At a recent private event with employees, an executive at UnitedHealth Group said, "The last thing you want to do is become the poster child during the presidential campaign." (Jim Mone/AP)

At a company town hall meeting in late February, a UnitedHealthcare executive assured employees that the private health insurance giant was indeed working to undercut support for Democratic lawmakers’ push for Medicare-for-all. But the company, he said, is trying to tread lightly.

“One of the things you said: ‘We’re really quiet’ or ‘It seems like we’re quiet.’ Um, we’ve done a lot more than you would think,” chief executive Steve Nelson said in response to an employee’s question about the company’s role in the Medicare-for-all debate, according to a video of his remarks obtained by The Washington Post. “You want to be kind of thoughtful about how you show up and have these kind of conversations, because the last thing you want to do is become the poster child during the presidential campaign."

The remarks come amid a broader push from the health insurance industry to prevent legislation to enact Medicare-for-all from getting off the ground, including by trying to direct Democrats toward more centrist efforts and reject plans that would effectively legislate many of the companies out of existence.

Wary of bringing unwanted political controversy to their companies, some private health-care firms have in part relied on advocacy groups and lobbyists in their fight against Medicare-for-all — joining the push without leaving too many company-specific fingerprints.

Congressional Democrats, including some of the party’s leading 2020 presidential contenders, are pushing proposals that would establish a single-payer health-care system in which all Americans would receive government insurance. Legislation in both the House and the Senate would outlaw coverage that is duplicative with generous government plans, reducing the multibillion-dollar health insurance industry to a small, supplemental role.

The bills are still long-shot proposals that are near-universally opposed by Republicans, and their passage into law would require Democrats to take the White House in 2020 and win sizable majorities in both chambers of Congress. But they have moved from a fringe position among Democratic lawmakers to a goal that is broadly embraced by much of the party.

Facing this threat, some private health companies are mounting a lobbying offensive, sending literature to staff members on Capitol Hill, starting advertising campaigns, and regularly warning politicians, reporters and the public about the dangers of a single-payer system.

These private insurers have pushed for Democrats to instead focus on repairing the Affordable Care Act passed under President Barack Obama, arguing a more incremental approach could include extending health insurance to all Americans without requiring a radical transformation of existing markets.

“These companies completely understand that the federal government can discipline prices, and that doing so could have a fundamental impact on every single thing in their business,” said Harold Pollack, a health-care expert at the University of Chicago, referring to proposals that could set prices or create government programs to compete with private insurers.

In an email, UnitedHealth spokesman Tyler Mason said Nelson’s comments came during an internal company meeting and were made in response to a question from an employee who may not have known about the company’s existing policy positions, which have been publicly available for many years. Mason pointed to a company report that calls for, among other policies, expanding Medicaid and protecting the health insurance that tens of millions of Americans receive through their employers.

“We have publicly supported universal coverage for over 20 years and have been engaging in thoughtful conversations with policymakers, employers, care providers and our own employees on solutions that build upon the success of existing public-private partnerships," Mason said in an email.

In the February meeting with employees, Nelson said the company opposes Medicare-for-all because it excludes the private sector, which he said does a better job of delivering health care than the government, and said he doubted how a single-payer system could be funded or effectively administered.

“We are advocating heavily and very involved in the conversation,” Nelson said. “Part of it is trying to be thoughtful about how we enter in the conversation, because there’s a risk of seeming like it’s self-serving.”

The UnitedHealth Group, which recorded about $17 billion in earnings in 2018, spent about $8 million on lobbying efforts last year on a broad range of health-care issues, according to the Center for Responsive Politics, which tracks money in politics. The company, the parent of UnitedHealthcare, declined to comment on whether it had met with Democratic presidential candidates.

Other industry groups also are fighting back against a single-payer system. America’s Health Insurance Plans, a trade association representing private health insurers, has lobbied Congress on a single-payer bill by Sen. Bernie Sanders (I-Vt.), as has the Healthcare Leadership Council, an industry group whose members include private health insurance giants such as Anthem, according to the Center for Responsive Politics.

AHIP last summer also joined with insurers such as Blue Cross Blue Shield, as well as hospital associations and pharmaceutical companies, in forming a group called the Partnership for America’s Health Care. In February, the partnership — whose members spent $143 million on lobbying in 2018 — said it would begin a six-figure digital advertising campaign to oppose both Medicare-for-all and a public option that would allow Americans to buy into Medicare. The group also is running an ad attacking Rep. Lori Trahan (D-Mass.) for backing Medicare-for-all legislation, according to Politico.

A report in Splinter, a left-leaning publication, revealed last month that several people quoted in the partnership’s news releases had ties to lobbying firms or private health insurance companies not mentioned in the statements. A spokesman for the group declined to comment on the Splinter story, but Lauren Crawford Shaver, executive director of the partnership, said the organization is committed to “fixing what is broken so that it works better for every American,” such as by improving the number of Americans with insurance and reducing health-care costs for consumers.

On Capitol Hill, meanwhile, about half a dozen representatives of lobbying firms said they had pushed for meetings with Democrats over single-payer and other proposed government expansions of health care. Lobbyists with the National Association of Health Underwriters, which represents health insurance agents and brokers, recently delivered a list of talking points critical of Medicare-for-all to Sen. Jacky Rosen (D-Nev.). It included the argument that single-payer “would be prohibitively expensive” and “reduce the standards of quality and access Americans currently enjoy in their health care.”

“You have a new majority with a lot of new members, so it’s a whole new pool of folks to get in and talk to,” said Robert G. Siggins, a senior policy adviser at the lobbying firm Alston & Bird who previously served as the chief of staff to a House Democrat. Siggins has lobbied on behalf of several private health-care companies. “You’re really trying to get a sense of where they’re coming from, and provide information.”

Democratic staff members also are receiving mailers warning against health plans that fall short of single-payer health care. One report sent last month to Senate Democratic offices, written by the KNG Health Consulting group but prepared on behalf of the American Hospital Association and Federation of American Hospitals, warned against “Medicare X,” a plan from moderate Democratic Sens. Michael F. Bennet (Colo.) and Tim Kaine (Va.) that would allow all Americans to buy into a public health insurance plan, according to a copy of the report.

To some political insiders, this lobbying push from private health-care companies underscores the enormous obstacles facing Medicare-for-all legislation and other large government interventions in health care. When Obama pushed the Affordable Care Act, Democrats tried working with private insurers and hospitals to minimize industry opposition to the legislation. Health insurance companies at the time helped defeat a proposed “public option” that would have competed with private plans.

“The insurance industry is still a very powerful force within the political process,” said Jim Manley, who served as an aide to former Senate majority leader Harry M. Reid (D-Nev.). “Having them on the opposite side of single-payer will be a very difficult obstacle to overcome.”

But single-payer advocates have argued for the necessity of their more radical proposal to transform the American health system, noting that the United States spends about twice as much per person as peer nations on health care despite lagging behind significantly on several key health indexes. To supporters of single-payer, the frenzy of federal lobbying against Medicare-for-all highlights the need to upend the health-care status quo.

“When the people begin organizing against private insurance, the lonely insurance executives turn to their only friends: the elected officials beholden to their cash,” said Tim Faust, an activist for single-payer health care.