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Opinion Health care will dominate the midterms. That won’t help Republicans.

House Speaker Paul D. Ryan (R-Wis.) on Capitol Hill on March 22. (J. Scott Applewhite/AP)

Health insurance is poised to turn into a major political issue this fall. That is the almost certain result of last week’s failure by Congress to attach payments to insurers — meant to financially stabilize the health-care exchanges — to the government spending package signed by President Trump last Friday.

As a consequence of that failure, the Wall Street Journal reported, “health-insurance premiums are likely to jump right before the November elections.”

Spoiler alert: this will almost certainly cause major problems for the already troubled prospects of Republicans running for Congress.

The most recent evidence comes from Gallup, which released a poll today showing that 55 percent of Americans worry “a great deal” about “the availability and affordability of healthcare.” That group includes slightly more than seven out of ten Democrats, as well a majority of self-described independents. Thirty-nine percent of Republicans agreed with the statement, as well.

Making the Gallup finding even more remarkable: even as coverage of gun control spiked in the weeks following the deaths of 17 people in a mass shooting at a Parkland, Fla., high school, health care concerns still trumped crime and violence, and the availability of firearms.

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The Gallup poll echoes previous findings. Last December, an Associated Press-NORC Center for Public Affairs Research poll found that nearly half of Americans identified health care as the number one issue they wanted government to focus on in 2018. Similarly, a poll by HuffPost/YouGov in spring 2017 said 45 percent of voters said health care was one of their top two issues.

And why wouldn’t consumers blame Republicans for the continuing woes of the Affordable Care Act? Republicans politicos have spent the better part of eight years railing against it and, since Trump’s victory in 2016 left them in charge of both Congress and the executive branch, they have devoted no small amount of time attempting to undermine or destroy it.

For example, after the GOP drive to repeal the law failed, the tax reform package passed in December did away with the mandate requiring individuals to either acquire insurance or pay a fine. That’s something that will cause premiums to increase. Why? The people most likely to sign up for coverage will disproportionately be likelier to need to use it. Those who are healthy and expect to remain so are more likely to decide they have better uses for their money.

Then there is the Trump administration’s ongoing effort to set up what can only be termed a parallel insurance market by loosening the regulations on less than comprehensive short-term plans. While current regulations limit sign-ups to three months of coverage, the Trump administration is proposing allowing a household to purchase such a plan for a year. These policies are allowed to prescreen potential enrollees for pre-existing conditions, and they do not need to cover such things as prescription drugs. If this comes to pass, this will also almost certainly put more pressure on the exchanges.

And let’s not forget the Trump administration recently granted permission to Kentucky and Indiana to impose work requirements on able-bodied Medicaid recipients. Now a number of states are also seeking to put lifetime limits on Medicaid coverage, at least for those they say are capable of working.

Even before last week’s lack of congressional action, health-care experts were predicting major woes for the Affordable Care Act beginning in 2019. A recent report by Georgetown’s Center on Health Insurance Reforms and the Urban Institute, based on interviews with insurance company executives conducted in late 2017, found that almost all of them expected significantly increased premiums in 2019.

Compounding the political impact of this: It is not only people who obtain insurance through the Affordable Care Act exchanges who find out about their premiums for the following year in the weeks leading up to Election Day. Employers also reveal their changes for the following year at that time.

This seems to have the effect of reminding voters how much they are spending on health care themselves: A majority of Americans who obtain their health insurance through work now have plans with four-figure deductibles, and their out-of-pocket spending on medical care is up by more than 50 percent since 2010. I have long argued that many Americans conflate their feelings about the Affordable Care Act with their feelings about the health-care system overall. If they are angry at the system, they may now turn on Republicans — similar to how many blamed Democrats for their woes during the Barack Obama presidency.

Look no further than Pennsylvania, where a poll conducted by Public Policy Polling during the recent special congressional election found that a majority claimed health care was the political issue that concerned them the most. That district, which Trump carried by 20 points in 2016, went to Conor Lamb, a Democrat who campaigned on a platform of fixing the ACA while his Republican opponent argued for its repeal.

In the last few elections, Republican politicos viewed health care as a political cudgel to attack Democrats. Many Americans probably hoped they would do something to help them deal with it. Now that they haven’t, voters are turning on them over the issue. Karma!