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Opinion The oft-forgotten key issue in 2020

People celebrate outside the Supreme Court after a ruling in favor of the Affordable Care Act on June, 25, 2015. (Bill O'Leary/The Washington Post)

Last month, longtime pollster Stan Greenberg listened to a number of focus groups conducted in working-class and rural areas of Wisconsin, Michigan, Maine and Ohio. They were heavy on people who supported President Trump in 2016, and many were now leaning toward voting for Joe Biden in 2020. But if Democrats want to gain these voters, they’ll need to do better on one key issue.

“In today’s working class and rural communities, health care is everything,” Greenberg wrote in recent piece in the American Prospect. “The health care system is failing them, and they want someone to fix it.”

And they will vote for whomever promises to do just that — and abandon those leaders when they don’t deliver, Greenberg warns. It’s why they voted for Trump in 2016, and why they turned on the Republican Party in 2018. (It’s also, I should add, one reason people voted for Barack Obama in 2008 but turned on the Democratic Party in 2010. As I’ve long observed, people seem to conflate the phrase “Affordable Care Act” with their own situation.)

As for now, it’s the covid-19 pandemic, but it’s more than that. It’s the epidemic of opioid deaths — which appear to be rising significantly this year — and the increasing costs of coverage, both of insurance, co-pays and other out-of-pocket expenses. It’s the impossibility of navigating our health-care system and managing to emerge financially intact.

Full coverage of the coronavirus pandemic

These long-running crises are more pressing than ever. More than 4 in 10 working-age Americans experienced inadequate health-care coverage at some point in the past year — either because they lacked health insurance or were forced to pay such a high percentage of their income in the form of deductibles and co-pays that they might as well have been. The percentage of people with a deductible of $1,000 or more has doubled since 2010 and now stands at 46 percent, according to a recent Commonwealth Fund survey. In particular, 40 percent of Latinos reported lacking insurance either at the time of the survey, or at some point within the past year, something to keep in mind when wondering why, as a group, they are much more likely to die from covid-19 than White Americans.

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Over and over again, people sitting in the focus groups Greenberg listened in on talked about medical bills in the tens of thousands of dollars, and how the high deductibles made health insurance plans all but unusable — one person had a $16,000 deductible — and arbitrary denials that made their often hard lives even more precarious. One women discussed not being able to afford an EpiPen for a grandchild suffering from allergies after her insurance company refused to authorize it.

Biden says he plans to improve on the Affordable Care Act, increasing subsidies as well as demanding that Medicare negotiate with pharmaceutical companies over the price of drugs, something currently banned by law. He also says he will offer up a “public option” — a Medicare-like government offering that competes with private insurers — and expand Medicare to cover people 60 and up.

But how serious Biden, who has been a faithful servant of corporate interests for the entirety of his legislative career, is about fixing the monster that is our health-care system is entirely unclear. The medical industrial complex is adamantly against the public option, for starters. Biden says he’s committed, but when the Hill recently asked the Biden campaign whether officials would immediately present legislation on a public option, or start with smaller health-care fixes, the newspaper received no response. And as Libby Watson noted at the New Republic, at the Democratic convention, even Sen. Bernie Sanders (I-Vt.) didn’t mention the public option during his appearance.

One of the conundrums of the Democratic primaries — when Medicare-for-all loomed large — was that a large number of people supported substantive health-care reform but often didn’t vote their preference. They’re supporting Biden over Trump, in many cases, because they want to see Trump gone, not because they support his position on health-care reform.

Moreover, Biden’s health-care pitch, much of which rested on the shaky premise that Americans loved their workplace health insurance, increasingly feels like something out of a time warp. Tens of millions of Americans have lost their jobs since mid-March, and the pace of weekly layoffs is picking up.

Republicans certainly have no answer. When a constituent with cancer recently called Sen. Thom Tillis’s (R-N.C.) office asking about the high cost of health insurance and her fears she would lose hers, the response was heartless. “Sounds like something you’re going to have to figure it out,” the staffer told her, while comparing the need for health insurance to a “new dress shirt” she shouldn’t buy if she couldn’t afford.

But if the Democrats don’t come up with a solution that actually helps people — if they don’t put a stop to surging premiums and deductibles, not to mention arbitrary denials and surprise medical bills and the entire cornucopia of financial horrors that comes with accessing the most necessary and needed health care in the United States, it seems likely voters will, once again, move on. If Biden is elected president but fails to deliver, don’t be surprised to discover that 2022 turns out to be a repeat of 2010.

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Read more:

Helaine Olen: How’s that workplace health insurance working out for us now?

Catherine Rampell: On health care, is Trump malicious or just incompetent? Yes.

Helaine Olen: We’re in a pandemic. Why have we stopped talking about Medicare-for-all?

Paul Waldman: A political disaster is looming for Republicans on health care

The Post’s View: We must learn the lessons of the pandemic. A bipartisan commission can help with that.