The sick stakes for health care in this election

Millions of people could gain — or lose — coverage, for starters.

Welcome to a Saturday evening edition of Progress Report.

With just a few days left until the midterm elections, it’s easy to get fall down and rabbit hole of polling data and obsess over trends, ad buys, superficial analysis, and margins of error — it’s how we’re taught to process elections by most national political media.

The horse race approach has two problems. First, it keeps most voters in the dark on the issues that matter to them. Second, it presents the candidates on more or less even footing, even if some are sociopaths that quite literally seek to institute a theocratic fascism and expedite the planet’s meltdown.

The upshot is that people largely miss out on substantive stories like the one below, which I just reported and produced for More Perfect Union (yes, I’m technically on parental leave, but things are too crucial to stay on the sidelines):

More Perfect Union @MorePerfectUS

NEW: Attacks on public education could swing elections in Democrats favor. After decades of conservatives defunding public education, there's a backlash brewing. And it’s happening in Oklahoma and other conservative states across the country.

Here at Progress Report, we’re also focused on the actual stakes of these elections, especially for working families. So tonight, we’ve got a story from Natalie Meltzer about the tens of millions of people whose health is on the ballot on Tuesday.

Note: I’ll be opening a new chat thread in the substack app tomorrow. I’ve been posting lots of news stories in the first thread, which is open to everyone. Tomorrow’s will be for paid subscribers.

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by Natalie Meltzer

Since the Supreme Court overturned Roe v. Wade, the Democratic machine has zeroed in on reproductive rights as the most salient issue that will bring voters to the polls this midterm election. 

Over the last weeks, however, the party has begun to recognize that their focus on abortion has potentially been to their detriment, as they have ignored the pocketbook issues that are front of mind for most voters, given the massive squeeze of inflation. 

One issue that intersects with both reproductive health access and inflation is healthcare. The issue consistently ranks among voters’ top priorities, in part because along with housing and food, the rising cost of medical care is one of the largest contributors to the increased cost of living. 

Unsurprisingly, healthcare costs are top of mind for voters across the political spectrum: 87% of Americans say a candidate's plan to reduce the cost of healthcare services was very or somewhat important in casting a vote and almost 40% of Americans are willing to vote for a candidate from the opposing party who made lowering health costs a top priority, according to a Gallup/West Health poll. 

While they have not made it a central component of their messaging, Democrats at the national level have passed significant policy to help ease the financial burden of medical care. The Inflation Reduction Act included a few major provisions that will save Americans thousands of dollars per year in healthcare premiums, prevent an estimated 2 million people from losing insurance coverage, and expand access to and limit price increases for prescription drugs. 

These achievements could be rolled back if Republicans take control of Congress. 

House Minority Whip Steve Scalise said in August that his caucus plans to reverse the Inflation Reduction Act. Moreover, Congressional Republicans are planning to reduce federal spending on Social Security and Medicare should they win a majority in both the House and Senate. Republican control of Congress would also certainly mark the end of the COVID-19 emergency declaration, which has provided healthcare coverage to millions of Americans during the pandemic. An estimated 15 million people — including 6 million children — will lose Medicaid coverage when the public health emergency ends. 

Centering Healthcare Can Give Democrats an Edge 

In Iowa, State Representative Christina Bohannan is centering healthcare in her campaign to unseat incumbent U.S. Representative Mariannette Miller-Meeks in the new 1st District. The race is projected to be very tight; Miller-Meeks won election in 2020 by just six votes.

Bonahan has said healthcare has been an important issue in her family since she was a child. Growing up in rural Florida, her construction worker father got sick and lost his health insurance.

“With my dad losing his health insurance and us already struggling from paycheck to paycheck, social security and Medicare were absolutely essential for our family and I am hearing that a lot when I am talking to people out in the district,” said Bohannan.

In a new ad, Bohannan puts healthcare costs and the social safety net front and center. Her campaign website tracks Miller-Meeks’s record of voting against the IRA provisions that allow Medicare to negotiate for lower prices, cap seniors’ out of pocket drug expenses at $2,000 per year, and cap the cost of insulin at $35 per month for seniors on Medicare. 

Christina Bohannan @BohannanIowa

Our new ad, "Back on Track," is on TV! Getting back on track and giving everyone a fair shot. #Onward

“It seems clear that Miller-Meeks is working harder for big pharmaceutical companies than she is for the people of southeast Iowa,” the website says. 

Healthcare is Particularly Salient in Rural Areas

A focus on healthcare can also help Democrats gain supporters in the ever important rural communities, where already limited access to healthcare is decreasing as hospitals merge, reduce services, or shut down. 

Hospital shutdowns and doctor shortages are happening everywhere, but the impact is felt most accutely in rural regions. In Pennsylvania, five rural hospitals have closed since 2005 in the state and eighteen rural counties are or are forecasted to be maternity care deserts where there are not enough providers for all pregnancies. Only Texas and Georgia have had more rural hospital closures (more on the political consequences below).

The gubernatorial candidate who wins on Tuesday will likely have his hands full with healthcare issues, and Democratic nominee Josh Shapiro and Republican nominee Doug Mastriano have very different ideas of how to address the state’s medical needs.

Shapiro’s campaign website is rich in specifics about what he’d do to enhance health care as governor.

“As governor, Josh will tackle the health care workforce crisis and ensure more funding is available for recruitment and retention of nurses, mental health professionals, home care aides, and other important health care workers. Josh will also expand telehealth services, strengthen the pipeline for health care providers in under-served areas, and fund a mental health counselor in every school. He will stop rural hospitals from closing, aggressively seek to rein in drug prices, and ensure that large pharmaceutical companies are not taking advantage of Pennsylvanians.”

Shapiro also says he “will make healthcare more accessible and lower the cost of services to make healthcare more affordable.”

His resume backs up the rhetoric, especially on the regulation of hospital mergers and closures. As the state Attorney General, Shapiro joined a 2018 lawsuit challenging Trump administration efforts to undermine the Affordable Care Act and filed an amicus brief opposing a legal push by Republicans to repeal the entire ACA without a replacement. He also recently intervened in a lawsuit to keep Delaware County Memorial Hospital from shutting down.

Mastriano, on the other hand, does not even mention healthcare in his campaign platform. The only healthcare-related policy he includes is on abortion, where he commits to “sign the Heartbeat bill into law, end funding to Planned Parenthood, and expand counseling for adoption services.

Despite his current silence on healthcare issues, his previous policy platforms and proposals indicate that a Mastriano governorship could be literally fatal for many Pennsylvanians. 

During a failed congressional bid in 2018, Mastriano announced his opposition to the Affordable Care Act on his campaign website, arguing that “health care and benefits for the American people should be by our choice and based on our needs. There should be no penalties nor astronomical costs for individuals or families.

“Obama Care must go,” Mastriano said at the time.

In Georgia, the hospital doors are literally being shut on poor people. In September, the medical group Wellstar Health System announced that it would be closing down its downtown Atlanta Medical Center, an iconic hospital that for a century was devoted to providing care for those that could not pay for it. It was the second hospital that Wellstar has shut down this year.

Democratic gubernatorial nominee Stacy Abrams has seized on the closures to illustrate the urgency of a campaign that has focused in large part on health care, including the expansion of Medicaid.

More than a decade later, one battle still rages on

Ever since the Supreme Court axed the provision of the Affordable Care Act that obligated states to expand Medicaid, there’s been no better indicator of a state’s politics than whether or not it has expanded Medicaid.

The number of holdouts has slowly dwindled as citizen-led ballot initiatives have circumvented GOP-controlled legislatures that refuse to expand the low-income health care program. This year, South Dakota is likely to become the latest otherwise deep red state in which voters take the matter into their own hands and expand Medicaid, which is deeply ironic given the state’s conservative politics compared to the much more competitive politics of other holdout states.

Even if Abrams were to pull off an upset victory over Gov. Brian Kemp, Georgia is likely too gerrymandered to motivate Republican legislators to vote for expansion.

It’s amazing what fair maps can do.

In North Carolina, Democratic Gov. Roy Cooper has long advocated for Medicaid expansion, only to be ignored by a Republican legislature that had gerrymandered itself out of accountability. But this cycle, legislative maps are far less gerrymandered, which has put the heat on lawmakers to actually work on behalf of their constituents or risk getting the boot. Legislative leaders suddenly had a change of heart, and had it not been for interference from the hospital lobby and differences in the House and Senate’s bills, Medicaid expansion may well have passed.

NC Democrats are hoping to pick up a few seats this cycle, but given the difficult climate, their backstop goal is preventing GOP supermajorities. Should they hold all their seats, Medicaid could finally get expanded in North Carolina next year.

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