In the 2018 midterm elections, the Democratic Party rode to victory in the House of Representatives on a changing political tide driven by healthcare. It may be this very issue that proves to be the Party’s undoing in the 2020 general election—again.
In battleground states where highly contentious races between candidates played out on the public stage, liberals banked on an electorate wanting the government to address health insurance coverage while conservatives focused on immigration. A tracking poll by the Henry J. Kaiser Family Foundation found that across the nation, 71 percent of voters reported that healthcare was “very important” in determining how they would cast their ballot while immigration not so much.
It wasn’t the availability of coverage or the conditions and benefits, but the actual costs of the premiums that concerned the electorate—a point that perhaps Democrats may have missed. The election results speak to the effectiveness of both of the parties’ strategies.
When the dust settled, Democrats controlled the House with a final tally of 235 to 199. Although they gained a few key committee chairs, Republicans managed to retain control of the Senate 53 to 47.
If history is any indication of what lies ahead, Democrats might have a tough time in 2020 over the issue of healthcare. Another possibility is that the voters have learned that nothing in life is free and they’ll have to make certain painful sacrifices to get the type of health services they want.
How We Got Here
The Republican-led Congress made several ultimately failing attempts by to pass some form of healthcare reform in 2017. After close calls and near misses, the Republican Party was able to successfully undo the most unpopular provision of the Affordable Care Act (ACA) with passage of the Tax Cut and Jobs Act in December 2017.
This law repealed the “individual mandate” which required Americans who could afford it to purchase health insurance. It wasn’t just any policy either as taxpayers were forced to have specific types of coverage.
The ACA required that participants enroll in plans that met the “minimum essential requirement” (MEC), a standard of qualifying healthcare coverage. Those who failed to do so and weren’t eligible for an exemption would pay a penalty known as an individual “shared responsibility payment.”
It was that fine that proved unpopular back in 2016 and likely cost the Democratic Party several races in the last general election. It was healthcare that led to GOP domination in Washington.
How Unpopular Was the Mandate?
Depending on how pollsters framed the question, somewhere between 50 percent and 63 percent of voters found the individual mandate unfavorable way back in November 2016. However, it should be noted that since that time more Democrats and independents have warmed to the idea.
But what cost many races was the big disadvantage of the ACA because many of its provisions were dependent on each other. The individual mandate had a strong basis on protections for people with preexisting conditions.
The rationale was that if insurers were forced to cover everyone, then they should benefit from a larger pool of participants to share in the risk. Forcing compliance in the program with monetary penalties would provide the numbers needed.
The result was that relatively healthy individuals ended up subsidizing older, sicker Americans. They were obliged to pay higher premiums for coverage they were unlikely to ever use.
And they were very unhappy about it.
Many people transitioned out of employer-sponsored plans or marketplace exchanges and needed interim coverage. They found a solution via plans that focused on short-term healthcare that didn’t meet ACA requirements and yet still covered the basics.
These short-term healthcare plans were originally designed as temporary policies meant to bridge a gap between jobs while waiting for circumstances to change or the next ACA open enrollment. Few people understood that these skinnier plans were going to transform the insurance industry—and, by extension, future political races as a result.
The short-term healthcare approach was all about providing customized plans, with only the benefits that the consumer wanted. No more minimum essential requirements or major medical premiums to make health care unaffordable.
Often these policies were less expensive than those found in marketplace exchanges. And they coincided with the end of the individual mandate.
What this gave voters was affordable policies through short-term healthcare at the cost savings they had been demanding since 2016. And this is likely what Democrats will want to undo.
The question is whether voters will accept going back to higher premiums because of bloated coverage and forced penalties. The nation will find out in the next general election.
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