The partisan fight over health care will likely be hotly debated during the 2020 presidential election. This prediction partly reflects Republicans’ ceaseless efforts to “repeal and replace” the Affordable Care Act (ACA). Most recently, the Trump administration abandoned its legal defense of pre-existing condition protections, thereby offering a crucial point of debate for the 2018 midterm elections. More broadly, however, the persistence of the health care battle also reflects the prominence of health policy in presidential races for decades. As a new Commonwealth Fund report documents, since 1988, health care has been among the most important issues in presidential elections. Since 1940, virtually every presidential candidate has put his or her health care vision forward through the party’s platform (Figure 1).
The contours of the 2020 health reform platforms have already emerged. President Trump, who has indicated he will run for reelection, included in his budget the so-called Graham–Cassidy–Heller–Johnson amendment. The proposal would repeal federal financing for the ACA’s Medicaid expansion and Health Insurance Marketplaces, using most of the savings for a state block grant for health care services. A revised version was introduced by conservative think tanks this week. The Democratic contender will likely embrace a “Medicare for More” or “Medicare for All” proposal, expanding rather than contracting government’s role in coverage. Numerous such proposals have been introduced in the last year. That said, key questions about the campaign plans remain, with their direction and details to be developed in the coming months and into next year.
Studies suggest that roughly two-thirds of campaign promises have been kept by presidents in the last five decades.
Contrary to conventional wisdom, campaign plans matter—including, and perhaps especially, health reform plans. They signal to voters the direction of each party; they impact elections and are used to hold elected officials accountable; and, perhaps most importantly, they set the agenda for a president and influence future policy outcomes. Studies suggest that roughly two-thirds of campaign promises have been kept by presidents in the last five decades.
Policymakers, experts, and concerned citizens alike should start caring about the major health reform plans. And now is the time to do so, for now is when they are being developed, modified, and solidified. In short, now is when they most merit our scrutiny. If past is prologue, this work today will yield better public policy on the other side of the presidential election.