As Democrats look for a viable healthcare message ahead of the midterm elections, one well-connected think tank is pushing the party to embrace a new idea: free primary care for all Americans.
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Searchlight Institute senior fellow David Bowen, a former Senate aide who helped craft the Affordable Care Act, said it would be delivered either through that law’s marketplaces, expanding on the preventive services mandate, or through a new “public option” that the group is calling the “American Health Gateway.”
“We know very, very well that getting people better primary care is a conduit to better overall health,” said Bowen, who led the policy report, which was first shared with NBC News. “It’s conduit to savings, and we want to make sure that people are not dissuaded by cost from doing that. We also provide a new way of expanding people’s coverage to recognize the reality of families today.”
The proposal comes as millions of Americans have lost access to health insurance or seen their coverage downgraded after Republicans allowed enhanced ACA subsidies to expire at the end of last year.
The ACA’s preventive services mandate requires most insurers to cover things like vaccinations and cancer screenings without charging a copay or deductible. Searchlight’s primary care proposal takes that much further: If a person shows up at the doctor and has an ear infection, for instance, the evaluation and prescription for that would be cost-free.
“If you get basic primary care, sort of in a variety of settings, this too would be free at the point of service. So it’s an expansion of that policy,” said Bowen. “It’s not, obviously, free care for everything, but it is a significant chunk of additional services that are going to make a difference in people’s lives.”
Free primary care wouldn’t cover things like surgery, hospital stays, cancer treatment or most specialized care.
Still, Art Caplan, the head of the medical ethics division at NYU Grossman School of Medicine in New York City, who was not involved in the report, said “primary care is probably the most crucial domain of healthcare.”
“It’s for everyone, from newborns to all the way up to those age 100,” he said. “It helps you stay healthy. It helps you maintain and deal with chronic issues.”
Behind the push by the new group, launched last year by former Democratic operatives and policy wonks, is a belief that their party is stuck in a rut on healthcare, with a decadelong divide between those who want “Medicare for All” and others who want to preserve the current system, perhaps with a “public option” (a federal health insurance plan to compete with private insurers).
Adam Jentleson, the president and founder of Searchlight Institute and a former longtime Senate aide, said Democrats must offer fresh ideas and cannot afford to coast on past health policy successes or simply oppose Republican proposals.
“This is still our best issue, but we have not been on offense in a way that’s capturing people’s imaginations and getting them excited,” Jentleson said. “We don’t need to be on defense or just advocating for incremental reforms.”
“And we think we can bring something new to that conversation,” he said. “We hope it will be useful to candidates in 2026 but will hopefully build toward something bigger in 2028.”
The group plans to distribute a polling memo to congressional Democrats and leadership offices that undergirds the case for its proposal. A survey the group commissioned found that voters tend to like their own health coverage but are dissatisfied with the insurance system as a whole.
Larry Levitt, executive vice president for health policy at KFF, a nonpartisan research group, said free primary care is a more realistic path than Medicare for All, since people could keep their existing insurance and private plans would still exist. Many people, he added, are already exempt from deductibles for primary care visits, though they often pay a copay.
As the group didn’t detail how the program should be funded, Levitt wondered whether the cost would fall on insurers, taxpayers or some combination of the two.
“The money to pay for it has to come from somewhere,” he said. “And it would likely mean a modest increase in premiums that would be paid for by employers and employees.”
It would also need to address E&M codes, the billing system providers use to get paid for office visits and other care.
“And how would it work for people who didn’t have insurance at all?” Levitt asked.
Caplan said the U.S. would also need to address a shortage of primary care doctors.
“A lot of people still won’t have access because there’s not a family doctor or a primary care provider in their area,” he said.
Searchlight, which launched last year and is named after former Senate Democratic leader Harry Reid’s hometown, is seeking to establish a foothold in the Democratic policymaking debate. It is criticizing a recent health policy blueprint by the influential Center for American Progress, a Washington-based think tank with deep ties to the last three Democratic administrations. (Jentleson used to work at CAP.)
“If you see the Center for American Progress, their big healthcare release for the entire year is like two pages on price negotiations,” said Ahmad Ali, Searchlight’s communications director and a former aide to House Democratic leadership. “I mean, this is very small thinking, and we have more to do to actually go out there and start changing minds.”
