The Role of Health Care in the New Presidential Election

There is no Clinton health reform plan or (then) controversial Obamacare plan to command the attention of voters in this presidential election. Former President Trump will focus on other issues he views as advantageous—not health care—and Vice President Harris is unlikely to make new health proposals of her own. Nevertheless, health is likely to be a consequential factor in the campaign. Here’s how.

First and foremost, it will be a campaign weapon for the vice president. That starts (and has already started) with abortion and reproductive rights. Vice President Harris will try to rally the Democratic base and appeal to younger voters and women, arguing that former President Trump will sign a national ban on abortion and has selected a running mate with extreme views on women and reproductive freedom. This is not news, but it is the main role health will play in the presidential election.

From there, expect Vice President Harris to attempt to tie former President Trump to a long list of proposals made by various conservative groups that support him to roll back public programs and insurance coverage. These include plans that would dilute protections for pre-existing conditions, let enhanced ACA subsidies lapse, transform Medicare into a voucher-like program, place a time limit on Medicaid eligibility, and severely cut and cap Medicaid and hand it off to the states. How far Vice President Harris goes down this list remains to be seen, and which items on the list are emphasized may depend on which audiences she is engaging. Her selection for vice president could also influence these choices. These policy ideas may have some appeal to the conservative Republican base, but polling shows they are unpopular with the general public. Many of these issues could have traction down ballot as well, but that’s a different subject for another day.

Former President Trump and Republicans have their own issues on which they have similar advantages, including immigration and inflation, and they are already pushing them. (This is a political analysis, and no judgement is intended here about the merits of claims made by either side, or the techniques used to make them).

The Democratic advantage on health is about the same size as the Republican advantage on immigration. We won’t know for some time what the picture looks like with Vice President Harris at the top of the ticket. Voter trust in the Democratic candidate to handle health care issues could grow or shrink. The same is true for former President Trump’s advantage on other issues now that he has a new opponent.

Substantive health policy platforms do matter in the election, but more for signaling than substance. The voters don’t usually digest the details of policy plans, they hear the candidate’s concern for the problem and for them. No doubt Vice President Harris will talk about the Biden-Harris record on health care during the campaign, featuring several policy achievements, including Medicare drug price negotiations (first prices are due in late August or early September); capping the cost of insulin at $35 a month for Medicare beneficiaries; the Medicare cap on out-of-pocket costs; enhancing ACA subsidies through 2025 to make coverage more affordable for many enrollees; and eliminating medical debt from credit reports.

All of these policies have two common attributes: voters can understand them and talking about them sends a signal: “I am the candidate who cares about your health care costs.” These policies only reach very targeted groups, and most voters don’t actually feel their impact, but for Vice President Harris and Democrats, they are a way to show voters they care about their economic worries—the critical issue area where former President Trump and Republicans otherwise have an advantage. When we asked voters who said they were most concerned about the economy what they meant by that in our polls, health care costs were near the top of the list, trailing inflation by just a few percentage points and well ahead of gas prices and every other economic worry. Politically, focusing on health care costs isn’t about health care, it’s a partial answer for Democrats to the advantage Republicans currently have on inflation and the economy.

Presumably, Vice President Harris will also pick up on a number of Biden-Harris policy proposals, including increasing the number of drugs subject to negotiation, extending the insulin cost cap and the out-of-pocket cost cap beyond Medicare, and extending the enhanced ACA subsidies. It’s always a plus politically to talk about addressing people’s health care costs in concrete ways. The downside is alerting voters who were not previously aware that these policies reached narrower populations to begin with.

Policy proposals made in elections are often more about signaling than details and substance. The media dissects them. Stakeholders react to them. But for all except the most engaged voters, they are mostly signals of what candidates care about and ways for voters to locate candidates on the ideological spectrum. More for big government. Or more for smaller government. And so forth. Legislation is a different matter. Laws affect people’s real lives and elected officials are held accountable for them.

Finally, it would be surprising politically if Vice President Harris made significant new health proposals of her own during the campaign. She has the Biden-Harris health care record to run on and can play offense on health care and build on an established advantage on abortion and health generally. As she learned when she made an ill-fated Medicare for All proposal with a Medicare Advantage option as a candidate in a Democratic primary, putting out your own proposal puts you on defense and gives your opponent a target to shoot at. It can alienate groups who support you, who may want you to do more, or less, or something different.

Playing offense on abortion and health and signaling concern about kitchen table worries to voters are the most important roles health will play in the presidential election. Policy platforms and plans will matter far less this time.