Many Democratic congressional hopefuls are making healthcare their top talking point for the upcoming midterm elections, which is not surprising given the low unemployment rate.
Another issue is stagnant wages, which, all economists agree, are directly related to higher healthcare spending. Every additional dollar spent by employers and households on higher insurance, co-pays and drug costs is a dollar that can't be spent on housing, food and the latest iPhone.
That healthcare is once again atop the Democratic Party agenda should come as no surprise. The GOP-led Congress and President Donald Trump gave their opponents a huge gift when they decided to make “repeal and replace” their No. 1 priority last year. The residue from its narrow defeat in the Senate (with a little help from Jimmy Kimmel) is that tens of millions of Americans finally understand that repealing Obamacare could result in their losing coverage protection if they have pre-existing conditions.
The administration's efforts to undermine the individual market by cutting payments to insurers and allowing skimpy plans has also fallen flat as a political issue. Most Americans still get coverage through their employers. They worry far more about rising out-of-pocket costs than the fate of the uninsured.
These policy blunders have reshaped the political landscape. Gallup's annual poll on top healthcare concerns invariably places access and costs at the top (followed by specific social and medical concerns like drug and alcohol abuse, cancer and obesity). But at 24% and 16%, respectively, access and costs have jumped a combined eight percentage points in the past two years.
Given the shifting national mood, the best election outcome for healthcare providers and insurers who support the exchanges is divided government. It would put an end to the charade that there is some alternative to Obamacare other than single-payer. It would also foster bipartisan approaches to dealing with rising drug and service costs.
But there's no guarantee the changed national mood will produce that result. Gerrymandering, dark money, disenfranchisement of minority populations, and millennials' disaffection will feed the traditional drop in off-year turnout. That works to incumbents' advantage.
It doesn't help that the interests of healthcare's different sectors are diverging. For many, it's business as usual inside the Beltway.
The well-heeled pharmaceutical industry is gearing up to fight the popular idea that the government should negotiate drug prices. Some of the largest players in the insurance industry welcome the opportunity to sell the bare-bones health plans made highly profitable by their low medical-loss ratios.
Campaign contributions by PhRMA and AHIP's political action committees, as well as the individual companies that belong to those groups, are heavily tilted toward Republican incumbents in House races, according to their most recent filings. The two groups are also offering scant help to endangered Senate Democrats running for reelection.
The American Medical Association's PAC is also leaning toward the GOP. About 57% of the physician group's contributions as of early August have gone to Republican incumbents.
Only the American Hospital Association, and to a lesser extent the Federation of American Hospitals, have thrown their weight behind divided government. The AHA's PAC has given 57% of its contributions to Democratic incumbents. Both hospital group PACs also have given generously to the campaigns of Democratic senators facing tough re-election campaigns in states that voted for Trump in 2016.
Of course, the real tell will come from the far larger campaign contributions that will be made over the next few months. If hospital officials don't want to go through another two years fighting repeal-and-replace and deficit-fueled cuts in reimbursement, they will need to find a way to counter the other groups' support for the status quo.
Clarification: An earlier version of this editorial, stated that the American Medical Association's contributions to GOP candidates is a signal the association favors slowing the movement to value-based payment. In comment letters to HHS, the AMA has asked the administration to continue moving forward with alternative payment models.