Andy Slavitt Opinion columnist
Published 3:00 AM EDT Jun 26, 2019
The firing pistol went off on the 2020 election and the incumbent President Donald Trump aimed it in a strange direction — directly at his own health care record.
“If we win back the House, we’re going to produce phenomenal health care,” Trump said in an interview with ABC News on the eve of his 2020 kickoff rally in Florida. “And we already have the concept of the plan. And it’ll be much better health care.”
As Democrats enter the presidential primary debate season, this presents an opportunity. They would be smart to talk about health care as a core economic issue facing Americans, not a theoretical debate on how to cover more people. Polls show
health care has been an area of repeated and considerable failure for Trump. He came to office promising “great” health care. And once it became clear he didn’t have a plan, the one he ended up supporting was exposed as cutting coverage for up to 20 million Americans, eliminating protections for preexisting conditions, and raising premiums on many.
ACA success is a problem for Trump
Midterm elections historically don’t go for the incumbent president’s party, but of all the controversy Trump courted, health care turned out to be his biggest political disaster. It was a major factor in the 2018 drubbing of House Republicans, as Republican House leader Kevin McCarthy acknowledged, according to The Washington Post.
Even after he failed to repeal the Affordable Care Act and took a beating in the midterms, Trump still endorses a plan today that ends Medicaid expansion, cuts Medicare and cuts premium subsidies for low- and mid-income Americans.
Trump may be having an especially difficult time with the ACA for more reasons than his own bad policies, as some of its substantive successes are becoming increasingly apparent. Five years after the ACA took effect, there is now an abundance of glowing evidence about the law Trump continues to call a “disaster.”
Going broke despite coverage: I had a good job and insurance — but high health care costs still drove me to bankruptcy
The best way to judge the ACA today is not by what one political party or other says, but by comparing the most important health and economic outcomes in states that fully adopted the law with those that didn’t (an experiment the Supreme Court enabled by making the law’s Medicaid expansion optional). The key question: Are people healthier and more financially secure?
Economic results are as important as health
Several recent studies show positive health outcomes in states that chose to expand the Medicaid program to more low-income families and individuals: lower cardiac deaths, lower maternal and infant deaths, better early cancer diagnosis, improved medication compliance and decreased health disparities between black and white, to name a few. This is complemented by a whole array of economic benefits like increased home ownership, decreased payday lending and housing foreclosures, improved credit scores, reduced bad debt and fuller employment.
While the health benefits from the ACA are eye-popping, it’s the economic results that should be more worrisome for Trump and that Democrats should take note of. Indeed, health care has become cemented in voters’ minds to the economy and economic security. One in four Americans report having difficulty paying for their prescriptions, and deductibles are rising eight times faster than wages.
The 2018 midterms showed health care to be more about cost than anything else. If, after all, one has to choose between seeking care and paying other bills, or can’t change jobs because preexisting condition protections might be lost, health care is a kitchen table issue, not just a bedside one.
It’s also an issue of economic rejuvenation, particularly in rural communities where many community hospitals, often the largest employer, have benefited from more and better health coverage under the ACA.
Financial insecurity is key issue for voters
In 2020, Democrats should welcome Trump’s desire to run on health care. There’s no area that lays out as clearly how out of touch he and the Republican Party are with everyday Americans, or how poorly he does his job. Trump’s term is replete with lawsuits to strip Americans of benefits, sabotaging policies he doesn’t like, half-steps and reversals, and a lot of bark about reducing drug costs, but ultimately little bite.
In this week’s presidential debates and throughout the campaign, Democratic candidates should go further than simply pointing to Trump’s abysmal record or even just talking about how they would cover more Americans — universal coverage, “Medicare for All” or a public insurance option. They should seize on health care as central to an economic message of security, financial mobility, racial equality and rejuvenating rural America.
Get practical: ‘Medicare for All’ is a distant dream. Here’s how to start fixing health care right now.
Democrats have a good record to point to with the ACA and their defense of the law, but must now go further to address the health-related financial insecurities Americans face. They should highlight the outrageous cost of insulin and other prescription drugs, out-of-network bills and myriad efforts to improve the affordability of health care that has begun in states.
From the White House on down, Democrats have their best chance to win if the 2020 election is about these real issues that hit Americans every day, and where Trump has a record of continued lies and failure.
Andy Slavitt, a member of USA TODAY’s Board of Contributors, is a former health care industry executive who ran the Affordable Care Act and the Centers for Medicare and Medicaid Services from 2015 to 2017. Follow him on Twitter: @ASlavitt
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