As much attention as we all give to the latest outrage from President Trump, polls have repeatedly shown health care to be at or near the top of the public’s agenda when it comes to the midterm elections. Republicans are clearly nervous: They are planning symbolic votes in the House on the same old GOP health-care ideas (health savings accounts!) as a way of dealing with Democratic attacks on the issue.
Unlike many issues, with health care, Democrats can make a persuasive argument no matter to whom they are talking. To their own base, they can say, “Republicans tried to repeal the Affordable Care Act and take away Medicaid from millions, and now they want to do even more to take away health security.” And to swing voters, they can say, “Look what Republicans have done to you. Your premiums keep going up, your out-of pocket costs keep going up, and now the Trump administration even wants to take away protections for people with preexisting conditions. They said they’d fix everything, and they failed.”
Both arguments are correct. And in October, premium rates for 2019 will be announced, leading to a wave of stories about rising health-care costs.
The GOP is facing two political problems when it comes to this issue. First, the public is dissatisfied with the status quo, particularly rising premiums and out-of-pocket costs. Second, just about everything Republicans want to do about it is deeply unpopular. They’re in charge and things aren’t good — and the solutions they offer aren’t appealing either.
Here is another way to think about it. For years, Republicans have said: Put us in charge and things will be great. Once we sprinkle that free-market fairy dust all over your health care, it’ll be fantastic — you’ll get great care, have security, and pay less than you do now. Trump made particularly grandiose promises, saying “We’re going to have insurance for everybody,” and that it would be “Much less expensive and much better.” The claims were utterly bogus, but as long as it was a hypothetical future, Republicans could keep making them.
But that future has now arrived. Republicans are in charge. They didn’t succeed in repealing the Affordable Care Act, but they are still taking lots of actions that the public hasn’t heard about and that are far too wonky for most people to understand, such as suspending risk adjustment payments to insurers. The net effect is that insurance markets will be less stable and premiums will rise. In other words, at the levels people currently see in their lives, things will get worse. If there’s any saving grace, it’s that they didn’t manage to completely repeal Obamacare, which would have been absolutely catastrophic.
The root cause of these political difficulties, beyond the fact that free-market ideology isn’t equipped to deal with the health insurance market, is that on a fundamental level, Republicans just don’t care about health care as an issue. They got roped into talking about it when Democrats passed the Affordable Care Act and they decided to make it a symbol of nightmarish statist oppression. But, apart from a few resident scholars at conservative think tanks, none of them can be bothered to even learn the details of how the health-care and insurance systems work, let alone think creatively about how to solve their many challenges. Which is why they spent seven years railing against the Affordable Care Act and saying they’d “repeal and replace” it, but somehow never got around to coming up with a plan to do the replacing part, leaving them flat-footed when they got control of the entire government and had to follow through on all those promises.
It is why, even when they get the chance to implement their ideas, they fail: Witness this remarkable article in Politico about how the conservative National Federation of Independent Business, which spent couple of decades advocating for “association health plans,” got what they wanted from the Trump administration but now say they won’t be setting one up themselves because they have concluded “that establishing an association health plan would be too complex and not worth the effort.”
There is another effect of the unique combination of bad faith and incompetence that has characterized Republicans on the issue of health care: It has pushed Democrats to the left, making support for some kind of universal coverage all but dogma within the party. There is now a Medicare For All Caucus in the House which already includes a third of the chamber’s Democrats. As The Post’s Colby Itkowitz recently noted, “Of the 57 Democrats . . . who have won primaries and will challenge GOP incumbents in swing districts this fall, 33 support some form of Medicare for all, according to data from the Progressive Change Campaign Committee.”
While Republicans would like to imagine this creates an opening for them to cry “Socialism! Big government takeover!” the truth is that there is no evidence those kinds of attacks will work. We can have a substantive argument about whether Medicare for all is really the best path to universal coverage or how exactly it should be designed, but as a piece of marketing, “Medicare for all” is dynamite. Everyone loves Medicare, and the idea of just giving it to everybody is incredibly appealing. A recent Kaiser Family Foundation poll found that 59 percent of respondents favored “Medicare-for-all, in which all Americans would get their insurance from a single government plan,” while 75 percent favored a Medicare for all plan that would be open to anyone but not required.
That’s not to mention that this is all happening against the backdrop of another health-care issue: the fact that the newly conservative Supreme Court is likely to strike down Roe v. Wade, a move that would be a political nightmare for the GOP, and the prospect of which is likely to get even more liberals out to vote in November.
We’re still a few months away from the election, and it’s always possible that other issues will come up that will make voters think of something else besides health care. But for now, it’s just one more thing working against Republicans in November.