These Are The Issues To Track

“History doesn’t repeat itself, but it often rhymes.” – Mark Twain

Foreign policy has vaulted to the top of voters’ minds in light of the conflicts in the Middle East and Ukraine, and while it will almost certainly remain a critical issue through next year, healthcare policy will also have significant influence on the election outcome.

Healthcare ranked as a key issue for over 60% of voters in the 2022 midterm election, according to Pew Research, and the healthcare policy issues on that ballot undoubtedly shaped numerous races. The U.S. spends more per capita on healthcare than any other developed country, while achieving poor outcomes when measuring life expectancy and maternal and infant mortality rates. Forecasters should expect a “rhyming” outcome in the 2024 presidential race, as many of the same healthcare issues that influenced the midterms remain at the forefront of voters’ minds.

Heading into an election year, these are the healthcare policy issues that may help determine the presidential race—and the next four years of healthcare reform—and deserve close attention from industry stakeholders.

Reproductive Rights

Increased restrictions on abortions have created ripple effects across the entire continuum of care, including impacts on care providers and insurers. More patients are seeking care across state lines, straining resources in blue states such as Illinois, which borders highly restrictive Missouri. Nonprofit hospitals can help to cover bills for some patients, but the University of Illinois Health in Chicago, for instance, cannot provide financial assistance for out-of-state residents and may be on the hook for care provided. For insurers, the issue is also complicating care for an at-risk patient population and creating delays that can make the final costs higher per patient.

Nearly 70% of respondents to a KFF/AP poll called the Supreme Court overturning Roe v. Wade an important factor, or the single most important factor, in the 2022 midterms, and voters came out in force to back pro-choice candidates. It showed clearly in Congressional races in states such as Pennsylvania and Kansas, where voters also rejected a referendum to ban abortion.

Ohio voters scored another win for abortion rights this November, passing an amendment to the state constitution that protects the right to choose. The 2022 midterms set the stage for the amendment when voters in that swing state soundly rejected a measure that would have required a supermajority to alter the state constitution—a Republican-backed proposal tied to the party’s efforts to restrict abortion access.

With those results in mind, the few Republican candidates who have taken a moderate stance on abortion may have some advantages at the polls. Both former New Jersey Governor Chris Christie and North Dakota Governor Doug Burgum oppose a federal ban on abortions. Meanwhile, Florida Governor Ron DeSantis and former South Carolina Governor Nikki Haley have taken hardline positions against abortion. If this issue drives Democratic voters to the polls as it did in 2022, it may mark a major boon to President Joe Biden’s reelection bid.

Entitlement Program Protection

An AARP survey of voters in the most contentious districts after the 2022 midterms found people aged 65-plus helped to swing the race for Democratic candidates. A quarter of those surveyed cited threats to Social Security and Medicare as a top issue, alongside inflation and threats to democracy. Entitlement program protection will only grow more influential as our population ages. By the year 2060, over 90 million people will be eligible for Medicare coverage—a significant climb from the 60 million who qualified in 2020.

In the deep purple state of New Hampshire, Democratic Senator Maggie Hassan handily defeated U.S. Army veteran Don Bolduc in the midterms, thanks in part to her commitment to protecting Medicare. Bolduc came out in favor of privatizing Medicare to disastrous results.

Any Republican candidate thinking about making cuts to Medicare spending should consider reading the giant flashing neon sign that says: voters like Medicare. Some polls have shown as many as 70% of Americans support the progressive Democratic idea of “Medicare for all.”

Since the Covid-19 public health emergency ended last spring, 10 states have refused to accept federal funds to expand Medicaid coverage, which would have prevented millions of people from losing coverage. Nearly 400,000 people in Florida, for instance, fall in a “coverage gap” that disqualifies them from Medicaid coverage, but they cannot afford the premiums of an Affordable Care Act plan.

Candidates such as DeSantis and Haley, who hail from states with that coverage gap, may feel a negative impact from it at the ballot box. Their most notable rival in the Republican primary, former President Donald Trump, has repeatedly opposed entitlement reform. Other candidates, including Arkansas Governor Asa Hutchinson and Governor Christie, already enacted Medicaid expansion in their home states.

Voters’ Mindset On Healthcare

Presidential candidates dating to FDR have made national healthcare a key talking point in stump speeches. But in the wake of a health emergency the scale of the Covid-19 pandemic, healthcare has never felt as rooted in the national conversation as it is now.

Voters clearly established maternal healthcare and entitlement protection as issues that matter to them in the midterm elections, and the hardliners with opposing views struggled at the ballot box. For those of us invested in the future of healthcare, we must consider what the ecosystem will look like in the next four years and leverage the most recent midterm as a potential barometer for next year’s results.

Medicare already has an increasingly loud voice in the room in the aftermath of the Inflation Reduction Act, which allows it to negotiate prescription drug prices. What adjustments can we make as an industry to perform in an environment where Medicare has even more influence? We also must evaluate the long-term economic sustainability of our healthcare system. Economic headwinds, geopolitical strife and domestic policy, including overturning Roe, have all recently added strain to an already beleaguered system. The next four years may shape a generation of healthcare performance.

The end results of next year’s election might not sound exactly like they did in 2022, but they could rhyme.