COVID-19 | Health Care Access & Coverage
What Does COVID-19 Mean for Health Care Reform?
Experts talk political feasibility before, after pandemic
Back in February 2020, when COVID-19 didn’t prevent us from gathering in a room with 300 people, Penn LDI’s conference, Medicare for All and Beyond dug into some of the major sticking points around health care reform. We capped off the day with a discussion on political feasibility, in which an expert panel shared their insights on public opinion and the viability of various reform proposals.
Americans are living through a generation-defining pandemic, a public health threat that most would have found unimaginable only a few months ago. What is politically feasible now may be very different from what our panel discussed in February. Could a pandemic usher in dramatic health care reform in the United States? We reconnected virtually with the same expert panel recently to hear their latest thoughts. Several themes emerged from these conversations:
“Change elections” are common – and they tend to usher in major health care reform legislation.
At the conference, we considered the possibility that 2020 would be a “change election,” one that would herald a shift in direction for public policy. The White House has changed hands every eight years from Republican to Democrat, and back again, since the early 1990’s. Each of these transitions ushered in major health care reform proposals, including the Medicare Modernization Act in 2003 and the Affordable Care Act in 2010. Our last change election was four years ago, so the timing is off for another one in 2020. However, some of our experts believe that the pandemic will expose significant vulnerabilities in our current health care system – such as inadequate insurance coverage and access to care – and increase public support for major change. As one expert noted, losing one’s job and employer-sponsored health insurance in the middle of a pandemic could be a pretty persuasive argument for universal coverage expansion.
Health care and the economy continue as top concerns for voters.
Before the pandemic, more than 60% of voters polled listed health care and the economy as their major concerns. The Kaiser Family Foundation’s latest polling indicates that this sentiment has remained stable during the pandemic.
Single payer health insurance is no longer a “fringe” idea – but support isn’t growing rapidly. And partisanship remains strong.
Since 2016, Kaiser polling has consistently found that most Americans support the idea of a single-payer health plan. While Bernie Sanders ultimately lost the Democratic nomination in both 2016 and 2020, his campaign clearly put single-payer insurance on the map. Kaiser’s latest polling finds that as of April, there are similar levels of public support for a single-payer health plan as compared with a few months prior despite the pandemic.
The partisan divides in attitudes toward single-payer health insurance continue to be stark. More than 3 in 4 Democrats favor the idea of a single-payer system, while 3 in 4 Republicans oppose it. Kaiser finds that partisan responses to single-payer health care have not changed significantly since the onslaught of COVID-19 cases in the United States. This is consistent with the finding that party affiliation is strongly associated with approval (or disapproval) of President Trump’s handling of COVID-19.
Proposals for incremental change have more support among both Democrats and Republicans.
Despite the enthusiasm among some Democrats for the general concept of a single-payer system, Kaiser found that most Democrats would prefer a candidate build on the ACA rather than replace it with a new system. A “public option” is more popular than a single-payer health plan among both Democrats and Republicans. There has been little change in these views since the pandemic hit. As of April, nearly 7 in 10 Americans support the idea of a public option, including 82% of Democrats and 46% of Republicans.
Even for Democrats, the devil is in the details. When presented with messaging about increasing taxes under a single-payer system, support for the idea dwindles – even across party lines. Experts point to industry talking points that have shaped beliefs about Medicare for All across parties. Asymmetrical language, such as calling a single payer system “government-run health care,” without describing our current system as “corporate-run health care” is commonplace. The notion of choice has also been framed in ways that cast single-payer systems in an unfavorable light.
Experts also cite the impact of behavioral science principles on public opinion. Negativity bias – the tendency to focus more on the potential negative impact of a proposal than on its potential positive impact – plays a significant role in American perceptions of health care reform. This bias was particularly visible in past health care reform debates, as attitudes towards the ACA became more favorable after the law was under threat of repeal. One expert suggested that negativity bias could cause Americans to focus more on recouping specific losses from the pandemic, rather than wholesale transformation of health care.
Health care reform will continue to be a top issue in the general election.
At the conclusion of our February session, one panelist noted that many political issues – not just health care reform – affect Americans in a life or death way. In an ordinary climate, the American public can generally focus on only one or two of these issues at a time, and candidates must choose the focus of their campaign wisely. In 2020, however, COVID-19 is the issue of the day, putting health care on center stage. There is little doubt that health care and the economy (especially job loss) will be central in the upcoming election. And, given the long-term health consequences of a COVID-induced economic downturn, these concerns will be top of mind for Americans for a long time. Polling to date shows that partisanship and division over major health care reform has stayed fairly constant, which does not bode well for the political viability of single-payer or Medicare-for-All proposals. However, as the pandemic exposes key vulnerabilities in our health system, especially with millions of people losing their job-based health insurance coverage, the appeal of significant health care reform may grow. Stay tuned.