You probably read a lot about health care over the past week. But here’s one piece of health-care-related news I’m betting you missed: The Georgetown University Health Policy Institute released a report showing that from 2016 to 2018, around 400,000 children lost health-care coverage.
Yes, that’s from the last year of the Obama administration through the second year of the Trump administration, and no, that’s not a coincidence. Here’s how CNN summarized the situation: “Several factors have contributed to the bump in uninsured rates for children, the center says. They include: efforts to repeal the Affordable Care Act and cut Medicaid, delays in funding the Children's Health Insurance Plan, the effective elimination of the individual mandate penalty, cuts to Affordable Care Act enrollment outreach and advertising and an increase in state-based eligibility checks for Medicaid.”
That’s five factors. Gee, who’s behind them? The Republican Party. Every one of them. Republicans are the ones trying to repeal the ACA, cutting Medicaid, delaying CHIP funding, eliminating the mandate penalty (in their 2017 tax bill), cutting enrollment funding, and, at the state level, toughening eligibility requirements.
The report is devastating; it’s not too long and has lots of easy-to-read charts. Take a look at it. The long and short of it is that a sizeable chunk of the gains in children’s health coverage that Democrats made are being wiped out. Also (and naturally), states that refused the ACA Medicaid money are doing three times worse on average than states that took the money. Also, if you want to read the report with your political eyeglasses on, you won’t help but notice that some of the states that have been hardest hit in the last two years are potential battleground states: Arizona, Florida, North Carolina, Ohio, and Georgia.
In other words, this is the hanging curveball for Democratic presidential candidates. It’s as open-and-shut as anything in politics gets. Children, for God’s sakes. With an emphasis on babies and toddlers.
And what are the Democrats talking about? Multi-trillion dollar plans based on nearly impossible assumptions that aren’t going to become law anyway.
As I’ve written many times, if it were up to me and I could wave a wand, this country would have a National Health Service more or less like England’s. Unlike in the plans of Bernie Sanders and Elizabeth Warren, private insurers continue to exist in the Tomasky plan; I’d cap their profit margins, but people would be able to buy supplemental insurance, as they can in our Medicare system and in both the U.K. and Canada. Also, unlike Sanders and Warren, this plan would require modest, means-tested contributions from beneficiaries. We have these now in this country under Medicare, and they cover 13 percent of Medicare’s overall costs, which is not nothing.
But it’s not up to me and I can’t wave a wand, and neither can Warren or Sanders. What the Democrats can do, however, is one of two things: They can seek to unseat Donald Trump on the basis of popular and non-controversial proposals, or they can try to do it on the basis of proposals that are highly controversial and whose popularity may look good on the surface but vaporizes as poll respondents are walked through the likely trade-offs.
Tom Edsall cited some interesting NBC/Wall Street Journal polling data in a recent column (scroll down toward the bottom). The questions here compared Democratic primary voters’ levels of support for certain policies versus general election voters’ support for those policies.
Solid majorities of general election voters were lined up with Democratic primary voters on three issues: allowing dreamers to stay in the country; forgiving student loan debt after 15 years of payments; and allowing a Medicare buy-in for people under age 65. Narrower majorities were with primary voters on two more matters: making college free, and shifting to 100 percent renewable energy.
Majorities of general election voters were at odds with Democratic primary voters on four other issues, where the Democratic primary voters supported an idea that general election voters opposed: banning fracking; cancelling all student debt; providing health care to the undocumented; and imposing Medicare for All.
I’m not saying on the basis of this one poll that Democrats should reject those four things. Maybe they shouldn’t. Of the four, providing health care to the undocumented seems to me like something on which a Democratic candidate could maybe construct a case based on both morality and cost-effectiveness that might convince 51 percent of swing voters.
But I am saying that adopting positions like that across the board means taking some obvious risks. Take the immediate fracking ban, which Warren and Sanders also support. I’m sure you agree that winning Pennsylvania is a must, right? Well: Do you have any idea how many fracking wells there are in Pennsylvania? About 7,800. Mostly in counties that lean red, but where Barack Obama did miles better than Hillary Clinton did, and she didn’t even oppose fracking. Support for an immediate fracking ban really complicates the job of winning that state’s 20 electoral votes, which in turn really, really complicates the job of taking back the White House.
Same with Medicare for All. The Republicans should be the ones spending the next year playing health-care defense. The Democrats should be spending the next 12 months shooting Republican fish in the health-care barrel, like those 400,000 kids they threw off the rolls. Right now, though, the Democrats are shooting, but in the all-too-familiar direction of themselves.