Candidate Health Policy Proposals Not Aligned With Voter Concerns

Christopher Holt January 10, 2020

In less than a month, voting begins in Iowa in the Democratic presidential primary, and health care is one of the top issues for voters. A plethora of polling tells us that voters are concerned about rising health care costs, so of course the candidates are fixated on … not costs, but coverage.

Recent polling commissioned by the Bipartisan Policy Center (BPC) found health care to be the number one issue for voters in 2020. Fifty-six percent of voters nationally listed health care as one of their most important issues when thinking about who they will vote for; the economy broadly came in second at 44 percent. Democrats and Independents cited health care more than any other issue as one of their top concerns, but even among Republicans it was the third-most mentioned policy concern.

It isn’t surprising, then, that health care has been a major topic among Democratic contenders. But the BPC polling digs deeper, showing that what voters care about most is the cost of health care. Among the top four health care issues cited by voters, three are explicitly about costs. In other polling, conducted by CBS last fall, 66 percent of Americans said health care costs are the nation’s number one health policy challenge, while 56 percent cited universal insurance coverage. Only 45 percent said that improving quality was their top concern.

All of this makes sense: Americans are largely happy with the care they receive, and a majority of Americans think their own health care is affordable. But issues such as surprise medical bills, increasing pharmaceutical prices, and the growth in out-of-pocket costs have made Americans nervous that they won’t be able to afford care in the future.

Nevertheless, the Democratic presidential candidates have chosen to focus on, wait for it, expanding coverage. Medicare-for-All (M4A), Medicare Buy-in, and even many proposals to build on the existing foundation of the Affordable Care Act (ACA) are all primarily aimed at addressing activists’ disappointment that the ACA didn’t cover more Americans. Notably, these proposals are not focused on bringing down health care spending.

Expanding coverage in and of itself won’t stem rising health care costs. If anything, the type of single-payer system Senator Sanders is advocating will lead to increased utilization and increased spending. Voters seem to understand this fact, as overall support for a M4A system is low. According to BPC’s polling, when given the choice between repealing the ACA, enacting M4A, or the nebulous “Improving the current health care system,” more Americans surprisingly support repealing the ACA (23 percent) than passing M4A (22 percent). And new polling from the Kaiser Family Foundation found Democrats prefer elected officials focus on improving the ACA (51 percent) over enacting M4A (38 percent).

Not only is a focus on coverage strategically questionable, but the problem of the uninsured is smaller than it looks at first glance. The most recent figures show that roughly 28 million individuals are still uninsured 10 years after the ACA’s passage. In some ways, for many progressive voters, the original sin of the ACA is that it didn’t achieve universal coverage. But the majority of those who are uninsured today do have coverage options, either through an employer or public insurance programs they have simply not signed up for. The number of Americans who are truly lacking coverage options is relatively small—most obviously the 2.4 million adults below the federal poverty line who live in states that didn’t expand Medicaid.

It will be interesting to watch how all of this plays out, but as of right now Democratic candidates and voters seem to be talking past each other.

https://www.americanactionforum.org/weekly-checkup/candidate-health-policy-proposals-not-aligned-with-voter-concerns/#ixzz6B0s554xf
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