In June 2018, three of the most powerful lobbying organizations in Washington sat down to build something. The Federation of American Hospitals represented the investor-owned hospital chains. America’s Health Insurance Plans represented the private insurance industry. The Pharmaceutical Research and Manufacturers of America — PhRMA — represented the drug companies. These three organizations compete against each other constantly. They fight over reimbursement rates, drug pricing policy, and market share. On most days they are not allies.
But they agreed on one thing: Medicare for All could not become law.
What they built was the Partnership for America’s Health Care Future. It has been described in its own materials as a coalition committed to “improving what’s working in health care and fixing what’s not.” Internal documents tell a different story. Leaked planning materials obtained by The Intercept in 2018 state the coalition’s two actual objectives plainly: “change the national conversation around single payer/Medicare for All” and “minimize the potential for this option in health care from becoming part of a national political party’s platform in 2020.”
Those are not the same thing as improving what’s working and fixing what’s not. They are the objectives of an organization built to prevent a specific policy from advancing. The benign public framing is the first strategic asset. It is harder to criticize a coalition that says it wants to help than one that says it wants to block.
The Structure That Makes It Work
The Partnership for America’s Health Care Future is organized as a 501(c)(4) social welfare organization under the tax code. It has a separate lobbying and action arm. The 501(c)(4) designation is not a technical detail. It is the foundation of the coalition’s operating model.
A 501(c)(4) organization is not required to disclose its donors. It can raise unlimited amounts of money from corporations, trade associations, and wealthy individuals and spend that money on advertising, lobbying, media relations, and public persuasion campaigns without revealing where the money came from. This is what is meant when journalists and researchers describe PAHCF as a dark money organization. The money is real. The spending is documented. The source is legally concealed.
The American Medical Association was a founding member. It left in mid-2020, citing a desire to focus on what it called “practical solutions” — though it maintained its opposition to Medicare for All. The current membership includes the American Hospital Association and the Blue Cross Blue Shield Association in addition to the three founding organizations.
In December 2019, PAHCF removed all leadership members and biographies from its website’s about page. The coalition that presented itself publicly as a broad coalition of concerned healthcare stakeholders made the decision to stop identifying who was running it. The executive director, Lauren Crawford Shaver, coordinates what are described as “grassroots efforts” for the lobbying firm Forbes Tate Partners.
This Is Not a New Strategy
The federation of American Hospitals CEO Chip Kahn has publicly taken credit for the idea of forming PAHCF. Kahn is not a newcomer to this kind of operation. He is best known for creating the “Harry and Louise” advertising campaign that helped defeat the Clinton administration’s healthcare reform plan in the early 1990s — a campaign that depicted an ordinary couple sitting at a kitchen table expressing worry about government bureaucrats making their healthcare decisions. He was also reportedly involved in negotiating the removal of a public health insurance option from the Affordable Care Act during backroom discussions with the Obama White House in 2009.
The same person. The same strategy. Three decades of application.
The “Harry and Louise” playbook has a documented structure: identify the specific reform gaining momentum, build a coalition that looks broad but is funded by concentrated interests, frame the reform as a threat to ordinary people rather than a protection for industry profits, and work the candidate and media landscape upstream of any legislative vote. PAHCF did not invent this approach. It refined it for the digital era and funded it at a scale the original version never reached.
This matters for understanding what PAHCF is. It is not a response to Bernie Sanders or to the particular political moment of 2018. It is the latest iteration of a thirty-year institutional strategy by the healthcare industry to prevent structural reform — updated, expanded, and equipped with tools the earlier versions did not have.
The Members and What They Spend
The coalition’s member organizations are not small actors. In 2018 alone, PAHCF member organizations spent a combined $143 million on lobbying, according to data from the Center for Responsive Politics. That figure covers their own lobbying activity independent of what they contributed to PAHCF itself.
What flows directly into PAHCF is harder to document, by design. What investigative reporting has surfaced from tax filings and corporate disclosures includes CVS Health — which owns Aetna insurance and operates thousands of pharmacies — contributing $5 million, the largest known single contribution. Tenet Healthcare, the nation’s third-largest investor-owned hospital operator, contributed more than $2.1 million, including $1.5 million in the first half of 2020 alone. Tax returns document that PAHCF received six contributions of $5 million each, and more than a dozen seven-figure contributions overall. Total spending for 2019 and 2020 reached $60 million, according to the coalition’s own tax filings.
These are the contributions that became visible through investigative reporting and tax disclosures. They are not the complete picture. The 501(c)(4) structure ensures the complete picture will not be available. What is documented is the floor, not the ceiling.
What the Public Mission Conceals
PAHCF’s public-facing materials present the coalition as a patient-focused effort to improve healthcare access, lower costs, and protect coverage. The website states: “We want to work together to lower costs, protect patient choice, expand access, improve quality and foster innovation.”
The leaked internal strategy documents establish what the organization is actually designed to do. The two stated objectives — changing the national conversation and preventing single-payer from becoming a party platform position — are pre-legislative goals. They are not about defeating a bill on the Senate floor. They are about ensuring the bill never gets that far.
This distinction is the operational core of how the coalition works. A campaign to defeat a bill in committee or on a floor vote is visible, datable, and attributable. A campaign to shape which candidates adopt which positions, which media voices say which things, and what ordinary people believe about a policy proposal before they ever hear a senator speak about it — that campaign is harder to see, harder to attribute, and more durable in its effects.
A peer-reviewed study published in PLOS Global Public Health in July 2025 analyzed 1,675 paid advertisements PAHCF ran on Facebook and Instagram between 2018 and 2021. The study found that the campaign received between 32 and 40 million views, and that its tactics — designed to increase doubt, undermine public trust in government, and promote alignment with industry messaging — directly mirrored the strategies historically used by the tobacco, alcohol, and ultra-processed food industries. The comparison is not rhetorical. It is a documented strategic inheritance.
Why It Exists Now
Medicare for All has majority public support. A July 2025 Data for Progress survey found 63 percent of Americans support the policy even when told it would eliminate most private insurance plans and require higher taxes. That is the framing the opposition has relied on for years. It is no longer sufficient to move the numbers.
In April 2025, Senator Bernie Sanders introduced the Medicare for All Act in the 119th Congress with 15 Senate co-sponsors. The House version carries 111 co-sponsors — a majority of House Democrats, the highest share in the bill’s history. The Fighting Oligarchy tour, co-led by Sanders and Representative Alexandria Ocasio-Cortez, drew 261,000 people to events across the country in 2025. The fundraising behind that civic energy came from 266,000 individual donors to AOC’s campaign alone, at an average contribution of $21.
PAHCF’s visible public activity has diminished significantly since its 2018-2021 peak. The coalition that spent $60 million in two years has no documented comparable campaign in the current cycle. This is consistent with the operating logic of an industry coalition that spends heavily when reform has momentum and operates at lower visibility when the legislative environment is unfavorable. The infrastructure does not disappear. It waits.
Understanding what PAHCF is — its structure, its funding model, its documented history, and its relationship to the longer history of healthcare industry opposition to reform — is the foundation for understanding what the civic side is actually up against. The following articles in this series document how the coalition operates in practice: the federal strategy, the state-level campaigns, the fabricated grassroots opposition, and the question of what the historical record shows it takes to break through.
How America’s Plan Addresses This
The organized interests side has a permanent institutional presence. PAHCF was not built for a single election cycle. It was built to operate across cycles — maintaining relationships, monitoring legislative activity, deploying resources wherever reform surfaces, and shaping the information environment continuously rather than episodically.
The civic side has historically responded to that permanent presence with campaigns. A campaign has a beginning, a peak, and an end. The knowledge it generates, the relationships it builds, and the analytical capacity it develops tend not to survive the campaign’s conclusion. The organized interests side knows this. The thirty-year record of the Chip Kahn strategy works in part because it can absorb episodic civic pressure and wait for it to dissipate.
America’s Plan is designed to address the specific structural failure that makes that dynamic possible. The platform’s four-stage pipeline — Sentiment, Plan, Pressure, Accountability — is designed to convert episodic civic energy into accumulating organizational capacity. The Commons preserves what civic campaigns learn so the next effort does not rebuild from scratch. The connective infrastructure links organizations working on related problems without requiring them to merge or subordinate their independence.
The honest assessment is that the platform is early-stage and has not yet demonstrated outcomes that would justify stronger claims. What it has is a design that addresses the specific structural problem this series documents. The organized interests side proved that permanent civic infrastructure works — for their side. The question the platform exists to test is whether the same model works when the people building it are the ones bearing the cost of the problem.
Sources: The Intercept — Lobbyist Documents Reveal Health Care Industry Battle Plan Against Medicare for All (November 2018); The Intercept — For-Profit Hospital Industry Is Leading Fight Against Medicare for All (October 2019); The Intercept — CVS Health Quietly Made Massive Donation to Dark-Money Group Fighting Access to Care (April 2021); OpenSecrets — Big Pharma, Insurers, Hospitals Team Up to Kill Medicare for All (March 2019); American Prospect — Top Democratic Consultants Working for Anti-Medicare for All Campaign (November 2019); PLOS Global Public Health — Generating Opposition to Universal Health Care Policies in the United States (July 2025); GovTrack — S. 1506 Medicare for All Act 119th Congress; Congress.gov — H.R. 3069 Medicare for All Act; Modern Healthcare — Chip Kahn and PAHCF founding; Wikipedia — Partnership for America’s Health Care Future.
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.