A Centrist Independent Alternative to Medicare for All

Chart comparing government single-payer health insurance with CIVPAC's competing private insurance approach, showing high and low public subsidy options.

CIVPAC has substantially rewritten the discussion accompanying our health care policy proposal. The proposal itself remains unchanged. What has changed is our examination of the case for and against government single-payer health insurance, commonly called “Medicare for All.”

We continue to support universal health insurance through competing private insurers, with public subsidies, an enforceable requirement to maintain coverage, meaningful deductibles and copayments, and explicit limits on federal expenditures in real per-capita terms.

The size of those subsidies is an important policy choice. At one extreme, generous subsidies could provide something approaching comprehensive, nearly free medical care. At the other, more limited subsidies could support primarily catastrophic insurance. People with very different views about the appropriate role of government could agree on the basic structure while disagreeing about how generously it should be funded.

Our revised discussion begins by questioning the name “Medicare for All.” The proposed single-payer system differs fundamentally from Medicare as it currently operates, not only in the benefits provided but also in the economics of reimbursing medical providers.

We also examine the argument that America’s substantially higher health care expenditures demonstrate the need for government single-payer insurance.

Some of that difference reflects higher compensation for medical professionals and other choices that may provide genuine benefits to patients. Other differences, including pharmaceutical pricing, hospital market power and excessive administrative costs, present opportunities for reform.

But these problems have potential solutions that do not require replacing the existing insurance system. Stronger antitrust enforcement, pharmaceutical pricing reforms and industry cooperation on administrative standards deserve serious consideration.

Our critique also addresses the fiscal obligations, incentives, administrative pricing decisions and transition costs associated with government single-payer insurance. We recognize that such a system could offer advantages, including greater purchasing power and simplified administration. The question is whether those advantages justify replacing a competitive insurance system that can itself be improved.

Universal coverage is the objective. How we achieve it, and how much government should contribute, are separate questions.

CIVPAC believes that we can provide universal health insurance while preserving the incentives for efficiency that competition and consumer choice offer, and without creating an open-ended federal financial obligation.

We invite readers to examine our revised analysis and the policy proposal that follows it.

Read CIVPAC’s Health Care Policy

CIVPAC Changes Its South Carolina Senate Endorsement of Annie Andrews from Provisional to Full

CIVPAC endorsement of Annie Andrews for South Carolina U.S. Senate in 2026

October 12, 2026

CIVPAC has changed its endorsement of Annie Andrews for the U.S. Senate in South Carolina from provisional to full following the October 11 candidate debate and new developments concerning U.S. sanctions against Russia.

Our original endorsement was provisional in part because we wanted additional evidence about Senator Darline Graham’s willingness to exercise independent judgment when she disagreed with President Trump, particularly on foreign policy.

That question became more immediate following Trump’s October 9 agreement to relax sanctions on Russian diesel exports. A bipartisan group of seven senators, including four Republicans, called for reversing the decision. The agreement is unlikely to have a significant effect on U.S. diesel prices, but it could provide substantial revenue to Russia while it continues its war against Ukraine.

During the October 11 debate, Graham did not join that criticism. Instead, she emphasized the sanctions legislation she had helped enact while leaving its implementation to the president’s discretion. The Washington Post also reported that she praised Trump’s diesel-policy change.

We continue to credit Graham for her work on the Lindsey O. Graham Sanctioning Russia and Iran Act. Nevertheless, her response to this particular decision adds to our previously expressed concerns about congressional independence.

CIVPAC has therefore removed the provisional qualification from its endorsement of Annie Andrews. Our reservations about aspects of Andrews’s domestic agenda and our unanswered questions concerning her broader foreign-policy views remain unchanged.

Readers can review our complete South Carolina Senate evaluation and our 2026 U.S. Senate endorsements.

CIVPAC Completes Its 2026 U.S. Senate Endorsement and Evaluation Review

Kentucky U.S. Senate 2026 candidate evaluation by CIVPAC — Andy Barr, Charles Booker and Christopher Campbell

CIVPAC has published its evaluation of the Kentucky U.S. Senate race, comparing Republican Andy Barr, Democrat Charles Booker and Kentucky Party candidate Christopher Campbell.

The Kentucky race remains a difficult one. Barr combines a strong record on Ukraine and the 2020 election certification with questions about presidential power and congressional independence. Booker offers a stronger check on the current administration and a more congressional view of war powers, while leaving important questions about Ukraine, NATO and other foreign-policy commitments. Campbell presents a distinct third-party alternative but differs substantially from us on the role of government and American military assistance abroad.

Read the full Kentucky U.S. Senate candidate evaluation.

With publication of the Kentucky evaluation, CIVPAC has now completed its initial endorsement and evaluation phase for the 2026 U.S. Senate general-election races.

We have made 29 endorsements, including our Alaska ranked-choice recommendation. In the remaining races, we have published full candidate evaluations but are not making an endorsement at this time.

That does not necessarily make those decisions final. Between now and Election Day, we will review candidate debates and other significant new information. Where unanswered questions are resolved or the balance of a race becomes clearer, some evaluations that currently make no endorsement may become endorsements.

Our purpose is not simply to issue a list of names. The evaluations are intended to give independent and centrist voters enough information to understand both the areas of agreement and the reasons we sometimes remain unable to recommend either candidate.

See CIVPAC’s complete list of 2026 U.S. Senate endorsements and evaluations.

See all of CIVPAC’s 2026 candidate endorsements and evaluations.

Arkansas U.S. Senate Race Evaluation, Remains Under Review for Possible Endorsement

Arkansas U.S. Senate 2026 candidate evaluation by CIVPAC — Tom Cotton, Hallie Shoffner and Jeff Wadlin, under review

CIVPAC has published its current evaluation of the 2026 Arkansas U.S. Senate race between Republican incumbent Tom Cotton, Democrat Hallie Shoffner and Libertarian Jeff Wadlin.

This is an unusually difficult race to reduce to party labels. Cotton brings by far the strongest record of government and national-security experience and deserves credit for rejecting efforts to overturn the 2020 election. But his positions on presidential war powers, emergency tariffs and several consequential Trump administration appointments raise concerns about congressional independence.

Shoffner brings substantial agricultural and small-business experience and is closer to CIVPAC on tariffs and congressional war powers, but her positions on foreign policy, immigration enforcement and several other issues remain insufficiently developed.

Wadlin offers the most detailed independent platform of the three and is surprisingly close to CIVPAC on a number of institutional, trade, immigration and foreign-policy questions. But he has no legislative record, and an important question remains unanswered: with which party, if either, would he caucus in the Senate?

Because Arkansas early voting begins before all of the scheduled debates have taken place, we are publishing our evaluation now rather than waiting. The race remains under review, and we intend to revisit it as the debates provide additional information. In the mean time, we hope this evaluation will help Arkansas voters with a difficult decision.

Read the full Arkansas U.S. Senate candidate evaluation.

See CIVPAC’s complete list of 2026 U.S. Senate endorsements and races under review.

See all of CIVPAC’s 2026 candidate endorsements and evaluations.

CIVPAC Makes No Endorsement in New Hampshire U.S. Senate Race

New Hampshire U.S. Senate 2026 — No Endorsement

CIVPAC has completed its side-by-side evaluation of Democrat Chris Pappas and Republican John E. Sununu in New Hampshire’s 2026 U.S. Senate election. We are not endorsing either candidate at this time.

Pappas presents a developed center-left record. We agree with him on important matters including support for Ukraine and America’s alliances, reproductive rights and the need for Congress to act as an independent branch of government. But we have substantial disagreements with him on organized labor, the scale of federal intervention in the economy and aspects of fiscal and social policy.

Sununu is closer to CIVPAC on a number of conventional economic issues and has a genuine history of independence from Donald Trump. But that independence has limits, and his current campaign leaves too many important questions unanswered. We would particularly like clearer positions on Ukraine and NATO, abortion, the Affordable Care Act, immigration, Social Security and President Trump’s January 6 pardons.

There is also an institutional consideration. With a Republican president, another Republican senator could affect control of the Senate—and therefore its ability to provide an independent check on executive power. We would probably be similarly concerned with a Democratic president. We have overcome that concern in other races when a candidate’s record of bipartisan governance and policy positions justified doing so. We are not prepared to do that here on the information presently available.

This may not be the final word. Pappas and Sununu are scheduled to appear together at an October 29 candidate forum, and we plan to revisit the evaluation afterward if the candidates provide meaningful new information.

Read our full New Hampshire U.S. Senate side-by-side evaluation.

See CIVPAC’s complete list of 2026 U.S. Senate endorsements and races under review.

See all of CIVPAC’s 2026 candidate endorsements and evaluations.

CIVPAC Publishes Massachusetts U.S. Senate Evaluation — No Endorsement

Massachusetts U.S. Senate 2026 CIVPAC candidate evaluation — no endorsement

In part because of an expressed interest in our position, we have completed our evaluation of the 2026 Massachusetts U.S. Senate race. For now, we are making no endorsement.

The race presents an unusual choice between Democratic Senator Ed Markey and Republican challenger John Deaton. Markey has a long and readily assessable record and is strong on several issues important to CIVPAC, including support for Ukraine and NATO, congressional war powers, limits on presidential tariff authority and aspects of Middle East policy. But his domestic agenda is well to our left, including the full Sanders version of Medicare for All, the broader economic and social components of the Green New Deal, abolition of ICE and an annual wealth tax.

Deaton presents almost the reverse problem. His positions on health care, energy and several economic issues are considerably closer to CIVPAC’s market-oriented approach. He also takes positions on abortion and legal immigration that differ significantly from much of the national Republican Party and has repeatedly emphasized his independence from President Trump.

But Deaton has never held public office, so there is no legislative record against which to test that independence. More importantly, his published foreign-policy positions leave significant questions about Ukraine, NATO and the circumstances under which he would support continued American assistance to allies.

Those unanswered questions matter enough that we are not prepared to endorse either candidate at this time. Markey and Deaton are scheduled to debate on October 13, and we intend to revisit the race afterward. If the remaining questions are not resolved, we may ultimately make no endorsement.

Our non-endorsement should not be read as a recommendation that Massachusetts voters abstain. Rather than manufacture an endorsement where our criteria point in different directions, we have tried to provide voters with enough information to make their own judgment.

Read the full Massachusetts U.S. Senate candidate evaluation.

You can also review all of CIVPAC’s 2026 U.S. Senate general-election endorsements and evaluations or see all CIVPAC 2026 endorsements and races under review.

Florida Senate Evaluation Published: CIVPAC Makes No Endorsement

CIVPAC Florida U.S. Senate 2026 candidate evaluation — no endorsement

CIVPAC has moved its Florida U.S. Senate evaluation from the draft pool to publication and makes no endorsement among Republican incumbent Ashley Moody, Democrat Angie Nixon and No Party Affiliation candidate Neil Gillespie.

Moody is considerably closer to us on a number of economic and foreign-policy questions, including support for sanctions against Russia. But her Senate record raises serious concerns about congressional independence. She has supported a series of controversial Trump nominees, backed the administration’s exercise of emergency tariff authority and repeatedly declined to support congressional efforts to assert its constitutional authority over military action.

Nixon would provide a stronger partisan check on the administration, an important consideration given our increasing concern about executive power and the value of divided government. But her domestic agenda—including Medicare for All, a federal jobs guarantee, national rent controls, tuition-free public college, a wealth tax and abolition of right-to-work laws—lies far to our left. Her positions on Israel and unanswered questions about Ukraine, NATO and broader American international leadership create additional concerns. Nixon’s own platform confirms many of these domestic and foreign-policy positions. Angie Nixon for U.S. Senate

The Democratic primary also demonstrates that this choice was not inevitable. Nixon defeated Alexander Vindman, who offered a substantially different combination of positions and whom CIVPAC would have viewed much more favorably. We mention that not to relitigate the primary, but because it helps explain the particular choices now before Florida voters. Washington Post

Gillespie’s rejection of conventional partisan politics initially merits attention from an organization focused on independent voters, but we have found too little of a developed policy program—and no clear indication of how he would caucus in the Senate—to recommend him as an alternative.

The result is an unusual but straightforward conclusion: Moody is closer on many policies but has not demonstrated the institutional independence we want from a senator serving under a president of her own party; Nixon offers greater institutional opposition to the White House but asks us to accept domestic and foreign-policy positions too far removed from our own; and Gillespie has not yet provided enough information for a comparable evaluation.

CIVPAC therefore makes no endorsement in Florida’s 2026 U.S. Senate election.

Read the full Florida U.S. Senate evaluation and no-endorsement.

See all CIVPAC 2026 Senate endorsements and evaluations.

See all CIVAPC 2026 Endorsements

CIVPAC Provisionally Endorses Annie Andrews in South Carolina Senate Race

CIVPAC provisional endorsement of Annie Andrews in the 2026 South Carolina U.S. Senate race

CIVPAC has published its evaluation of South Carolina’s 2026 U.S. Senate race and provisionally endorsed Democrat Annie Andrews over Republican Senator Darline Graham, Libertarian Kasie Whitener and Constitution Party candidate Mark Hackett.

This is not an endorsement without reservations.

Andrews is closer to our positions on reproductive freedom, immigration, evidence-based public health and congressional war powers. We also give substantial weight at this point to congressional independence and the value of divided government as a check on executive power.

At the same time, Andrews is to our left on much of domestic economic policy. We have reservations about the size and role of government implicit in parts of her agenda, including important unanswered questions about the design of her proposed public health-insurance option.

Our largest uncertainty concerns foreign policy. Andrews has made clear that she opposes open-ended wars and believes Congress should authorize sustained military action, but we have found much less from her on Ukraine, NATO, Russia, China and the broader international order.

Graham receives substantial credit for taking over the Russia and Iran sanctions legislation championed by her late brother, Senator Lindsey Graham, and helping carry it into law. But her limited foreign-policy preparation, her pledge to have President Trump’s back “100 percent,” and her vote against allowing an Iran War Powers resolution to proceed raise questions about congressional independence.

Whitener offers a strongly market-oriented and fiscally restrained alternative and has been unusually clear in challenging unilateral presidential war-making. Questions remain about what her noninterventionist approach would mean for NATO, Ukraine, Taiwan and Israel.

Hackett is clearer: he advocates ending U.S. support for Ukraine and Israel and withdrawing from NATO and the United Nations—positions fundamentally at odds with our approach to American foreign policy.

For now, the combination of divided government, congressional independence, reproductive freedom, immigration and public health tips our evaluation toward Andrews.

The endorsement is deliberately provisional. Andrews, Graham and Whitener are scheduled to participate in the October 11 South Carolina ETV debate, and we intend to review the endorsement afterward. In particular, we will be listening for clearer answers from Andrews on Ukraine and NATO, from Graham on congressional independence, and from Whitener on the practical implications of her foreign-policy philosophy.

Read the full South Carolina U.S. Senate evaluation and provisional endorsement.

See all CIVPAC 2026 Senate endorsements and evaluations.

CIVPAC Completes Its Review of the 2026 U.S. Senate Races

CIVPAC completes review of every 2026 U.S. Senate race with Oregon endorsement of Jeff Merkley

CIVPAC has published its evaluation of the 2026 U.S. Senate race in Oregon, completing its review of every Senate general-election race this year.

The Oregon evaluation endorses Democratic incumbent Jeff Merkley over Republican David Brock Smith, Libertarian Gary Dye and Progressive/Pacific Green candidate Chris Henry.

This is not an endorsement based on broad agreement with Merkley’s domestic agenda. The evaluation identifies substantial differences over Medicare for All, labor policy, wealth taxation and the use of government direction rather than market mechanisms to address climate change.

There are also important areas of agreement. Merkley has strongly supported Ukraine and has been an active advocate of Congress reclaiming its constitutional authority over decisions involving war. The evaluation also finds substantial common ground on democratic institutions and parts of Middle East policy. Merkley

Brock Smith is closer to CIVPAC on several economic and regulatory questions. But the evaluation raises concerns about climate change, the effort to challenge the 2020 election results, voting policy and abortion. OPB has reported both his rejection of human contributions to climate change and his participation in the 2020 Texas election challenge. (OPB) opb

His relationship with President Trump is also important to the evaluation. Willamette Week described Brock Smith as an outspoken Trump supporter and reported that, when asked whether he disagreed with anything Trump had done during his second term, he did not identify an example. CIVPAC was also unable to find sufficiently clear positions from him on tariffs, Ukraine, NATO or the Iran war. (Willamette Week) Willamette Week

In the end, the value of divided government tipped the balance. The Oregon evaluation argues that congressional checks on executive authority work less effectively when members of Congress are unwilling to challenge a president of their own party. For this moment, that consideration favors returning Merkley to the Senate. The endorsement is explicitly conditional: if the White House were occupied by a Democrat, particularly one well to the left of center, Merkley would probably not receive CIVPAC’s endorsement.

Read the full Oregon U.S. Senate evaluation and endorsement.

See all CIVPAC 2026 Senate endorsements and evaluations.

With the Oregon review, CIVPAC has now reviewed every 2026 U.S. Senate general-election race. We have published endorsements in 26 races, including Alaska, published evaluations without an endorsement in 3, and have 6 completed drafts still under review and awaiting publication.

That completes the research stage of the Senate project. The races will continue to be followed, and evaluations or endorsements can be revisited if significant new information warrants it.

Oklahoma Senate 2026: CIVPAC Publishes Candidate Evaluation

Oklahoma U.S. Senate 2026 candidate evaluation — CIVPAC no endorsement

CIVPAC has published its evaluation of the 2026 U.S. Senate race in Oklahoma. After reviewing all five candidates, we are not making an endorsement at this time.

The field offers Oklahoma voters unusually different choices: Republican Kevin Hern, Democrat N’Kiyla “Jasmine” Thomas, Libertarian Sevier White, and independents Ron Meinhardt and Curtis Stinnett.

Hern has the most extensive governing record and overlaps with CIVPAC on markets, taxation, regulation and fiscal discipline. But we have substantial differences with him over the 2020 election, presidential power, Ukraine, abortion and his close identification with President Trump.

Thomas offers a detailed domestic agenda and takes positions we regard as reasonable on a number of civil-rights, reproductive-choice and health-care issues. But her economic program would give the federal government a substantially larger role than CIVPAC supports, and important questions remain about fiscal and foreign policy.

Meinhardt’s emphasis on constitutional limits, congressional war powers and putting principle ahead of party machinery deserves attention. But his abortion position differs sharply from ours, and we found too many unanswered questions about his positions on major national and international issues.

Stinnett has produced an unusually detailed policy program. We appreciate the effort to confront difficult issues directly, but many of his proposals would move considerably farther toward federal direction of health care, wages, credit and resource allocation than CIVPAC favors.

There is simply too little publicly available information about White’s positions for us to make a meaningful comparison.

CIVPAC does not expect candidates to take centrist positions on every issue. We look instead at the overall combination of policy agreement, institutional responsibility, independence of judgment and willingness to confront difficult tradeoffs. In Oklahoma, none of the five candidates currently provides enough of that combination for us to make an endorsement.

Read our full Oklahoma U.S. Senate evaluation.

See all CIVPAC 2026 endorsements and evaluations.