Illustration: Aida Amer/Axios
The Affordable Care Act, a trigger for political campaigns for more than a decade, has been conspicuously absent from campaign debates and rhetoric this year. The question is how much of that robs Democrats of a valuable talking point.
The big picture: After multiple failed attempts to strike down the health care law in Congress and in the courts, Republicans broadly accept that the ACA is here to stay and are reluctant to touch the tripwire again.
- What’s remarkable is that Democrats aren’t touting the act’s affordable coverage in times of inflation, especially after extending ACA grants for three years in the Inflation Reduction Act. and prevented large premium increases for market enrollees.
What they say : “This is truly the first campaign in a decade where the ACA hasn’t been a dominant issue. Perhaps that’s because Democrats are generally more successful when fighting against Republican plans than when ‘They’re advocating for their own efforts,’ Larry Levitt, executive vice president of health policy at the Kaiser Family Foundation, told Axios.
- “In This campaign, Democrats have had the opportunity to campaign positively on things they’ve done but don’t seem to have been very successful,” Levitt added.
Driving the news: Most of the campaigns focused on abortion, while they only talked about health care. Some Democrats have also touted the IRA’s drug price controls for Medicare beneficiaries and how their party prevailed over powerful pharmaceutical industry interests.
- One exception was the North Carolina Senate race, where an Oct. 7 debate featured an exchange between Republican Ted Budd and Democrat Cheri Beasley over her support for a public insurance option. Budd also dodged the question of whether he would support repealing and replacing the ACA.
- The ACA is also a factor in South Dakota’s referendum on expanding its Medicaid program to more than 42,000 residents. The Health Act gives states increased federal funding for their expanding populations; some opponents said it put states on an unsustainable spending path.
- President Biden tried to frame Democrats’ efforts to lean on the ACA as a tonic against inflation, promoting how the IRA would cut health care costs as he clashes with states such as Oregon, California and New York.
- Meanwhile, Republicans in battleground states have remained silent on the ACA, and the House GOP’s “Pledge to America” makes no mention of the law strike.
Rollback: Fights over health care costs and coverage have played a defining role in the past six election cycles.
- The GOP overturned control of the House midterm in 2010, spurred by the backlash from the passage of the ACA.
- Republicans continued to tap the “repeal and replace” message for the next six years, including in the presidential campaigns of Mitt Romney and Donald Trump.
- Democrats took over the House in 2018, with messages about GOP efforts to remove ACA protections for people with pre-existing conditions.
- Biden in 2020 campaigned on both creating a public option and expanding the ACA. Meanwhile, Trump promised to offer an alternative Republican health care plan that never materialized.
Yes, but: Recent Senate debates have not presented many entanglements over health coverage. Nor political ads, according to the Washington Post.
- In battleground states like Arizona, Ohio, Wisconsin and Georgia, the economy, immigration, abortion and crime dominated the conversation.
- Republicans also didn’t have much criticism of the new drug price negotiations, even as vulnerable incumbent Democrats voted for the legislation.
- Dodging health care could be a faux pas: New Gallup/West Health poll finds nearly 40% of voters would cross party lines for a candidate who has made cutting health care costs a top priority of his campaign.
And after: Just because the campaigns are silent doesn’t mean there aren’t any fights to come.
- If Republicans attempt to repeal or change the IRA’s drug pricing provisions, they will face significant pushback from Democrats.
- Democratic congressional aides have signaled that making ACA grants permanent will be a priority if Democrats retain control of the House or Senate. Such a move would likely trigger intense Republican opposition.
Our thought bubble: The Democrats’ big debate over government involvement in health policy gave way to a campaign focused on reproductive health care following the Supreme Court’s decision to overturn Roe v. wade
- Rather than campaign on Medicare for All or a public option — both non-starters in a divided Congress — Democrats have mostly looked back, touting the Cut Inflation Act’s provisions on health care.
- “Democrats face a challenge going forward to figure out what’s next on their agenda,” Levitt said. “The ACA was the culmination of decades of work, and then Democrats spent another decade defending the law. Now there’s a question of what’s next for Democrats on health care? ”
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