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In election run up, voters eye health care as top concern

Why We Wrote This

Democrats have turned health care into their top theme, attacking Republican positions on Americans with preexisting conditions. The partisan back-and-forth belies a deeper battle over the future of health care.

Tyler Evert/AP
Democratic Sen. Joe Manchin of West Virginia (c.) speaks to voters at a restaurant in Charleston, W.Va. Senator Manchin has made health care a central focus of his campaign.

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In the 2018 midterm elections, no issue looms larger on the campaign trail than health care – a topic in nearly half of all ads for federal races. Voters want both low prices and high-quality care, and they show support for a strong government role on health policy, up to a point. Protecting people with preexisting conditions has become the election-year touchstone for these larger questions. Democratic candidates have put Republicans on the defensive in key races such as a US Senate contest in West Virginia, where incumbent Democrat Joe Manchin accuses his Republican challenger of putting sick people at risk. And nationwide, where Republicans pitch more consumer choices as a path to control costs, Democrats tout the ideal of universal care. A Pew Research poll last year found that 60 percent of Americans say it’s government’s responsibility to ensure health care for all, up from 47 percent in 2014. Still, many remain skeptical of government-funded health insurance. “I don’t think that’s realistic….,” says D.J. Beard, a West Virginia resident who relies on Medicaid. “Where do you get the money?”

Olivia Sheldon is one of those voters who’s still deciding who to vote for in a hotly contested Senate race. But she knows one issue she cares about a lot: health insurance.

“Health care definitely needs some work,” she says. “I would love to have some reform.”

Ms. Sheldon is an expectant mother who, at age 24, has a job in retail and is studying for a degree in psychology. And for this resident of the mountain town of Harpers Ferry, what’s needed doesn’t fit neatly on either side of a debate that typically pits ideals of government-provided care against reliance on free-market principles.

“I want the government support,” she says, citing the high costs of medical care. “But I want [government] out of the doctor’s office when I’m in for an appointment.”

Her views point toward an important reality of the 2018 election: No single issue looms larger on the campaign trail than health care ​– the subject of nearly half of all campaign ads for federal races. Voters want both low prices and high-quality care, and they show support for a strong government role on health policy, up to a point.

In this campaign cycle, one core tenet of Obamacare has moved front and center: that people shouldn’t face higher insurance prices because of preexisting conditions. Americans widely support that idea, and Democratic candidates have put Republicans on the defensive over the issue in key races such as the one here in West Virginia.

Yet even as a majority of voters say they trust Democrats more than Republicans on health care – and as proposals of “Medicare for all” gain a following in some quarters – policy experts don’t see an easy path toward meeting voter aspirations.

“There is not a magic bullet on health care, ...  regardless of what the political parties say,” says Chris Sloan, a director at Avalere Health, a Washington-based consulting firm. Referring to the Medicare-for-all idea, he adds: “It's not easy to create a single-payer system in the United States that saves a lot of money.”

What the parties are offering

The two major parties offer starkly different visions on health care.

Republicans focus on ever-rising costs and the risk to both individual pocketbooks and federal deficits. Their preferred solutions emphasize longstanding conservative ideals of consumer choice, competition, and flexibility for state-level innovation on policy. The Trump administration has moved to make slimmed-down insurance plans available to Americans who don’t feel they can afford Obamacare.

John Shaver/The Exponent/AP
Vice President Mike Pence (l.) and GOP Senate candidate Patrick Morrisey wave at a campaign rally in Bridgeport, W.Va., on Oct. 20. It was Vice President Pence's second stop in West Virginia in the past three months to stump for Mr. Morrisey, the state's attorney general.

But that, coupled with other moves, has left them vulnerable to attack – with GOP candidates scrambling to insist that they, too, support protecting people with preexisting conditions. At least in their rhetoric, the 2018 race has made it a principle both parties agree on, backed solidly by public opinion.

“Hardworking West Virginia families are hurting,” GOP Senate candidate Patrick Morrisey says in an interview on the campaign trail, noting “skyrocketing premiums.” He pledges to repeal President Barack Obama’s Affordable Care Act (ACA) – but then adds in the next breath, “we also need to protect people with preexisting conditions.”

Here in West Virginia, a state that Trump won by a wide margin in 2016, state Attorney General Morrisey is challenging incumbent Democratic Sen. Joe Manchin in a close race, though most polls have shown Senator Manchin leading.

Manchin, a former West Virginia governor who has long positioned himself as a centrist, symbolizes how Obamacare is no longer the liability for Democratic candidates that it’s been in past election cycles.

In one TV ad Manchin charges that a Morrisey-backed lawsuit against the ACA seeks “to take away health care from people with preexisting conditions.” The ad is tailor-made for this conservative-tilting state, as Manchin destroys a document representing the lawsuit – and sends an I’m-not-liberal signal by using a shotgun to do it.

Most Democratic candidates aren’t toting guns in their ads, but the health care emphasis here in the Mountain State has been echoed in other close congressional races across the nation. 

For most Democrats, the core ideal for health care policy is universal coverage – something Obamacare aspired to but didn’t achieve. As a next step, Democrats in solid-blue districts or states are pitching “Medicare for all.” But, as appealing as the idea of government-funded health insurance sounds to many Americans, many also question how to pay for it.

Questions in West Virginia

The skepticism is evident in Inwood, a small town in Northeastern West Virginia where Morrisey recently held a rally.

“I don’t think that’s realistic…. Where do you get the money,” says rally attendee D.J. Beard, referring to a single-payer (government) system. A resident of nearby Glengary, Mr. Beard says he’s registered as an independent and sees a role for government. He himself is on Medicaid and out of work due to a health challenge.

But he thinks Republicans “are looking out for the people” while, from what he’s heard from European acquaintances, single-payer is not a model for the US to aspire to.

His view hints at why Americans have given mixed responses when asked in polls if they’d support switching outright to a single-payer system. By contrast, polls have found majority public support for the idea of a public health-plan offered alongside other options. A CBS News poll this month found 65 percent of Americans in favor of that idea.

And a Pew Research Center poll last year found 60 percent support for the idea that it is government’s responsibility to ensure health care for all, up from 47 percent who felt that way in 2014.

“Those on the right just celebrate everything that Trump says,” says Scott Flanders, chief executive officer of eHealth, an online marketplace for insurance plans. “Those on the left want to brand anything that isn't the ACA as bad.”

He says the reality is more complex – that millions of Americans can’t afford Obamacare plans, that many are seeing premiums and deductibles soar even when they have insurance through their employer, and that “Medicare itself is headed toward an unsustainable path.” 

Still, for now Democrats appear to have momentum on the issue. They have fodder for saying Republicans have sought to undercut the ACA’s protections. The lawsuit Morrisey backed, along with officials from other states, seeks to overturn the whole law (including its guarantees that premiums won’t hinge on one’s medical condition) as unconstitutional.

In other races, GOP lawmakers are under attack for supporting legislation undercutting the ACA. Where Republicans say they’re still seeking to protect people with preexisting conditions, while promoting greater choice in insurance markets, Democrats say those safeguards are far from ironclad.

Meanwhile, more from Washington

The partisan battle over health policy has been ramping up in recent days.

The Trump administration has sketched a new plan aiming to tame prescription-drug costs within Medicare by linking prices to what’s paid in other advanced nations.

The administration also announced a move to let states get waivers from Obamacare, potentially opening the door to states using federal dollars to subsidize insurance plans that are cheaper, but which offer less coverage than ACA-compliant plans.

Already, another Trump move is expanding short-term health plans as a cheaper alternative to Obamacare. Critics call it “junk insurance” since the coverage isn’t complete. Mr. Flanders of eHealth argues the plans are a “constructive” adjunct to Obamacare, helping many of some 28 million uninsured Americans to afford some coverage rather than none.

Many Democrats meanwhile say that Medicare for all, paid for with cost controls coupled with some tax hikes, can offer solid insurance to every American.

It’s possible that a single-payer system could help the US cover more people at a lower overall cost, says Mr. Sloan, the policy expert at Avalare, but he adds, “it’s hard.”

“To do that, the United States would have to cut a lot of health care spending,” he says. And that could mean reductions in everything from drug prices to physician reimbursements to other areas where the US spends more than other nations. “There's a lot of stakeholders [and entrenched interests] in place that that would affect.”

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