Health Care and the 2016 Debates

This was published as a Wall Street Journal Think Tank column on November 11, 2015.

Until Carly Fiorina criticized Obamacare during Tuesday’s prime-time Republican debate, there hadn’t been much attention to health care in the GOP debates. During last week’s Democratic candidate forum in South Carolina, I didn’t detect a single question about health care or the Affordable Care Act. This is not a knock on hosts and moderators; debates and forums such as the Democratic meeting last week are not the best vehicles for drawing out presidential candidates on the intricacies of health policy. The result, however, is that the public is not learning much from these widely viewed events about what candidates would do regarding one of the country’s most divisive issues should he or she be elected president.

And against that backdrop, some things are notable:

There are big differences between former Secretary of State Hillary Clinton and Sen. Bernie Sanders on health care. Mrs. Clinton favors building on the ACA and, actually, going further with a set of pro-consumer proposals that would take on rising out-of-pocket costs and drug expenses. She is aggressively taking on the drug and insurance industries. Mr. Sanders, by contrast, supports a Medicare-for-all single-payer health-care system, which would represent a far more sweeping change. He mentioned single-payer and Medicaid expansion in response to a question from Rachel Maddow at last week’s forum about how his agenda was relevant to African Americans. His Web site includes a petition that people can sign to support single-payer (and his candidacy), but the document does not lay out a single-payer plan. It describes two other health proposals: one to lower prescription drug costs and another to improve care for veterans. Former Maryland Gov. Martin O’Malley doesn’t feature a health plan on his Web site.

Among Republicans, Jeb Bush, Marco Rubio, and Bobby Jindal have plans for health-care reform, but it’s hard for moderators to single out their proposals for scrutiny amid so many candidates on stage, and with every one of them supporting repeal of the ACA.

Health care won’t disappear from the 2016 primaries altogether. All the Democratic candidates will discuss it on the campaign trail, regardless of whether it is a focus of nationally televised debates and forums. And speculation about whether the election of Republican Matt Bevin in Kentucky’s gubernatorial race last week constitutes a rejection of Obamacare in a state previously viewed as an ACA success story in the South may become a talking point in future Republican debates.

It will be a while–probably not until the general election–before a clear and substantive contrast between the two sides on health re-emerges as a focus in campaign debates; when that happens, the contrast promises to be sharp. The eventual Democratic nominee may run against policy ideas expected from House Republicans such as Medicare premium support or Medicaid block grants. In the past, Democrats have had some success portraying these as threats to Medicare and Medicaid. Of course, Republicans in the House will reject those criticisms, and they may decide to wait until after next November to put forward specific plans in an effort to deny Democrats an election issue.

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