Non-Campaign Issue: Health Care Reform

Donald J. Trump tried to repeal Obamacare in 2017. Kamala Harris proposed the reconstruction of the US health care base in 2019, moving to a single payer system.

This bold attitude was not a mistake. In nearly every major presidential race for decades, health care has been a central issue. Do you remember Bill Clinton’s (disastrous) health care reform plan? George W. Bush’s Medicare drug plan? Mitt Romney’s Medicare privatization proposal? Bernie Sanders’s Medicare for all?

As you may have noticed, with less than two months until Election Day, big, prominent health reform plans are nowhere to be seen. Even in elections that have been relatively easy on policy proposals, the absence of health care is notable.

There were no caucus days of either party dedicated to the plight of the uninsured or middle-class families with high incomes. Health care is mentioned only briefly in candidate speeches or television commercials. There are no full pages on the candidates’ websites about their plans for the industry that represents one-sixth of the U.S. economy — although the Harris campaign recently published a few paragraphs. When the Affordable Care Act came up in the debate, toward the end, the candidates offered several unique policy proposals.

“This is the first election in maybe decades where health reform isn’t the primary issue,” said Larry Levitt, executive vice president for health reform at KFF, a health research group. .

The topic is completely absent from the political conversation, as Mr. Levitt noted. Both candidates are discussing the high cost of prescription drugs, and many Democratic convention speakers applauded the drug price changes passed in the Biden administration. Abortion has been a major campaign issue for Ms. Harris, who has talked about the medical bill and defending Obamacare. But no one is focused on major changes to the health insurance system.

The new status of health care as a secondary issue was clear in the debate on Tuesday, when the administration asked Mr. Trump about his first attempt to repeal Obamacare. They did so as the first question of the debate, emphasizing the extent of the crisis and other electoral problems. Mr. Trump was not particularly clear in his answer, saying that he has “planning ideas” to improve the insurance system. Ms. Harris said specifically that she wants to “maintain and expand the Affordable Care Act.”

“Republicans think they can ignore health care,” said Michael Cannon, director of health policy studies at the libertarian Cato Institute. “They can’t. Democrats think they have solved health care. They have never done that.”

The absence of a prominent debate has surprised policymakers on the right and the left. Many consumers are concerned about the rising costs of the government’s major health care programs: Medicare, Medicaid and Obamacare. And many Democrats are worried about the upcoming expiration of health insurance subsidies that could raise premiums for millions of Americans after next year.

“The fact that both parties have decided that we can’t deal with a health crisis is really surprising,” said Brian Blase, president at the Paragon Health Center, a think tank. right, and a former member of the White House. The National Economic Council in the Trump administration. Mr. Blase noted that reducing the budget for the future of Medicare was a priority for many Republicans and many Democrats. (Mr. Clinton and Barack Obama have both proposed major Medicare reforms as presidents.)

Mr Blase said this lack of attention to the financial crisis reflects “this populist moment now, where neither party wants to deal with the truth.”

Both candidates have learned the hard way that proposing sweeping changes can turn off some voters as much as it pleases others. Mr. Trump’s failed attempt to repeal Obamacare in 2017 was followed by a major Democratic victory in the 2018 midterms. Ms. Harris faced intense criticism after the 2019 Democratic primary debate in which she appeared to authorize the elimination of health insurance.

The overall landscape of the health system is also different now. After years of disasters and emergencies, no part of the system is burning now. Obamacare markets have stabilized and grown after a rocky start. The unemployment rate is near a record low. Obamacare is already popular. Total health care spending, while rising and growing, has not followed its historic steepness.

As a result, voters today are more focused on other issues such as the cost of living or the Southern border. And on the issue of health care that both candidates have spent time talking about – prescription drugs – Mr. Trump and Mrs. Harris agree in particular that the federal government should control the high prices of drugs.

“When people feel less vulnerable, it makes the need for a new system go down,” said Linda Blumberg, a professor of public policy at Georgetown and a member of the Urban Institute. “I think there’s an awareness of that.”

The fact that the candidates are silent on health care does not mean that they will control the health system in the same way if they are elected.

Although Ms. Harris has not yet commented on the issue in detail, a statement on her campaign website indicates that, like Mr. Biden, she supports the extension of health insurance subsidies that are scheduled to expire this year. coming. His campaign has said he no longer supports the single-payer policy he promised in his last presidential run. And in interviews, he stressed that he supports private insurance for more Americans. He also wants to limit how much consumers have to pay out of pocket for prescription drugs.

And while Mr. Trump has clearly vowed not to cut Medicare, his early record suggests he may want to make major changes to Medicaid, including the addition of requirements for work, changes in the way the program is funded, and deep, long-term cuts. -time money.

His first term also suggests that he will manage the Obamacare markets differently, promoting health plans that must comply with fewer rules, reducing funding for advertising, and allowing subsidies. more to complete. The health care chapter of Project 2025, a detailed policy directive document for Mr. Trump to consider if elected, recommends such policies and was written by Trump’s first health official.

And while he declined to make a proposal Tuesday, he also didn’t rule out the possibility of another effort to repeal Obamacare and replace it with a different administration.

That means health problems can still be serious, even if the conversation is small.