Republicans got pummeled at the ballot box last month on health care. Yes, it was an anti-Trump wave, centered in districts dominated by college-educated whites who deeply dislike the President. But, the often comparatively moderate candidates who dominated Democratic gains explicitly ran on health care as part of agenda designed to appeal to voters rather than inflame them – and not single-payer or Medicare-for-all either, but more modest undertakings such as protecting the Affordable Care Act/Obamacare.
Republicans may be prone to pay little heed to such a trend because aside from opposing Obamacare, health care is a leading campaign issue for Republicans about as often Democrats run on regulatory relief for small businesses. Yet, health care was not only the leading issue for Democrats, accounting for ½ of their advertising, it led exit polls as the top issue of voters at 41% (immigration was a distant second at 23%). Those citing health care voted 75/23 Democratic.
That’s, um, decisive.
But, health care didn’t just win at the Congressional level. Citizen initiatives to approve Medicaid in expansion in the face of reluctant legislatures all won in deep red states: Utah, Idaho, and Nebraska. Meanwhile, Kansas and Maine elected Governors who will not act as barriers to previously approved expansion in those states like their Republican predecessors. The map of state Medicaid expansion shows only 13 states that have not expanded Medicaid (presuming the Kansas legislature again sends Medicaid expansion to the Governor), which excepting current GOP legislative control in Florida and Wisconsin are deep red states.
Yes, again, it was a Democratic year, but health care was a winning issue in 2018.
The skeptic might say, “so what, why should it be again?”
Do you care about controlling government spending? Then health care will be an issue again.
The steady growth of health care spending as both of a percentage of GDP and government expenditures (including because of the rising number of Baby Boomers in retirement) is inexorable.
Moreover, the continued rise of health care spending coincides with an emerging understanding that costs are rising for the public and private sector not primarily because of waste, fraud, and abuse or the high cost of government regulation (though those are issues too), but because of the price of health care Americans receive.
Fun fact: what’s the one thing neither Obamacare nor Republican attempts to Repeal and Replace addressed? Health care prices. Yes, the law and its hoped-for GOP alternative were almost entirely focused on playing on the margins of regulating health care coverage, not the cost of care that is a dominant percentage of the premium dollar.
I say “hoped-for GOP alternative” generously, because Repeal and Replace was a walking disaster. Don’t just take my word for it, take also that of conservative health care wonk Chris Jacobs. While Jacobs and I are not likely to agree on exact policy solutions, we both agree GOP attempts to create a substitute for Obamacare were a hopeless combination of a grab bag of GOP policy ideas paired with support for access to coverage for people in the individual market with pre-existing conditions.
Part of the reason Repeal and Replace was such a mess is far too many conservative elected officials, staffers, think-tank wonks, and other opinion leaders don’t understand health care policy or the health care system all that well.
They better start. Aside from the lurking issue of government spending on health care, the private sector is increasingly animated about their health care costs as well. Note in the middle of the big announcement at the start of this year about Amazon, Berkshire Hathaway, and JP Morgan Chase teaming up on a health care venture was this key statement:
"The ballooning costs of healthcare act as a hungry tapeworm on the American economy," Berkshire CEO Warren Buffett said in a statement. "Our group does not come to this problem with answers. But we also do not accept it as inevitable. Rather, we share the belief that putting our collective resources behind the country's best talent can, in time, check the rise in health costs while concurrently enhancing patient satisfaction and outcomes."
Health care is a top tier issue for both the public and private sector. Future health care agendas are essential for good governance moving forward.
So what’s the conservative solution?
You’re not going to dramatically reduce eligibility for Medicare or Medicaid. A Republican President, Senate, and House, couldn’t even make relatively incremental changes to an already comparatively incremental law in Obamacare without major political fallout. If you think simply cutting Medicare or Medicaid are political winners, I invite you to enjoy your extended time in the Congressional minority.
Yes, Medicare and Medicaid will definitely require reform, even as addressing the issue of Obamacare’s problematic impact on the affordability of individual market coverage for middle class consumers is still necessary as well. Yet, a clear lesson of recent electoral politics is Republicans don’t have the combination of a winning message and a winning policy solution for health care. Not even close.
And that needs to change.