The GOP's anti-majoritarian health care agenda

The public's economic concerns provided an opening for Republicans to thwart the popular will on abortion, drug costs and more

What do Americans want on the major health care issues of the day? As we head into the homestretch of this year’s mid-term elections, the question is worth exploring since the final tally may not reflect what voters say they want.

The political polling industry, whose recent efforts have had about as much predictive value as a pack of Tarot cards, is convinced Republicans are about to win control of the House and possibly the Senate. If that comes to pass, only President Biden’s veto pen will stand between a Republican-run Congress criminalizing abortion in all 50 states, staging new assaults on the Affordable Care Act and further eviscerating America’s public health infrastructure, which was exposed as inadequate by the COVID-19 pandemic.

According to recent polls, the single biggest health care issue atop voters’ minds is access to abortion, which the Supreme Court all-but-placed on the ballot with its June decision to overturn Roe v. Wade and deny women the constitutional right to make their own reproductive health choices. Yet only 15 percent of all voters in the latest Kaiser Family Foundation tracking poll said abortion and reproductive rights was the issue they’d most like to hear candidates talk about. It was dwarfed by the 35 percent who chose economic issues as their main concern.

There was a huge partisan split in voter response to an open-ended question about their main concern. Democrats chose abortion rights (which was #2 overall) over economic concerns (#1 overall) by a 28-23 margin, while Republicans chose the economy by a 52-5 margin. That sharp partisan divide skewed the overall results with independents split between the two camps.

But what do voters – that is, all voters, Republicans, Democrats and independents – actually want to see when it comes to abortion rights? There are only small differences between the two partisan camps. A Pew Research Center poll taken in June found 61 percent of all U.S. adults wanted abortion legal in all or almost all cases, while only 37 percent said abortion should be illegal. “These views are relatively unchanged in the past few years,” the poll’s analysts noted.

In delving into the specifics of restrictive laws passed by Republican-run legislatures, the Kaiser poll found an overwhelming majority of voters opposed new restrictions. Four out of every five voters opposed laws prohibiting abortion in cases of rape or incest. A similar share opposed allowing private citizens to sue people who provide abortions or making it a crime for a woman to get an abortion. And three in four voters opposed making it a crime for doctors to perform abortions. Strong voter preference for maintaining abortion rights was only slightly lower in states with full abortion bans.

Democratic campaign commercials have pounded their opponents for opposing abortion in all circumstances. Clearly it is a message that resonates with voter attitudes. Yet whether it will sway a sufficient number of voters to prevent a Republican takeover of Congress (ugh, kill me for using this phrase) remains to be seen.

Unheralded victories

The health care issue voters are hearing much less about from Democrats are the victories they won for consumers in the Inflation Reduction Act, which the president signed into law earlier this year.

When asked if the law extended financial subsidies for Obamacare plans (it does), two-thirds of voters said it did not. More than six in ten voters did not believe the law limited out-of-pocket prescription drug costs or cap insulin prices for people on Medicare or cap insulin (it does). And more than half of voters were unaware the federal government will begin negotiating drug prices next year (it will).

Still, six in ten voters said they would support candidates who support those measures. You’d think those issues would have figured more prominently in Democratic candidate campaign ads.

Unlike some recent elections, Medicaid expansion will only be on one state ballot this November. Initial polls in South Dakota showed a large majority in favor of allowing people earning up to 138 percent of the federal poverty level to join Medicaid. But vocal opposition by the local chapter of Americans for Prosperity, the ultra-conservative political advocacy group funded by the Koch brothers, has narrowed the margin to a slim majority now saying they plan to vote yes with 28 percent still undecided. If it passes, it will leave 11 states without an expanded Medicaid program.

Meanwhile, in the waning days of the campaign, Democrats have seized on Republican comments suggesting full funding for Medicare could be on the table when the new Congress sits down next year to discuss extending the debt limit. Rep. Kevin McCarthy (R-CA), who is in line to become House Speaker if Republicans win control of Congress, said in an interview that he would not “predetermine” what issues would be on the table when those negotiations began.

Sen. Ron Johnson (R-WI), who is in a neck-and-neck race with Democratic challenger Mandela Barnes in Wisconsin that could determine control of the Senate, is campaigning on turning Medicare into discretionary program with annual appropriations subject to Congressional approval – not an open-ended promise to pay for necessary health care. Sen. Rick Scott (R-FL) wants to sunset the program and subject seniors’ health care to a reauthorization vote every five years.

One has to wonder if the Sunshine state state’s elderly voters are aware of his position.