subsequent exposure changes the record. It does not undo the effect.
What This Strategy Requires
The ghostwriting operation is sometimes discussed as though it represents a particular kind of corruption — individual lobbyists acting improperly, individual legislators being credulous or complicit. That framing misses the structural point.
What the operation required was not individual misconduct. It required the institutional infrastructure that PAHCF had built and funded: a network of state-level lobbyists and consultants with established relationships with legislators across multiple states, a media relations operation capable of circulating the resulting columns and citing them as evidence, a legal structure that concealed the funding source, and a planning framework that identified the surrogate operation as a core strategic element from the coalition’s founding.
A volunteer-run advocacy group cannot run this operation. A newly formed civic campaign cannot run this operation. It requires the kind of permanent institutional presence — staffed, funded, operating continuously across electoral cycles — that the organized interests side has built and the civic side has not.
The Montana Democratic legislators who published those columns were not venal or stupid. They were operating in a political environment constructed by an organization with far more institutional capacity than they had. A lobbyist with established relationships, a ready-made draft, and the backing of a $60 million operation contacts a state legislator who is managing a full legislative workload, a constituent service operation, and a reelection campaign on a part-time salary. The asymmetry is not a mystery.
The Information Environment It Created
The accumulated effect of the ghostwriting operation, combined with the advertising campaign, the surrogate network of former Democratic officials, and the candidate positioning work documented in Article 3, was the construction of an information environment in which Medicare for All appeared to face broad, distributed, organic opposition from across the political spectrum — including from Democrats, including from state legislators in progressive states, including from voices with no apparent financial relationship to the healthcare industry.
That appearance was substantially manufactured. The manufacturing was not visible as manufacturing because it was designed not to be. The peer-reviewed study of PAHCF’s Facebook and Instagram advertising campaign, published in 2025, found that the campaign was specifically designed to create the impression of widespread concern rather than coordinated industry opposition — mirroring the strategies tobacco companies used to manufacture the appearance of scientific uncertainty about the health effects of smoking.
The tobacco comparison is not rhetorical. It is a documented strategic lineage. The same consultants and lobbying firms that developed astroturfing strategies for the tobacco industry participated in the development of astroturfing strategies for the healthcare industry. The ghostwriting of op-eds by state legislators is one specific application of a broader strategy with a long institutional history.
How America’s Plan Addresses This
The manufactured opposition strategy works because the civic side has no aggregation mechanism that makes it visible in real time. Individual journalists filing FOIA requests in individual states can surface individual cases. A platform designed to aggregate affected-party knowledge and track the information environment systematically can do something different.
America’s Plan’s Commons function is designed to preserve exactly this kind of documented knowledge — not just the policy analysis, but the operational record of how the organized interests side has worked to prevent reform. The ghostwriting story documented in this article, the consultant networks documented in Article 3, the dark money funding structure documented in Article 2, the tobacco playbook documented in Article 6 — these belong in a shared repository that civic organizations working on healthcare reform can access without each rebuilding the research from scratch.
The information environment PAHCF constructed took years and tens of millions of dollars to build. Deconstructing it requires the kind of documented, preserved, accessible analytical record that the platform is designed to create. The Montana FOIA requests that surfaced the ghostwriting story were filed by a single advocacy organization — Medicare for All Now — working with limited resources against a coalition with unlimited ones. A commons infrastructure that preserved that organization’s research, connected it with organizations doing parallel work in other states, and made the accumulated record accessible to journalists, researchers, and civic organizations would change what is possible.
That infrastructure does not yet exist at the scale the problem requires. The ghostwriting story is part of why it needs to.
Sources: Washington Post — State Lawmakers Acknowledge Lobbyists Helped Craft Their Op-Eds Attacking Medicare for All, Jeff Stein (December 2019); Boston Globe follow-up reporting (December 2019); Montana Public Radio — Report: Lobbyists Aided Lawmakers With Health Care Columns (2019); The Hill — State Lawmakers Acknowledge Lobbyists Helped Craft Their Op-Eds (December 2019); Common Dreams — Insurance Industry Clearly Terrified, Says Sanders, As Lawmakers Admit Lobbyists Helped Them Write Attacks on Medicare for All (December 2019); The Intercept — Lobbyist Documents Reveal Health Care Industry Battle Plan Against Medicare for All (November 2018); PLOS Global Public Health — Generating Opposition to Universal Health Care Policies in the United States (July 2025); Flathead Beacon — Ghostwriters in the Big Sky (December 2019).
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
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