Update 299: Still Unrepealed and Undefeated,
Healthcare Weighs in at #1 Midterm Issue
Plus ça change. For the umpteenth cycle, healthcare is back on top among voting issues in the country. No surprise. The stakes are high and are faced practically universally. But anxiety and a sense of chaos surrounding basic protections and health-related economic issues have perhaps never been higher.
Today, we look at how healthcare is playing out on the campaign trail and offer an example of how the substantial and growing Democratic advantage on this central issue can be leveraged in the campaign context.
It’s the ACA, Stupid
Healthcare has been a hotly-debated area of policy among the American public long before the passage of the Affordable Care Act (ACA) in 2010. Despite initial hesitations, the majority of Americans now support the ACA and are worried about the prospect of it being repealed.
There are three main consequences of weakening and/or repealing the ACA that voters fear the most:
- Pre-existing condition protection loss: 133 mil. Americans under 65 have a pre-existing condition. Before the ACA, insurers could deny these people coverage or charge them exorbitant rates. Nearly three quarters of Americans want Congress to preserve the pre-existing condition protections codified in the ACA. Still, 20 states have signed a lawsuit against the federal government that, if successful, would render this provision and the ACA at large, unconstitutional. Some in the GOP realize they may be on the wrong side of the debate. In late August, Sen. Thom Tillis, with nine other red-state Senators, proposed a bill to protect the pre-existing conditions provision even if the ACA is repealed (S.3388, Ensuring Coverage for Patients with Pre-Existing Conditions Act).
- Skyrocketing premiums: When it comes to the ACA, many Republicans are in full sabotage mode. Last year, the October announcement by the Trump administration to end cost-sharing subsidies to insurers increased mid-tier “Silver Plan” premiums by between 7 and 38 percent. Last December, the individual mandate penalty was eliminated following the Tax Cuts and Jobs Act, taking healthy people out of the marketplace. This year, the Trump Administration expanded short-term, non-ACA compliant “junk” plans, originally designed to be transitory coverage. The individual mandate repeal and the short-term plan rule change are predicted to raise premiums an average of 16 percent in 2019.
- Higher out-of-pocket costs: Before the ACA, there were no limits to out-of-pocket expenses, leaving many Americans at-risk of financial ruin if they had a serious accident or illness. With the passage of the act, “even high-deductible plans must limit out-of-pocket expenses to $14,300 for a family or $7,150 for an individual.” Since the introduction of the ACA limits, out-of-pocket healthcare expenses have fallen as a share of total health spending. If the Texas lawsuit is successful and the ACA is deemed unconstitutional, Americans are rightly concerned that it might spell the return of out-of-control out-of-pocket expenses.
A Gallup poll earlier this year reported that Americans have listed the availability and affordability of healthcare as their number one concern for the past five years — above crime and the national debt. A once-unpopular law, recognition of the positive effects of the ACA and endless threat of repeal by the GOP have altered the political tide.
A Midterm Malady for Republicans
Republican attacks on key ACA provisions, such as pre-existing condition protections, have proven to be increasingly unpopular with Americans:
Source: Washington Post
Republicans face electorates who are angered by the slew of sabotaging measures enacted by the Trump Administration and GOP Congress over the course of the past two years. Democrats across the country are campaigning on an antithetical message to Republicans as they vow to protect Americans’ healthcare. In fact, over half of political ads for pro-Democrat candidates have focused on their healthcare message, compared to just 20 percent for pro-Republican candidates. Candidates are tailoring their messaging according to their regional zeitgeist, but whether it is Medicare-for-all or protecting the vital provisions in the ACA, their difference from the GOP on this issue is stark.
Since 2013, Americans’ views of the ACA have shifted steadily from unfavorable or unsure, to supportive. In February 2013, 36 percent of Americans supported the law, 42 percent did not, and 23 percent were unsure. This compares to a poll in August of this year where 50 percent of Americans said they supported the ACA, 40 percent did not, and just 10 percent were unsure. In the past five years, as the number of unsure Americans has halved, a majority of those uncertain individuals have come to view the 2010 reform bill favorably. Among Democrats, ACA support remains high at 77 percent of individuals polled. Slowly but surely, the public consensus on healthcare is rising and Republicans are increasingly finding themselves on the wrong side of the issue.
Democrats United Against the GOP
The common thread among Democratic candidates and incumbents is clear: protect healthcare. The way candidates are getting to that core message varies by district. Sen. Sanders’ campaign in 2016 brought Medicare-for-all into the mainstream. A policy idea once thought of as too radical for America, single-payer healthcare has become a more salient concept in unexpected parts of the country. In NE-02 and CA-45, both R-leaning districts, Kara Eastman and Katie Porter won their primaries running with healthcare, specifically Medicare-for-all, at the forefront of their campaigns. However, running on Medicare-for-all seems to be an exception rather than the rule.
In the majority of districts across the country, constituents are concerned with protecting the status quo and lowering costs rather than transforming the whole system. In MI-11 and TX-23, another two R-leaning districts, Haley Stevens and Gina Ortiz-Jones are running on an affordable healthcare message with the intention of defending and strengthening the ACA as opposed to replacing it with Medicare-for-all.
The Dakota Experience
In July, a local healthcare advocacy group, Dakotans for Health, deployed a strategy in North Dakota to drive home a pro-ACA message. Using a local report on the impact of ACA repeal and focusing specifically on the implications of taking away the pre-existing condition protections, Dakotans for Health created a buzz in the local media. Prominent figures such as former Congressman Earl Pomeroy, and former Sec. Mary Wakefield, Secretary of HHS during the ACA implementation years, took to the airwaves with the pro-ACA message.
Over the course of 10 hours, Earl and Mary gave around 15 interviews to local news and radio stations. After this 24 hour earned media drive, the initiative created a cascade effect, bringing the healthcare issue to the fore and creating a strong platform for Democratic candidates in the state to positively discuss the issue with the electorate. This same kind of model is not just marketable in the Dakotas. The Dakotans for Healthcare media blitz is replicable in smaller, more-rural districts all over the country. The model helps to amplify Democratic messaging on an issue that is proving popular with voters — a Pew Foundation poll in June found that voters trust Democrats over Republicans on the issue by a 16-point margin.
Don’t Forget Healthcare
During this election cycle, healthcare is playing out on center stage as an economic issue. Household budgets are being squeezed by rising premiums and any wage gains are being negated by the rising cost of healthcare under the Trump Administration and a GOP-led Congress. Regarding healthcare this cycle, Democrats are light years ahead of Republicans in the polls and policy. Candidates should double-down on their healthcare messaging ahead of November in the race to win back the House.