Drew Altman, Kaiser Family
Foundation April 1, 2019
As the 2020
campaign ramps up, Democrats may be able to rally their base by talking about
universal coverage and making health care a right through Medicare-for-all.
Republicans may be able to motivate their core voters by branding progressive
Democratic ideas as socialism.
The
catch: But it’s the candidates who can connect their plans and messages
to voters’ worries about out of pocket costs who will reach beyond the
activists in their base. And the candidates aren’t speaking to that much, at
least so far.
By the numbers:
- The anxiety over out of pocket
costs is real. In a January 2017 Kaiser poll,
48 percent of voters worried about paying their health care bills.
- People who are sick are especially
concerned, with 66 percent worried and 49 percent very worried.
- It isn’t just in their heads: a whopping half of
people who are sick have a problem paying
their medical bills over the course of a year. The health
insurance system is not working for people who are sick.
Thanks in part to the
Affordable Care Act, only 10 percent of the population remains uncovered. But
that means many Americans are less focused on getting to universal coverage,
even though candidate after candidate talks about it. They have insurance and
are focused on their own, often crippling health care costs.
- Most Americans are
healthy and
don’t use much care, but almost everyone, not just people with a major
illness, worries about what might happen if they or a family member get
cancer or heart disease or suffer a permanent injury.
- That's what fuels health
care as
an issue: the fear of facing costs people know they cannot
afford. And that’s why protections for people with pre-existing
conditions broke through as a prominent issue in the midterm election.
- The debate and the Democratic message could shift back
to the ACA again, after President Trump and the Justice Department’s
surprise decision to push for throwing out the entire law in the courts.
That move handed Democrats a political opportunity they will not ignore: a
pre-existing conditions debate on steroids.
Recent trends
have made problems with out of pocket costs worse:
- Deductibles rose eight
times faster than wages between 2008 and 2018 for the
156 million Americans who get their insurance at work.
- Forty three percent of all insured
Americans said in 2017 that it was difficult to pay their medical bills
before their deductible kicked in, up from 34 percent just
two years before.
Some of the
administration’s policies are exacerbating the problem, such as their
efforts to push cheaper short term insurance
plans for the healthy, which drive up costs for the sick because
they leave fewer healthy people in the regular insurance plans to help pay for
sick people's costs.
- Several of the candidates' plans address out of
pocket costs, including the Bernie Sanders plan, which eliminates them.
Their advocates just don’t talk about it much.
The bottom
line: It’s hard to see the new debate about the health system breaking
out of familiar boxes unless the messaging changes. And when the general
election comes, both parties will have to convince voters that they will do
something about out of pocket costs if they want to reach beyond core base
voters.
https://www.axios.com/winning-2020-health-care-out-of-pocket-costs-d5708e35-b308-4c91-a636-121e45f82032.html?utm_campaign=KFF-2019-Drew-Columns&utm_medium=email&_hsenc=p2ANqtz-_6WRVomMiiy8lsWxE8cAZy8hUDP-gFGG_vfoEcb7l59hR6UslFBD_YXOzwy0oDceDkALKPVO3c3CrJMIMTK2O6mDKqvQ&_hsmi=71313948&utm_content=71313948&utm_source=hs_email&hsCtaTracking=ab8ab66c-3d1b-42a1-b953-c4d046bcff5b%7Cfce949c7-8410-4639-aec1-8fc0b63660e1
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