The 2016 election could be the first one in eight years where Obamacare doesn’t drive the debate.
President Obama’s 2010 healthcare law was little more than an afterthought among Republican presidential candidates in their two face-offs so far, and on the campaign trail they’ve spent a lot more time talking about the Iran deal and how to treat illegal immigrants.
Americans are still divided over whether they like the law, although support has been slowly inching up. But its major provisions have been in place for several years and millions of low-income Americans have new government benefits that would be hard for politicians to rescind.
And as Obama prepares to leave office, the Democrats seeking to fill his shoes are focusing on skyrocketing drug prices, a different healthcare problem that Obamacare didn’t do much to address. Sen. Bernie Sanders has been hammering the issue and on Tuesday, Hillary Clinton rolled out her plan to deal with drug costs.
“I want to strengthen the Affordable Care Act because it didn’t fix all our problems,” Clinton said in a speech in Iowa. “So, while the overall growth in healthcare spending has slowed, for a lot of families it doesn’t feel like healthcare costs are under control because their out-of-pocket costs are rising.”
Focusing on drug prices could be strategic for Clinton and Sanders, who are eager to move past the Obamacare repeal discussions that have dominated past elections.
And polls show that drug costs are increasingly a pressing concern for around three in four Americans. One price hike sparked wide outrage last week, when the CEO of Turing Pharmaceuticals defended his company’s decision to raise the price of a medication used to treat a life-threatening condition caused by parasitic infections by more than 4,000 percent.
“This dramatic price increase will have a direct impact on patients’ ability to purchase their needed medications,” Sanders wrote in a letter last week to Turing.
Left-leaning groups are also bringing more attention to the issue, with the Center for American Progress releasing recommendations for public and private policies to lower the cost of drugs just a few days before Clinton’s speech.
Meanwhile, Americans are pretty much set in their views on the healthcare law and how they feel is largely dependent on which political party they identify with. Seventy-six percent of Democrats view it favorably and 71 percent of Republicans view it unfavorably, according to an August Kaiser poll, leaving candidates with little political capital to gain by talking about it, especially during the primary season.
“With the law now six years on the books, it’s very tough for Republicans to get traction by bringing it up,” said GOP strategist John Ullyot. “Anyone who’s against it is already going to vote with Republicans. It’s not so much a burning issue with centrist voters who are used to dealing with the law.”
All of the Republican presidential candidates officially support getting rid of the Affordable Care Act. But Donald Trump’s past statements supporting a single-payer system haven’t prevented him from holding the front-runner status for months.
Just two of the Republicans have proposed detailed plans to replace the healthcare law. One of them, Wisconsin Gov. Scott Walker, dropped out of the race last week. The other one is Louisiana Gov. Bobby Jindal, who’s trailing badly in the polls.
In the second GOP debate, Trump briefly referenced the law during his opening remarks, Walker touted his replacement bill and Sen. Ted Cruz, R-Texas, vowed to repeal it. But that was mostly the extent of the discussion around healthcare policy.
“It’s still part of the mantra,” said Tim Jost, a health law professor at Washington and Lee University. “I think they have realized that … it would be impossible to unravel the whole thing, it’s just so much part of our healthcare system now.”
Republicans’ best shots at ditching the law have come and gone twice now, first when they failed to seize the White House in 2012 and then again when they couldn’t gain a filibuster-proof Senate majority last year.
Clinton is backing some changes to the law, but she’s mostly been touting its coverage expansions to millions of Americans who couldn’t previously afford insurance. She wants to build on it by more strictly regulating drug companies and requiring them to pay higher rebates to Medicare. In addition, the plans proposed by Clinton and Sanders would both allow Medicare to negotiate with pharmaceutical companies to lower the prices of prescription drugs.
The Republican candidates have said little about the cost of prescription drugs so far, and whoever wins the Democratic nomination is likely to try to ding their GOP opponent on that score. Strategists say that could end up being an area of bipartisan concern during the election, although Republicans are less likely to support more regulations on drug makers.
But however the 2016 healthcare debate is themed, it’s unlikely to take the same flavor as in years past.
“I think now that people are seeing some concrete benefits from the Affordable Care Act, it’s going to be harder to demagogue it,” Jost said.
This article appears in the Sept. 28 edition of the Washington Examiner magazine.
