Health care & the election: What do voter beliefs say about future health policy?

While health policy hasn’t been at the forefront of this year’s presidential election, the next person to sit in the White House could have a transformative effect on health care access, affordability and inequity. Of course, with so many variables in play, it’s hard to predict what either candidate could realistically accomplish on the health care front. However, a new report might provide some insightful clues.

Published this week in the New England Journal of Medicine, the report complied results from 14 national public opinion polls from various sources and conducted as recently as September 2016. In analyzing the polls, researchers attempted to address four questions: What is the mood of the country about health care issues as we approach the 2016 election? How do voters feel about the major health care policy issues likely to be debated after the election? How different are the health care policy views of Republican likely voters and Democratic likely voters? What are the implications for future health care policy on the basis of the outcome of the presidential and congressional elections?

Here are a few of the findings and insights the researchers gleaned:

• Among all likely voters, the top health care issue is the future of Medicare. When split up by the two dominant parties, the top health care issues for Republican voters are the future of the Affordable Care Act (ACA), the future of Medicare and the role of the government in slowing health care costs. The top three issues among Democratic voters are the future of Medicare, the future of Medicaid and the role of government in ensuring all people have health insurance.

• More than half of likely voters, or 57 percent, said the government should play a big role making the health care system work better, though more Democratic voters support that position than Republican voters.

• On the ACA, likely voters are more likely to think it’s not working well. Split by party, 80 percent of Democratic voters think the ACA is working well, while 88 percent of Republican voters think it’s working poorly. Also, more than one-third of GOP voters want to repeal the health reform law, while about one-third of Democratic voters think the ACA should be kept as is and about a quarter think it should be replaced by a public insurance program similar to Medicare.

• On Medicare, the majority of voters think the program is working well. In regard to controlling Medicare costs, both Democratic and Republican voters believe the best option is using financial incentives and penalties to encourage providers and hospitals to practice in less costly ways.

• On the topic of abortion and reproductive health care, a majority of overall voters oppose eliminating federal funding for Planned Parenthood. However, a majority of voters also oppose getting rid of the Hyde Amendment, which prohibits using federal funds to cover abortions under Medicaid.

• In terms of inequalities in health care, a significant majority of both Democratic and Republican voters still believe that rich Americans receives better health care than poor Americans. Among Democratic voters, 91 percent believe it’s the government’s responsibility to narrow the health gap, whereas 54 percent of Republican voters do.

Overall, the researchers predicted that if Democrats take control of Congress and the White House, they will likely continue implementing the ACA and expand it to reach the country’s remaining uninsured. If Republicans win, the researchers predicted they would likely try to reduce the ACA’s reach, reduce and eliminate any mandates, decrease federal subsidies and give more authority to state officials. The report also predicted the “greatest potential bipartisan agreement” on fixing Medicare’s finances, while forecasting business as usual on Planned Parenthood funding and abortion access. In other words, if Democrats are in charge, they’ll continue to support Planned Parenthood and the right to abortion; if Republicans are in charge, they’ll continue their opposition.

The researchers write: “It is important to recognize that future changes in health policy are related more to the extent of political polarization between the parties on health care than to the importance of the issue itself in deciding the 2016 election.”

To download a full copy of the report, visit the New England Journal of Medicine.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.