Healthcare and the 119th Congress
-Jarrett Lewis and Donald Trigg
(This commentary originally appeared in RealClearHealth on 12/4/24).
After his win, many aspects of Donald Trump’s 2016 campaign are still ringing true in 2024. But while healthcare was a day one priority in 2016, it’s not high on Trump’s wish list today following his “Repeal and Replace” shortfall. It shouldn’t deter him from making it a priority in his new administration.
In The Heart of Power: Health and Politics in the Oval Office, David Blumenthal and James Morone write, “No president can escape the issue [of healthcare] and almost none can successfully manage it.” It remains to be seen if Trump and the 119th Congress will take this opportunity to deliver meaningful healthcare reforms.
Some prognosticators have argued the exit polling confirms little will happen on healthcare in the 119th Congress. Alternatively, others have boldly speculated about another round of Repeal and Replace. “Will Trump Have an Opening,” the New York Times headlined, “to Repeal the ACA?”
Healthcare reform, for its part, has been seen to have featured only modestly in the larger narrative of the election. Only 11% cited healthcare in exit polling (with only 3% calling it their most important issue). Jobs and the Economy, comparatively, was at 37% (Public Opinion Strategies).
Yet healthcare is not absent from voters’ minds. 65% of voters cite healthcare as “very important” — second only to the economy (Pew Research). Similarly, a Kaiser Family Foundation poll in February found concerns over unexpected medical bills and the “cost of healthcare services” outweighs worries about the costs of gasoline, utilities, food, and housing.
But amid the conflicting noise, history offers a clear signal. First and foremost, the Blumenthal-Morone dictate holds: no president can escape this issue. Healthcare is on pace to account for one-fifth of the U.S. economy by 2032. More importantly, the underlying forces of disruption that drove the election cycle create a massive opportunity for healthcare.
The defining issue in U.S. healthcare this decade is affordability. According to Kaiser Family Foundation, four in 10 adults have debt due to medical or dental bills. It sits on their credit cards, operates as a burdensome IOU to family and friends, and is being chased by credit collectors. The debt disproportionately falls on lower income individuals and families.
Moreover, a recent study (JAMA Network) found rising healthcare premiums have cost workers an estimated $125,000 in lost earnings power over the last three decades. And prospectively, a national survey of 1,800 employers (Mercer) found more than half plan to shift additional costs to employees through higher deductibles and cost-sharing.
Voters have made their voices heard about their cost concerns with healthcare in the United States. As one swing state voter recently said, “The current state of the healthcare in this country is pretty terrible. The system we have in place doesn’t work for everyone and is too expensive.” Another voter said, “It is difficult to get care unless you have unlimited funds.”
In the September debate, Trump was criticized for his comments on the Affordable Care Act (ACA). Our contrarian view was (and is) he got the framing right. “If [there is an approach] that costs our people less money,” the now President-elect said, “we absolutely will do it.” Healthcare politics, heading into the 119th Congress, are simple: anchor to affordability.
The second part of his comments in September, also roundly lambasted, noted “the concepts of plan.” But history recalls these comments as a page from Obama’s winning ACA playbook. Instead of extended task forces and the voluminous draft bill that doomed HillaryCare, Obama framed key principles. A directional framework focused on improved middle class affordability for healthcare is what the moment — and a winning hand — requires.
Finally, history tells us the legislative push to address rising healthcare costs should be early, not late. Obama got the timing right, but past presidents have fallen short. The happy news for the White House is that changing existing programs is easier and faster than creating new ones. Budget reconciliation creates an obvious vehicle for key provisions of a plan to be advanced.
As Blumenthal and Morone argued, neither Republicans nor Democrats can escape the issue of healthcare. And as affordability continues to decline, it is a when, not if, reality in the fight for the hearts and mind of the forgotten middle class. The question now is: who will best manage it in the early frame of the 119th Congress?
Donald Trigg is the CEO of apree health and the co-author The New Health Economy: Ground Rules for Leaders (Georgetown University Press). Jarrett Lewis is a partner at market research leader Public Opinion Strategies.
