Navigating Health Care in the Midterms

Democrats’ Advantage

Voters trust Democrats more than Republicans on health care, but the Democratic message and ideas still are not resonating deeply enough. As poll after poll has shown, voters continue to rank lowering health care costs as one of their highest priorities, even before the pandemic. In fact, voters are more worried about Congress not doing enough to address high health care costs than about it doing too much. The Democratic advantage on this highly resonant issue may start to wear off if voters feel that their concerns are not being addressed.

This problem has been building up for years as rising costs have crushed American families. While voters think health costs are too high overall, they are most worried their deductibles and other personal costs will prevent them from getting the care they need. Cost increases used up 45% of workers’ raises from 2009 to 2019. And deductibles for employers with coverage at work have risen 111% over ten years. According to a 2020 Gallup survey, half of all US adults said that a major health event in their household would bankrupt them. For nonwhite adults, that number was closer to two-thirds. For many of the most vulnerable communities, cost remains one of the biggest barriers to care.

When it comes to health care, messaging is half the battle. That is why a framing shift from coverage to cost is crucial. Universal coverage is vital and health care is a right, not a privilege. But it’s important to recognize that it is a lower priority for voters because 92% of Americans already have health insurance. When Democrats frame health care conversations under the message of lowering people’s health care costs, it is more saliant to more voters.

Also, expanding the ACA resonates far more than Medicare for All. Those running on Medicare for All rarely won in red and purple races, and it’s a liability in all but the bluest places. In fact, in a January 2020 poll of the Blue Wall states, voters rejected Medicare for All by double digits in two of the three states. And a generic Democrat running on preserving and expanding the ACA performed better against Trump in the general election than one running on single payer. That played out not only in the Democratic primary but in the general election as well.

Maximizing Our Advantage

An organizing health care policy and message focused on lowering health care costs works with voters. As an example of one policy to consider supporting, Third Way has a Universal Cost Cap. This policy would cap everyone’s health care costs to a portion of their income no matter where they get their insurance—whether it’s through the exchanges, an employer, Medicare, or Medicaid. That means that a family could budget at the start of each year exactly how much they would pay for in total costs even if they were to have a catastrophic event.

The best part about this idea is that it’s simple, universal, and proven. Low-income families with ACA exchange plans already have cost caps in place. They were expanded in the American Rescue Plan, capping more people’s costs at 8.5% of their income. Among those who already had caps, these families spent 17% less on health-care costs and had a 30% less chance of going into debt to pay for health coverage.

Additionally, Democrats could characterize most of their recent health care pushes as cost caps, here’s how:

• Lower prescription drug costs, Democrats would cap out-of-pocket costs for drugs and expand the cap on drug costs for low-income beneficiaries.
• The American Families Plan will seek to make permanent the cost cap on premiums for people who buy their own coverage.
• And other cost cap provisions under consideration include:
  • Extension of a cap on out-of-pocket costs to more low-income Medicare beneficiaries (Medicare Savings Program).
  • Cap on hearing, dental, and vision care costs.
  • Cap on premiums for families with coverage at work (family glitch).
  • Expanded cap on out-of-pocket costs for people who buy their own coverage.

If Democrats can focus on cost caps as their unifying idea and messaging frame, then they will be speaking directly to voters’ primary concern. The best way to maintain our edge on health care is with a strict focus on lowering costs—our majorities could depend on it.

Contrasts

Here are some quick facts to use while engaging Republican opponents:

• Republicans have tried and failed 70 times to repeal, modify, or replace the Affordable Care Act.
• Donald Trump still hasn’t released his replacement for the ACA (and neither has any Republican).