Cost is Key: How to Message Health Care in the Build Back Better Act

Democrats in Congress not only need to pass the Build Back Better (BBB) reconciliation bill—they also need to frame it so it resonates with voters. Luckily, there are a series of health care measures in the House version of BBB that could end up in a final deal and have a significant impact on voters’ lives. These include a cap on drug costs and other expenses in Medicare, a cap on premiums in the exchanges, and a cap on all costs for low-income Americans living in a state that has not expanded Medicaid. Once a final deal is sealed, it will be critical to talk about them effectively.

New polling from Third Way and GBAO confirms the wide support for framing the health care sections of reconciliation as cost caps and offers additional tips for an effective message to show voters what Democrats are fighting for. Below is a summary of the poll results.

Cost is key – Democrats, Independents, and Republicans all agree that cost is their top health care concern.

• When given five choices on which aspect of the US health care system is most in need of change, voters ranked “the cost of health care for most people” as the top problem (39%).” In second place at 22% was the concern that people were getting free or subsidized health care they don’t deserve. Only 11% answered “the number of people who are uninsured.”
• Voters were particularly concerned about runaway costs in case of a medical emergency and getting nickel and dimed for routine things like getting an aspirin in a hospital or changing a bandage. When asked what they liked about the cost caps proposal, 82% favored protection from bankruptcy in case of a medical emergency, and 76% favored protection from high costs for routine things like bandages and aspirin.

Health costs, like premiums and deductibles, are “kitchen table” concerns.

• Most respondents were satisfied with their current coverage. Of those that were dissatisfied, 80% were dissatisfied with the costs of their coverage split between their premiums (38%), out-of-pocket expenses not covered by insurance (23%), and deductibles (19%).

A “Cost Cap” that would limit health care costs for everyone is popular along the ideological spectrum and across racial groups.

• Before presenting arguments for and against a cost caps proposal, the idea of capping costs on individuals’ current health care plans had majority support across all groups, including Republicans.
• After hearing positive and negative messages, Democrats remain in support of the policy at 89% in support, as do independents at 62% in support. Even 52% of Republicans expressed support for the cost caps proposal after hearing arguments for and against.

Messages that resonate—focusing on protection from bankruptcy, runaway expenses in case of a medical emergency, and hidden costs.

• 72% of voters said a message focused on protection from bankruptcy and runaway costs in case of an accident, illness, or a sick child was very or somewhat convincing. 69% said a message focused on protection from billing abuses and hidden costs, like huge bills for bandages and aspirin, was very or somewhat convincing.

Messages that don’t resonate—fairness.

• There was a 12-point gap in favorability between the message we tested focused on lowering costs and the message focused on making our health care system more fair, with 72% preferring lowering costs to 60% preferring fairness.