Andrew Harnik/AP Photo
Biden speaking in Wilmington, Delaware, last week
If there’s anything resembling a lasting moment from President Trump’s contentious pre-election appearance on 60 Minutes, it will be his comments on health care. Despite the dustup over the tenor of Lesley Stahl’s questioning, and the purposeful self-leak of the not-at-all-controversial interview footage, the only moment from that conversation with any real half-life was his statement on Obamacare. “I hope they end it”—“they” being the Supreme Court and “it” being the Affordable Care Act—he said, days before Amy Coney Barrett was installed on the Court, granting Republicans more than enough judicial firepower to make that happen.
Indeed, much of the Democratic messaging around the cartoonishly mishandled Barrett hearings was about the Affordable Care Act, pre-existing conditions, and the issue of health care in a country ruled by an activist 6-3 conservative judicial junta. Given how many options existed in terms of pitching an opposition to Barrett, including her anti-LGBT track record, her profound lack of experience, and the impropriety of pushing her through in the midst of an election, the resolve to make Barrett’s case into a health care issue was a notable one.
In the final days of the 2020 election, health care has come to be a closing statement for Democrats and Republicans alike. It featured prominently in the final presidential debate, and has emerged repeatedly in Senate debates all over the country. Just recently, Georgia Senate candidate Jon Ossoff smacked down his Republican opponent David Perdue in a superviral clip over the incumbent Perdue’s willingness to take down the ACA, which would end protections for people with pre-existing conditions. Republicans, meanwhile, are scrambling to sell the American public on the Protect Act, which is not the 12-years-in-the-making replacement for Obamacare, but an industry-friendly bill that purports to protect those with pre-existing conditions should the Court strike the ACA down, replete with some massive loopholes. The 2020 election, like so many before it, is shaping up to be yet another health care election.
Yet again, the American people are heading to the ballot box motivated by a need for a better health care system.
With an out-of-control pandemic sweeping the nation, it makes plenty of sense that health care would be a top-of-mind issue for voters. It tends to be a winning issue for Democrats: Nancy Pelosi’s entire electoral strategy has been running on “health care, health care, health care.” But it also sets up some problems for Democrats, as Joe Biden was perhaps the weakest candidate on health care of anyone running in the Democratic primary, and Democrats have run on the issue in basically every major election since 2008.
Though the War on Terror and the collapsing economy were both major factors in the unpopularity of President Bush and the 2008 sweep, as a policy matter the election was primarily seen as an opportunity for Democrats to enact a health care proposal. With a majority in the House and a supermajority Senate, Obamacare was the primary flagship legislation passed in the first two years of his presidency. Since then, health care has been one of the main terrains upon which both parties have fought. Opposition to the ACA spurred the Tea Party to victory in 2010. President Trump ran on repeal in 2016. When Democrats retook the House in 2018, they ran largely on the strength of support for protecting the gains won by the ACA, and a quieter but still present support of Medicare for All among House hopefuls. Health care played an excessive role in the presidential primary debates this cycle.
But leaning again into health care also poses a problem for Democrats. Despite its increased popularity, a decade into the Obamacare era, the program has faltered badly in certain aspects, even without Republican opposition. Premiums have skyrocketed; a lack of cost controls has sent pricing on everything from procedures to prescriptions through the roof. Millions remain without coverage. And the coronavirus has badly exposed other shortcomings in that system. Millions of people have lost their employer-tied health insurance in the recession along with their jobs, while insurance companies have boasted earth-shattering profits over that same period.
Meanwhile, the ambition of the Democratic message on health care has receded substantially. While many Democrats in 2018 ran on Medicare for All bills introduced in the House and the Senate, or at least on actively expanding coverage, the messaging this time around has been a non-negative pledge to protect against further losses. Joe Biden has said time and again that he would protect and build on Obamacare, but the question remains: If Obamacare was so good, wouldn’t that have allowed us to move on to something else? Why do we keep having these health care elections?
Biden’s contribution, which he proudly dubbed “Bidencare” in the last debate, is supposed to come with a public option, something that polled above water 12 years ago and was supposed to be part of the ACA, before being dropped over industry objections and some grumbling in the Senate. Biden getting a public option across the finish line should be a bare-minimum contribution this time around. But there have been early signs that even that may not be in Democrats’ plans.
The 2021 agenda teased last week by Pelosi and Steny Hoyer, House Democratic leader, had “health care at top,” but no mention of the public option, simply a commitment to “strengthen” Obamacare, whatever that means. That sentiment is not shared unanimously in the chamber, which sets up for an interesting battle come January. In a Vanity Fair piece that ran the day after Pelosi and Hoyer unleashed their plans, Rep. Alexandria Ocasio-Cortez sounded a very different tune on Dems’ health care solution: “The main reason why I feel comfortable saying that the ACA has failed is because it failed me and it failed everyone that I worked with in a restaurant.”
Indeed, those failures are substantial. Long-term care insurance, another program that made it into the Obamacare draft proposal but never got enacted, has since descended into a state of total collapse. Only a dozen private long-term care insurance providers still exist, down from nearly 100 at the start of the century. There are private-sector failures all over the health care world, with significant concentration of hospital and pharmaceutical networks. The public need for health services, with an aging population and a raging virus, is only increasing.
So, yet again, the American people are heading to the ballot box motivated by a need for a better health care system. Republicans, of course, have nothing to offer the American people on this issue beyond a shoulder shrug. But if Democrats finally delivered on their pledge to bring health care to the American people, we could finally put an end to these health care elections, and focus on other issues. There are plenty.
