Health care powered the Democratic Party to victory in the 2018 midterms, when we retook the House by picking up 41 seats. Democrats emphasized health care in that campaign, with a full half of all their TV ads featuring the issue. That figure compares to a measly 10% in 2016.
Voters made clear that health care was a high priority for them as well. According to 2018 exit polls done by CNN, 41% of respondents ranked health care as the most pressing matter our government needs to address (compared to immigration, the economy, and gun policy). That number is up from 25% in 2014, and 18% in 2012 (CNN didn’t include health care as an option in 2016 when it asked that question). Polling in 2018 from the Kaiser Family Foundation and the Public Religion Research Institute, among others, found similar results.
There is serious concern as to whether the 2020 Democrats remember that lesson.
One healthcare activist laid it out for the New York Times.
“I do think it’s a missed opportunity to educate voters about what’s really at stake in the fall,” said Leslie Dach, chairman of Protect Our Care, a group that ran a campaign-style war room in 2017 to defeat House Republicans seeking to repeal Obamacare, “and that’s having to stop Donald Trump’s relentless war on health care.” [...]
“If you were to talk about the two things that mattered the most to people, it’s the pre-existing conditions and it’s the cost of health care. Every candidate should be talking more about what’s wrong with Donald Trump as well as what they want to do [on health care.]”
The entrance polls from the 2020 Iowa caucuses again showed health care coming in a strong first, with around 40% of voters ranking it their number one issue. Climate change was a distant second—about twenty percentage points behind, followed by income inequality and foreign policy. Multiple caucus night surveys found similar results.
A California voter and Elizabeth Warren supporter named Lise Talbott summed up the worries of a lot of progressive voters: Candidates are focused on the wrong aspect of the issue.
“The candidates seem to be in this battle over who’s going to get us closest to Medicare for all instead of talking about the care and coverage we have now and could lose. And because the candidates aren’t talking about it, I think a lot of people have sort of forgotten.”
This story’s headline mentions Michael Bloomberg, or more specifically his campaign, but I’m not endorsing his candidacy by any stretch. I’m on record, going back 12 months, as wanting the nominee to be Sen. Warren—although without question I will enthusiastically support the Democratic nominee no matter who it is (and no, it won’t be Tulsi Gabbard). But I do want to recognize and praise what Bloomberg is doing—namely waging an intense, powerful attack on Individual-1 over health care.
As part of a spending blitz that blew past $250 million in late January, Bloomberg has bought more than $88 million worth of TV commercials that talk about health care. Three-quarters of those ads hit Donald Trump on the issue. It’s important to note that none of them have taken aim at Bloomberg’s ostensible competitors in the Democratic primary, at least for now. One ad includes video of Trump, in trademark monotone style, telling an audience: “Let. Obamacare. Implode.”
Another ad points out that Trump broke his promise to protect Americans with preexisting conditions—a core element of Obamacare. Instead, the voiceover reminds viewers, “Trump repeatedly tried to undermine coverage for 134 million Americans with preexisting conditions.”
That 30-second Bloomberg commercial didn’t go into specifics on how Trump has worked to undermine that protection, but Factcheck.org did, examining the details of the Republican proposals that Trump backed.
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The House Republican bill, passed on May 4, 2017, would require insurers to charge 30% higher premiums for one year to those who were entering the individual market and had a gap in coverage of 63 days or more over the previous 12 months. That’s regardless of a person’s health status. But states also could get waivers to allow insurers to charge even more for one year to people with preexisting conditions and that lapse in coverage.
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The Senate GOP bill — which was rejected by the Senate in a July 25, 2017, procedural vote — would have required insurers to offer coverage regardless of health status on state and federal marketplaces or exchanges, such as HealthCare.gov. But insurers could sell non-compliant plans, charging more or denying coverage, on the individual market outside of those marketplaces. The bill would have provided federal money to compliant plans to help lower their costs, as those with medical conditions would likely get that coverage.
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A third GOP plan — known as the Graham-Cassidy bill — would have enabled states to allow insurers to charge more based on preexisting conditions. The bill, which Republicans pulled from consideration in late September 2017, would have allowed states to establish insurance market rules, including how insurers could vary premiums. Insurers couldn’t vary them based on gender or genetic information, and states would have to describe how they would “maintain access to adequate and affordable health insurance coverage for individuals with pre-existing conditions.”
Additionally, the Trump administration has put its weight behind a lawsuit seeking to have Obamacare declared unconstitutional, a lawsuit made possible only because that law’s individual mandate was eliminated in late 2017 by Trump’s Rich Man’s Tax Cut—which passed the House and Senate with only Republican votes. If the Supreme Court tosses out Obamacare, there go protections for preexisting conditions. Trump would bear the blame.
But are Bloomberg’s anti-Trump healthcare ads working? Democratic strategist Brad Bannon seems to think so: “I think [Trump] is feeling the heat on the issue. He knows he’s been on the wrong side of it. He’s trying to cover his tracks.” One way we know these ads are effective is that they have prompted a response from Herr Twitler.
I loved this matter-of-fact (under)statement from Factcheck.org in response to Trump’s tweet: “We’re not sure how Trump can argue he “saved” pre-existing conditions, when the failed Republican bills he supported would have weakened the ACA protections.” I’m also not sure how Trump can spew forth an average of about one lie per waking hour over the three years since he began occupying the Oval Office. There are a lot of things that I’m not sure about anymore. But I digress.
Beyond the healthcare spots, let’s give the Bloomberg campaign credit for running ads that don’t talk down any of his fellow Democrats (so far). Whatever the issue, his ads typically go after Trump or talk about why Bloomberg is great. The second part certainly helps his campaign, but attacks on Trump will ultimately benefit any Democratic nominee. Essentially, Bloomberg is running general election ads during the primary season. The other candidates can’t afford to do that, because they have to focus their limited resources on winning the nomination, while Bloomberg’s resources are, essentially, unlimited.
There’s been speculation that the Bloomberg campaign is, at least in part, designed to get better advertising rates for attacks on Trump than it could get by simply setting up an anti-Trump PAC (the campaign’s spokesperson dismissed such talk as “ridiculous.”) Trump’s former Manhattan neighbor has also promised that, if he loses the nomination, he will turn over his entire campaign structure—including a staff that is reportedly expanding to 2000 employees in the wake of Joe Biden’s poor showing in Iowa—to the person who beats him, and continue to foot the bill through Election Day for those he hired. Clearly he’s committed to the principles of “Blue No Matter Who.”
The issue of health care is much bigger than Mike Bloomberg—who will not and should not be the Democratic nominee, no matter how much he spends. Whatever healthcare plan the ultimate nominee supports is likely to differ substantially from any legislative package Congress might pass. After all, Sen. Barack Obama opposed the individual mandate early in the 2008 campaign, only to sign it into law just over two years later as part of the Affordable Care Act.
On health care, the most important thing our nominee should say this fall—and the most important thing all our candidates should be saying right now—is that Donald Trump wants to take away healthcare coverage protections. He’s already allowing companies to sell junk insurance that won’t provide coverage when people need it most, and his policies are already causing millions of people to lose their insurance coverage (not to mention that he also wants to cut Social Security as well as SSI disability benefits, and gut Medicaid ... but that’s another story).
Democrats will not only preserve Obamacare, they will strengthen it and ensure all Americans have access to real health coverage that they can afford. Further, Democrats will tackle costs by permitting the government to negotiate prescription drug prices. Health care remains the number one issue as the 2020 campaign gets underway, and Democrats need to hammer away at Trump on it. Without mercy.
Ian Reifowitz is the author of The Tribalization of Politics: How Rush Limbaugh's Race-Baiting Rhetoric on the Obama Presidency Paved the Way for Trump (Foreword by Markos Moulitsas).