A new analysis predicts health care could be a campaign weapon for Democrats in a tight presidential race, with the media already stressing stark differences between Donald Trump and Kamala Harris on the issue.
The two have already sparred over health insurance. Trump said Harris wants to outlaw private health insurance, and Harris responded by accusing Trump of wanting to end Obamacare, CNN reported on August 2.
KFF said in its analysis Harris may use health care as a counteroffensive against discussion of inflation and immigration, pushing the idea of abortion as health care and Obamacare as the only way to protect people with preexisting conditions.
“The Democratic advantage on health is about the same size as the Republican advantage on immigration,” stated the July 25 KFF analysis. “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.”
Contrasting Histories
As a U.S. senator, Harris supported single-payer health care outlawing private health insurance. Harris softened that position when she ran with Joe Biden in 2020.
Trump established a strong record of opening the health care market to more competition, by expanding short-term health insurance, association health plans, and portable health insurance for employees during his term as president.
Restoring Medicaid’s Mission
The candidates can distinguish themselves on Medicaid reform, says Linda Gorman, director of heath care policy at the Independence Institute and a policy advisor to The Heartland Institute, which publishes Health Care News. Medicaid provides poor-quality health care, says Gorman.
“Medicaid was designed to care for people who were too frail and compromised to work,” said Gorman. “It makes sense to reserve Medicaid funding for those people. Their conditions are expensive, but they are relatively few in number.
“Huge waiting lists, appointment shortages, specialists not included in networks, poor drug coverage, poor-quality hospitals, and decrepit facilities are some of the problems people encounter when trying to use Medicaid for health care.”
The Democrats’ Affordable Care Act in 2010 made Medicaid, and health care in general, unaffordable, says Gorman.
“The Affordable Care Act eliminated all of the financial controls private insurers had to control spending and ensure that incentives were properly aligned to reduce fraud,” said Gorman. “As a result, Medicaid costs are uncontrollable, its quality is declining, and it is taking the private health care system down as well.”
Reconsidering Alien Lawbreakers
The candidates should discuss reforming Medicaid spending by reducing red tape and revising expensive policies like the Emergency Medical Treatment and Labor Act (EMTALA), says Gorman.
EMTALA requires hospitals to provide health care to people in the country illegally, who often cannot pay for the services they use.
“It is essential to keep the interplay between illegal immigration and EMTALA in mind,” said Gorman. “Under EMTALA, hospitals must treat illegals no matter what, and Medicaid coverage just pays [the providers] a bit toward the cost of care. Medicaid does not pay the full cost.
“When hospitals are overwhelmed by people who do not pay, they try to reduce their attractiveness by closing emergency rooms and maternity centers,” said Gorman. “When the nonpaying population gets too big, hospitals cannot pay market wages.”
An excess of nonpaying patients causes hospital quality to decline and deprive paying, legal citizens of good health care, says Gorman.
“Public money should be reserved for people who are sick,” said Gorman. “The regulatory thicket needs to be cleared. Government needs to stop shifting the cost of government programs to the private sector through programs like EMTALA and federal price controls.”
Eliminating Cost Shifting
The shortcomings of Medicaid and Obamacare provide candidates an opportunity to appeal to a large group of voters, says Lauren Stewart, a senior legislative affairs liaison with Americans for Prosperity
“Enrollees in both Medicaid and Obamacare plans have learned the hard way that access to health insurance does not equal access to health care,” said Stewart. “These enrollees experience their already limited networks continuing to shrink; boxing out options, which can include a doctor you’ve been seeing for years but simply and suddenly is no longer in-network, delaying care with long wait times, or even due to the exorbitant costs of the premiums.”
Frustration is growing over inconsistent and unreliable health care coverage, says Stewart.
“The plans offered change frequently, and in some instances in a very untimely manner, as it was for my friend Mary Katharine Ham, who was recently widowed and seven months pregnant when she was informed that her ACA plan was simply not going to exist anymore,” said Stewart.
Enjoying Bipartisan Support
Polls conducted by AFP show bipartisan support for some reforms, including site-neutral payment under Medicare. Currently, Medicare reimburses hospitals more than independent practices for the same service.
“There are a number of Democrat lawmakers on [Capitol] Hill that are on board with enacting site-neutral payments across the board or even for certain services,” said Stewart.
The current payment system incentivizes hospitals to buy up independent practices, which reduces competition, lowers access to care, and raises prices, says Stewart.
“Rampant hospital monopolies drive up the cost for patients across the board,” said Stewart. “Democrats and Republicans support this idea, but one reason particularly exclusive to Democrats is their desire to keep Medicare solvent.”
Jesse Hathaway (think@heartland.org), a policy advisor to The Heartland Institute, writes from Columbus, Ohio.
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This article was updated on August 9, 2024 to include new developments.
