History does not repeat itself, but it often rhymes. Mark Twain
Foreign policy has risen to the top of voters’ minds in light of the conflicts in the Middle East and Ukraine, and while it will almost certainly remain a critical issue over the next year, health policy will also have a significant impact on the outcome of the election.
Health care ranked as a key issue for over 60% of voters in the 2022 midterm elections, according to Pev Research, and the health policy issues on that ballot undoubtedly shaped a number of races. The US spends more per capita on health care than any other developed country, while scoring poorly in life expectancy and maternal and infant mortality rates. Forecasters should expect a topsy-turvy outcome in the 2024 presidential race, as many of the same health issues that affected the midterms remain at the forefront of voters’ minds.
Ahead of an election year, these are health policy issues that could help determine the presidential race and the next four years of health care reform and deserve close attention from industry stakeholders.
The increased restrictions on abortion have created ripple effects across the continuum of care, including the impact on care providers and insurers. More patients are seeking care across state lines, straining resources in blue states like Illinois, which borders highly restrictive Missouri. Nonprofit hospitals can help cover bills for some patients, but the University of Illinois at Chicago, for example, can’t provide financial aid for out-of-state residents and may be on the hook for care provided. For insurers, the problem also complicates care for at-risk patient populations and creates delays that can increase final costs per patient.
Nearly 70% of respondents to the KFF/AP poll called on the Supreme Court to overturn Roe v. Wade an important factor, or the single most important factor, in the 2022 midterm elections, and voters turned out in force to support the candidates for the election. This was made clear in congressional races in states such as Pennsylvania and Kansas, where voters also rejected referendums on abortion bans.
Ohio voters scored another victory for abortion rights this November, passing an amendment to the state constitution protecting the right to choose. The 2022 midterm elections set the stage for the amendment when voters in the volatile state decisively rejected a measure that would have required a supermajority to amend the state constitution, a Republican-backed proposal tied to partisan efforts to limit access to abortion.
With those results in mind, several Republican candidates who have taken a moderate stance on abortion may have some advantages at the polls. Both former New Jersey Gov. Chris Christie and North Dakota Gov. Doug Burgum oppose the federal abortion ban. Meanwhile, Florida Gov. Ron DeSantis and former South Carolina Gov. Nikki Haley have taken hardline anti-abortion positions. If the issue drives Democratic voters to the polls like it did in 2022, it could be a big boon for President Joe Biden’s re-election bid.
Protection of rights program
An AARP poll of voters in the most contested districts after the 2022 midterm elections found that people over 65 helped swing the race for Democratic candidates. A quarter of those surveyed cited threats to Social Security and Medicare as the top issue, along with inflation and threats to democracy. Protecting entitlement programs will be increasingly influential as our population ages. By 2060, over 90 million people will be eligible for Medicare coverage, a significant increase from the 60 million who qualified in 2020.
In the deep purple state of New Hampshire, Democratic Sen. Maggie Hassan successfully defeated U.S. Army veteran Don Bolduc in the midterms, thanks in part to her commitment to protecting Medicare. Bolduc pushed for the privatization of Medicare to disastrous results.
Any Republican candidate thinking about slashing Medicare should consider reading the giant flashing neon sign that says: voters love Medicare. Some polls have shown that as many as 70% of Americans support the progressive Democratic idea of Medicare for all.
Since the Covid-19 public health emergency ended last spring, 10 states have refused to accept federal funding to expand Medicaid coverage, which would have prevented millions of people from losing coverage. Nearly 400,000 people in Florida, for example, fall into a coverage gap that disqualifies them from Medicaid coverage but cannot afford the premiums from an Affordable Care plan.
Candidates like DeSantis and Haley, who hail from states with that coverage gap, could feel the negative impact of that at the ballot box. Their most prominent rival in the Republican primary, former President Donald Trump, has repeatedly opposed entitlement reform. Other candidates, including Arkansas Gov. Asa Hutchinson and Gov. Christie, have already pushed for Medicaid expansion in their home states.
Voters’ opinion on health care
Presidential candidates dating back to FDR have made national health care a key talking point in their speeches. But in the wake of a health emergency the scale of the Covid-19 pandemic, health care has never been more ingrained in the national conversation than it is now.
Voters made clear maternal health care and rights protections as issues that mattered to them in the midterm elections, and hardliners with opposing views battled it out at the ballot box. For those of us investing in the future of health care, we need to consider what the ecosystem will look like over the next four years and use the latest mid-term period as a potential barometer for next year’s results.
Medicare already has an increasingly loud voice in the room after the Inflation Reduction Act, which allows it to negotiate prescription drug prices. What adjustments can we make as an industry to operate in an environment where Medicare has even greater impact? We also need to assess the long-term economic viability of our health care system. Economic obstacles, geopolitical conflicts and domestic politics, including the overturning of Roe, have recently added to the strain on an already beleaguered system. The next four years could shape a generation of health outcomes.
The final results of next year’s election may not sound quite like 2022, but they might rhyme.
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