Megan Shade and Victoria Rivera participate in a protest outside the office of Rep. Carlos Curbelo (R-Fla.) in Miami to ask the congressman to protect the Affordable Care Act. (Joe Raedle/Getty Images)

In 2012, Barack Obama won Macomb County, Mich., by 16,000 votes. Four years later, Hillary Clinton lost the same county by three times that — a 64,000-vote swing in a state that Donald Trump won by only 10,000 votes overall. In February, Democracy Corps’s Stan Greenberg conducted a focus group in Macomb with Democrats and independents who shifted to Trump after voting at least once for Obama to see whether they might return to the Democrats in the future. What issue came up most? “The cost of health care dominated the discussion in these focus groups,” Greenberg writes. “They speak of the impossibly high costs and hope Trump will bring ‘affordable healthcare.’ ”

The GOP leadership’s disastrously designed replacement for Obamacare has only highlighted the fact that millions of Americans struggle with the rising costs of health care. Instead of offering their own plan to fix and build on Obamacare, though, Democrats have opted to simply let the Republicans fail. The strategy could cost them in the long run.

Even before the new president and Congress were sworn in, Democrats had settled on “stay quiet.” Politico reported in February that although Democrats will “publicly goad Trump on subjects he’s clearly sensitive about . . . on other issues, like Obamacare and tax reform, they’ll get out of the way and let Trump and House Republicans fall on their face.” With some exceptions, such as Sens. Chris Murphy (D-Conn.) and Bernie Sanders (I-Vt.), most of the Democratic caucus has stuck to that plan.

There is a certain logic to this approach. In a debate, you don’t interrupt while your opponent is floundering. Creating a Democratic alternative would give the GOP something to unite against. It could also alienate health-care-industry interests — doctors, hospitals, pharmaceutical lobbies and so on — that might otherwise rally to Democratic candidates.

But the cost of health care is not a news cycle to be won. It is a major, everyday problem that represents a key test for voters of whether a politician or party is serious about addressing their concerns. It’s not just Macomb voters who want answers: Two-thirds of Americans believe lowering health-care costs should be a “top priority” for lawmakers.

(Reuters)

The Affordable Care Act’s defenders will point out that the main goal of the law was to reduce the number of uninsured, that the law probably slowed the rise of premiums and that most people with plans purchased on the ACA exchanges are happy with their premiums and deductibles (though that majority has shrunk since the exchanges opened). All these arguments are true. They are also cold comfort to people facing still-rising costs, with premiums for employee plans climbing 50 percent in the past eight years. This is reflected in the fact that, even as the ACA’s approval rating ticks into positive territory for the first time, few believe the law is perfect. In a February NBC/Wall Street Journal poll, only 4 percent of respondents said they thought the law was “working well the way it is.” In poll after poll, most who support the law still say it needs fixing.

This is where Democrats will shout: “Clinton did have a health-care policy!” That’s true, but her campaign didn’t make much use of it. A recent study found that more than 60 percent of the ads Clinton and her allies ran were focused solely on the candidates’ personalities, rather than policy, “a huge difference from every other presidential campaign” since 2000. (Yes, that includes Trump — 70 percent of his side’s ads had at least some mention of policy.) It should not be surprising that Clinton’s health-care plans didn’t move most voters.

Even some conservatives recognize that the GOP rollout leaves an opening. On Tuesday, Trump ally Christopher Ruddy, chief executive of the conservative media company Newsmax, wrote that Trump “should be sticking to his guns on healthcare reform” — i.e., his repeated support for universal coverage — instead of following the House GOP’s plan. Ruddy goes so far as to suggest that Trump back a Medicaid-for-all plan. After all, Ruddy points out, that position helped “him win Democratic states like Wisconsin, Michigan and Pennsylvania.”

Rather than stay on the sidelines, Democrats in Congress should introduce and promote a new health-care plan. The outlines of such a plan are straightforward: expand Medicare and Medicaid, create a public option for everyone else that can use those programs’ pricing power, push regulatory reforms to lower drug prices, and give Medicare the power to negotiate prescription drug prices. Many progressives would prefer a Medicare-for-all system, but this plan would satisfy most of the party, and it has the political advantage of being closely tied to the extremely popular Medicare program.

More important, it’s a real policy solution that could appeal to millions of struggling Americans, regardless of whom they voted for in November. Voters want solutions, not silence.