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Dem Strategists: Candidates Should Focus On Trump’s ACA Sabotage, Health Costs In Debate

September 12, 2019

Health care issues made up a large portion of the first two Democratic debates as candidates parried over their respective visions on universal health coverage, and some Democratic strategists say the candidates in tonight’s debate need to also make clear that the Trump administration has been working to undermine the existing law, both through regulatory moves and by backing a lawsuit that aims to scrap the Affordable Care Act.

The candidates should also take time to talk about how they will address health care costs, which is a top concern among Americans, say some Democratic strategists.

It’s good for the candidates to let voters know their position on how they hope to expand coverage, said Brad Woodhouse, executive director of the pro-ACA group “Protect Our Care,” which helped rally Democrats in the 2018 mid-terms. But, while “coverage is part of the conversation, it’s not the whole thing,” he adds.

Protect Our Care is hosting a pre-debate event to talk about what the group believes the candidates should be highlighting instead of beating each other up on the topic: health costs and the Trump administration’s attacks on the law.

The debates so far have been a missed opportunity to highlight those issues, Woodhouse told Inside Health Policy in a Wednesday interview. He pointed out the Texas lawsuit to overturn the ACA has barely been mentioned, even as the Fifth Circuit decision is likely to be out soon, and the case is bound to loom large during the general election.

Protect Our Care has had informal conversations with some campaigns on the importance of focusing on the administration’s attacks on the law, and on explaining how they would tackle health care costs.

Woodhouse said that he would love to see the debate moderators drill the candidates on what they would do, in the absence of passing Medicare for All on day one of their administration, to improve the current system and roll back the Trump administration’s damage. While candidate Joe Biden has called for building off the existing health care law, other top Democratic candidates have touted their plans to eventually move to a new Medicare for All system, which Republicans have likened to socialized medicine.

Woodhouse, for one, would like to see the candidates speak to how they would they reduce prescription drug costs -- would they promote House Speaker Nancy Pelosi’s proposal to give the government power to directly negotiate drug prices, or the slightly less-aggressive bipartisan bill out of the Senate Finance Committee, or something in between? He’d also like to know specifically how candidates would deal with the Texas lawsuit should the appeals court overturn the ACA, with struggling rural hospitals, with increasing insurance deductibles, and with other health care issues that directly affect people lives.

But he doesn’t expect that to happen.

The networks want to see conflicts on the stage and some candidates may want to use that time to create a bright line between themselves and their rivals on their health care vision, he said. For example, Vermont Sen. Bernie Sanders has made clear he wants to completely overhaul the current system, while other candidates have slightly different views. Most Democratic candidates spent the first couple debates hammering on each other’s visions to eventually move to a new health system instead of hammering on the Trump administration’s policies and saying how they would immediately fix health care problems.

All of the Democrats would probably benefit greatly from showing that they understand the damage done by the Trump administration and pledge to do something on “Day 1,” Woodhouse said.

While a new president could not immediately transform the system, he or she could quickly reverse much of the sabotage done by the Trump administration, including by restoring funding for exchange outreach and ending work Medicaid requirements.

If a candidate were to tick through the litany of Trump administration sabotage -- the Medicaid work requirements, the so-called junk health plans, cuts to enrollment assistance -- and concluded with ‘not on my watch,’ Woodhouse said, they would “get a standing ovation in the hall."

In fact, New Jersey Sen. Cory Booker received high praise when he questioned the tone of the second debate. “Well first of all let me just say that the person who is enjoying this debate most right now is Donald Trump as we pit Democrats against each other while he is working right now to take away America's Health Care,” Booker had said.

Woodhouse said Booker’s response had him cheering in his living room.

He also pointed out that House Democrats have been passing legislation that would roll back many of the administration’s changes to the law and have created a clear contrast with the president. The candidates also need to highlight these moves.

This is critical, he argued, because “Trump will lie."

The president will say that the GOP wants to protect preexisting conditions, even as this Justice Department seeks to dismantle them through the courts and other means, he will say he wants to tackle prescription drug costs, even as he demurs on drug negotiations, Woodhouse said.

Let’s also not lose sight of the fact that the Affordable Care Act has the support of a majority of Americans and is extremely popular among Democratic voters, Woodhouse said.

On Thursday, the Kaiser Family Foundation released its latest tracking poll, which found ACA favorability at an all-time high, with support from 53% of Americans. Kaiser also found that 84% of Democrats support the law, the largest share in the nine years of the tracking poll. “The share of Democrats who hold favorable views of the ACA has increased 11 percentage points over President Trump’s term, up from 73% in February 2017,” Kaiser found.

Democratic consultant Chris Jennings agreed that the candidates should focus more on current threats to the law. He also said they should focus on “here and now” issues related to high out-of-pocket costs, including surprise medical bills and high drug costs.

But another consultant said there will be plenty of time for the Democratic candidates to contrast their positions with those of the president.

“Politically speaking, there is little incentive for the Democratic presidential candidates to be just another voice in the monotone chorus of opposition to the Trump administration,” said Shea McCarthy, senior vice president of Thorn Run Partners.

“As the candidates continue to jostle for position, watch for them to focus more on drawing distinctions between each other on health policy than hurling arrows at President Trump -- there will be plenty of time for that during the general election,” he said. -- Amy Lotven (alotven@iwpnews.com)