President Trump made perhaps a politically life-threatening mistake for Republicans when his Justice Department joined the suit to invalidate all of Obamacare, then promised to present a plan before the 2020 election and said that any vote would occur after the election.
Contrary to how the mystery plan has been portrayed in the media, changing its arrival from before to after the election is actually worse. Now, Democrats can run with the message that Trump tried to destroy Obamacare (or maybe he will), let people suffer and will come back with another horrendous effort like the variations we saw in 2017, which were hugely unpopular.
Trump made a very bad issue for Republicans potentially fatal. They were already sucking wind on health care. Morning Consult reports in a survey taken March 29-April 1 (just after the administration embraced the strategy of wiping out the Affordable Care Act completely but before Trump’s tweets about a GOP plan):
Asked how much trust they placed in Trump or congressional Republicans to protect or improve the health care system, nearly 3 in 5 voters said “not much” or “none at all,” according to the latest March 29-April 1 survey. By contrast, a 53 percent majority of the electorate said they had “a lot” or “some” trust in Democrats on the same question. . . .
At the onset of the 115th Congress, voters placed their trust in Republicans over Democrats on health care by a 4-point margin — a lead the GOP lost and never recovered following its unsuccessful attempts to repeal and replace former President Barack Obama’s signature 2010 health law. Democrats’ current 12-point lead is consistent with the average 10-point lead the party has held ever since.
Even the “scariest” plan, the Medicare-for-all proposal embraced by Sen. Bernie Sanders (I-Vt.), does not get most Americans riled up. “Just over a quarter of voters — 26 percent — believe a single-payer system would be more disruptive to the health care system than overhauling the ACA (22 percent), while 18 percent said both would be equally as disruptive,” Morning Consult reported.
If politicians want to win the health-care debate, they’d do well to listen to what voters’ precise problems are. Drew Altman of the Kaiser Family Foundation writes that “it’s the candidates who can connect their plans and messages to voters’ worries about out of pocket costs who will reach beyond the activists in their base. And the candidates aren’t speaking to that much, at least so far.” He explains:
In a January 2017 Kaiser poll, 48 percent of voters worried about paying their health care bills. People who are sick are especially concerned, with 66 percent worried and 49 percent very worried.
It isn’t just in their heads: a whopping half of people who are sick have a problem paying their medical bills over the course of a year. The health insurance system is not working for people who are sick.
Thanks in part to the Affordable Care Act, only 10 percent of the population remains uncovered. But that means many Americans are less focused on getting to universal coverage, even though candidate after candidate talks about it. They have insurance and are focused on their own, often crippling health care costs.
In other words, Sanders’s focus on Medicare-for-all misses the mark by fixating on universal coverage.
Democrats would be smart to spell out the problem. “Deductibles rose eight times faster than wages between 2008 and 2018 for the 156 million Americans who get their insurance at work,” Altman says. Some 43 percent of Americans say it’s hard to pay medical bills, up 9 points from 2017. That shows that these candidates get the problem — and put the focus on Trump for making matters worse by, among other things, removing the individual mandate that keeps healthy people in the plan, withholding cost-sharing reductions designed to keep out-of-pocket costs low, and pushing “cheaper short term insurance plans for the healthy, which drive up costs for the sick because they leave fewer healthy people in the regular insurance plans to help pay for sick people’s costs.” In other words, Trump intentionally made Obamacare more expensive.
The Democrats should keep it simple. Increase the subsidies for premiums in the exchanges and fund the cost-sharing reductions. That alone would reduce costs for Americans. Sure, health care is expensive. Some Democrats want to go a step further and give people the option to sign up for Medicare. It’s not clear how Democrats would get the latter through the Senate (it’s not clear reconciliation would work), but a simple message — you keep what you want, you pay less — makes sense, given what people want. How to pay for it? Democrats will say roll back the Trump tax cuts and increase taxes even further on estates of the super-rich. Given how Americans feel about income inequality, that’s likely to get applause as well.