Health care was a central topic of last year’s Democratic presidential debates.
A year later, the focus has shifted. Those who watched the Republican and Democratic conventions heard more about leadership, threats to the democracy, violence and the pandemic.
COVID-19 “sucked up a lot of the health care space,” said UNC’s health politics expert, Jonathan Oberlander. “And protests in cities and the police have sucked up a lot of the remaining oxygen, so there’s not much room left.”
There is some irony in the fact that the worst health care crisis in our lifetime has taken the focus off of health care coverage, even though, according to the Economic Policy Institute think tank, an estimated 6.2 million Americans lost their employer-sponsored health coverage because of the coronavirus-caused recession.
A year ago Joe Biden was focused on his plan to strengthen and expand on the Affordable Care Act, also known as Obamacare. By this summer, however, most of his campaign ads were more likely to mention COVID-19 , the economy, business and jobs. Health care ranked fifth in importance in Biden ads, according to a survey by the Wesleyan Media Project.
As for the Trump campaign? The Wesleyan study found almost all of its ads focus on crime, protests and riots. Health care didn’t rank among the top issues.
That may be because — while Americans still think health care coverage is a major problem — that’s not what’s going to drive them to the polls. The Pew Research Center found that Trump’s voters say the economy and crime are their most important issues. And the main reason Democrats will vote for Biden? He’s not Donald Trump.
But the fact is, Americans remain very worried about their health care, especially its cost. A recent Gallup poll found half of all U.S. adults fear a major medical event will push them into bankruptcy. And according to an NBC News-Commonwealth Fund poll, one in three Americans worry they can’t pay their medical bills. That includes some people who have insurance.
“They have health insurance but they don’t want to use it because they’re so afraid of what they’re going to have to pay out of pocket,” said Liz Hamel of the Kaiser Family Foundation.
“There are actually people with employer-based coverage which has become so skimpy that they are making choices about using their health care or buying groceries.”
Health care is a pocketbook issue, agrees Amelia Thomson-DeVeaux of the politics site FiveThirtyEight.
“People really want to hear from politicians about how their costs are going to be affected, how their health care is going to get better and you know maybe a little bit more cautious about big changes to the system,” she said. “They might not trust government to carry those out.”
That may be one reason why Democratic primary voters preferred Biden, with his plan to strengthen and expand existing law, over his “Medicare for all” primary opponent, Bernie Sanders.
And when Trump talked about health care in his convention speech, he didn’t mention his four-year campaign to overturn the Affordable Care Act. Instead he talked about bread-and-butter issues like his recent executive orders to reduce drug prices and his promise to reduce surprise medical bills. And he pledged that he’d prevent insurance companies from discriminating against people with preexisting conditions, although that’s already prohibited by the ACA.
“Those are popular things,” said Thomson-DeVeaux, though he doesn’t think the election-year orders will have an immediate impact. “The question is whether an incumbent president who doesn’t have a lot of concrete successes to show on health care can make that case compellingly to voters who really may have not seen that many changes in their own experience.”
The Trump campaign says it has a lot of concrete successes, including its expansion of telemedicine to help rural residents and the repeal of an Obamacare provision which “forced people to buy expensive insurance and taxed those who couldn’t afford it.”
But UNC’s Oberlander thinks voters will remember that “Trump strongly supported Republican legislation in Congress in 2017 that would have ended the Affordable Care Act’s protections for consumers who have preexisting conditions and allowed states to opt out of those protections.”
Oberlander also questions the political wisdom of the president’s recent decision to join an ongoing lawsuit asking the U.S. Supreme Court to overturn the entire Affordable Care Act, including its consumer protections.
“I think it puts Republicans and President Trump in a very difficult political position,” Oberlander said, “because here we are in the middle of a pandemic, millions have lost their jobs, and at least several million have lost their health insurance.”
It could be a factor in North Carolina's U.S. Senate race, in which Democrat Cal Cunningham is putting health care front and center in his bid to unseat Republican Thom Tillis. Cunningham is running a series of ads highlighting Tillis’ vote to repeal the ACA and for blocking Medicaid expansion for the state’s poorest residents. Like Biden, Cunningham supports strengthening the Affordable Care Act and expanding Medicaid. His campaign says that’s especially important now because an estimated 238,000 North Carolinians have lost their coverage because of the recession, according to a June report by the left-leaning organization Families USA.
Cunningham’s campaign says its health care message will help with swing voters. It points out that Medicaid expansion has proved popular with voters in states that are more conservative than North Carolina. Missourians and Oklahomans, for example, recently voted for Medicaid expansion, overcoming the resistance of their elected representatives.
The Tillis campaign so far hasn’t emphasized his health care positions. Back in 2014, he unseated Democratic Sen. Kay Hagan in a campaign based in part on his opposition to the ACA.
Tillis ad: “Obamacare is a disaster, and the president won’t admit it.“
Tillis’ campaign says Obamacare still isn’t working and Tillis would prefer “a market-based solution,” although congressional Republicans have been unable to come up with one.
The campaign also says Tillis opposes the “Democrats’ government takeover of our health care system that will eliminate the employer-based coverage that 150 million Americans are happy with” although neither Biden nor Cunningham support such a plan.
On his opposition to Medicaid expansion, Tillis points out that North Carolina’s program had been mismanaged and had to be fixed first. But he won’t comment on whether expansion should now go forward, saying that decision should be left up to the state.
The race in North Carolina is one of a handful which will determine which party controls the U.S. Senate, so there’s plenty of outside money pouring into the state. Majority Forward, which last year spent $36 million on ads attacking Republican Senate candidates, is airing footage of Tillis taking credit for stopping Medicaid expansion in the state.
And the Taxpayers Protection Alliance, a Washington, D.C.- based conservative group, is paying for an ad thanking Tillis for standing up against a “government-run Medicare for all scheme,” although the group’s president admits the “scheme” he stood up to was actually a Republican bill on surprise medical bills, not government-run insurance.
Voters may begin to hear more about the candidates’ health care plans soon. The first Tillis-Cunningham debate aired Monday night and Trump will debate Biden at the end of the month. But Oberlander says that regardless of whether voters focus on health care, this election will have dramatic consequences for health care in the coming years, even if the Supreme Court upholds some or all of the Affordable Care Act.
If Trump is reelected, Oberlander said, he “will use executive orders, state waivers, rulemaking and so forth to undermine the law. That’s what they’ve tried in the last four years. A President Biden would try to strengthen and expand Obamacare.”
But how far a Biden presidency could go depends very much on which party controls Congress. And that will depend, in part, on the results of the Senate race here in North Carolina.
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