Republicans say Democratic activists’ goal of government-funded health care would be so expensive that taxpayers might as well “set their money on fire.”
Eight years and five election cycles after the 2010 Affordable Care Act’s passage, health care remains a powerful political issue — and neither Republicans’ push for skimpier, cheaper options nor Democrats‘ demand for more robust and costly coverage has prevailed.
“Republicans still are blaming Obamacare for many of the current ills and saying if Democrats take over, they will push for greater government involvement in health care,” said Darrell West, director of governance studies at the Brookings Institution. “Democrats say Republicans have made the current situation worse and people are losing coverage and seeing their health costs soar. It remains to be seen which arguments will resonate with voters, but health care will be a big part of how the election turns out.”
Democrats plan to make a defense of Obamacare their top issue heading into November, injecting it into nearly every debate including tax cuts and the battle over the Supreme Court vacancy.
They have been bolstered by polling that suggests Mr. Trump and his Republican allies will be held largely responsible for troubles in the insurance markets because Republicans tinkered with Obamacare and gutted its mandate to hold insurance, prompting insurers to request higher rates for next year.
“In roughly 100 days, voters will hold every GOP Senate candidate accountable for their toxic proposals, and we won’t stop until every voter knows that Republicans want them to pay more for less care,” said David Bergstein, spokesman for the Democratic Senatorial Campaign Committee.
While some Democrats want to go beyond Obamacare and embrace a full government-backed health care system, party leaders instead are promoting a range of “public options” to patch holes in Obamacare, such as allowing people to buy into Medicare or Medicaid programs.
Republican leaders say those efforts will lead to skyrocketing prices and overbearing government controls. What consumers need, they say, are cheaper plans that are better tailored to the coverage they want.
“When you look at the contrast, while we’re talking about helping lower premiums and giving families more choice, Democrats are talking about a single-payer health care system,” House Majority Whip Steve Scalise, Louisiana Republican, said in previewing House bills that eat into Obamacare.
Still, Republicans are aware of the political danger. The House last week passed a series of bills to repeal Obamacare’s tax on medical device sales, delay its tax on health insurers and make cheaper “copper” plans more widely available.
The administration is moving to open the door to “association health plans” for like-minded businesses and short-term insurance for individuals, which might siphon customers out of Obamacare’s marketplace.
Republicans are determined to try to force Democrats to defend the “Medicare for all” plans of their most liberal candidates, including Ben Jealous in Maryland and Gavin Newsom in California, both of whom are running for governor on platforms that include universal health care.
The Republican Governors Association took aim at Mr. Jealous’ plan in an ad titled “Fire.” The ad says an estimated $24 billion price tag would mean new taxes if he defeats Republican Gov. Larry Hogan.
“Jealous would raise Maryland taxes to never-before-seen levels to fund his experimental health care plan,” it says.
Even if taxes were increased, the Jealous campaign said, Marylanders would pay less than what they do in premiums under the current administration and that a single-payer system would supplant spending on an array of programs, not be tacked on top of it.
“Once those are factored in, we do not believe this plan would cost $24 billion and any potential tax increases would be offset by these savings so that the average Marylander is paying less, while having access to far greater care than what is currently available,” said Kevin Harris, senior adviser to the Jealous campaign.
Seema Verma, who oversees federal insurance programs for Mr. Trump, counters that the costs would be so high that it would amount to “Medicare for none.”
Ms. Verma hinted last week that the administration would take a hard line on states that request federal waivers to try to pursue single-payer systems.
“I think a lot of the analysis has shown it’s unaffordable,” Ms. Verma said. “It doesn’t make sense for us to waste time on something that’s not going to work.”
Neither would it work nationally, she said, adding that the expansion of Medicaid insurance for the able-bodied poor is stretching resources for people who historically relied on the program so people should think twice about straining Medicare for seniors.
Progressives who champion taxpayer-funded solutions say their ideas poll well and Republicans are wielding empty rhetoric to spook swing voters.
A Kaiser Family Foundation poll from last fall suggests the reality is somewhere in the middle. More than half of Americans — 53 percent — support a national health care plan.
However, 47 percent said they would be able to keep their current health insurance arrangement under single-payer, which would probably not be the case.
Indeed, the specter of big changes makes some red-state Democrats leery.
Sen. Claire McCaskill, a Missouri Democrat facing re-election in Trump country, said her constituents have voiced concern about what would happen to their employer-provided coverage under single-payer. Sen. Joe Manchin III, West Virginia Democrat, said he is focused on protecting Obamacare from a pending lawsuit that could cancel its protections for people with pre-existing conditions.
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