Healthcare is the Most Important Issue for Voters

The Midterms Highlight Reel

The voters of the 2018 Midterm elections have spoken: The Democrats took the House of Representatives, while the Republicans maintained their majority in the Senate. The election brought forth several historical victories for diversity across the country. The results show that [1,2]:

• A record number of women will be seated in the House, including the first Native American women, Sharice David and Deb Haaland, and the first Muslim women, Rashida Tlaib and Ilhan Omar

• Tennessee and Arizona will elect their first female Senators
• 29-year old Alexandria Ocasrio-Cortez will be the youngest woman elected to Congress.
• Colorado will elect the first openly gay man for governor

Another notable election includes Republican Ted Cruz’s narrow victory over the breakout star of the Democratic party, Beto O’Rourke, in Texas’ Senatorial race. Meanwhile, Florida, Georgia, and Arizona have faced nail biting elections. Only one day after conceding to Republican Ron DeSatis from Florida’s gubernatorial race, Democrat Andrew Gillum withdrew his concession. Florida began a recount over the weekend of more than 8 million votes for the governor’s seat and the Senate seats [3]. In Georgia, Democrat Stacey Abrams has yet to concede to Republican Kemp because of claims of voter suppression [4]. Although Kemp currently leads Abrams by more than 60,000 votes, thousands of provisional ballots have yet to be counted.

Here in Arizona, the Senate race between Martha McSally and Kyrsten Sinema has garnered national attention. On Wednesday November 7, McSally led Sinema by 16,000 votes. By the next evening, Sinema took the lead over McSally [5,6]. Sinema’s margin slowly grew over the weekend amidst claims of election misconduct by President Donald Trump. At the time of this publication, Sinema leads McSally by 1.5 percentage points [7]. Cook Political Report has projected Sinema’s defeat over McSally, which means Sinema will be the first Democratic Senator from the State since 1995.

The Role of Healthcare in 2018

More momentous than the candidates elected to office are the issues that drove the election. Polls showed that healthcare was the most salient force for voters. A Gallup poll taken one week before the election revealed that 80% of registered voters said healthcare was “extremely” or “very important” to their vote. Healthcare outranked the economy, immigration, and taxes from Gallup’s list [8].

Notably, three traditionally red states—Utah, Nebraska, and Montana—voted for Medicaid expansion, giving 300,000 low income individuals access to healthcare. This also brings the total number of states that have expanded Medicaid under the Affordable Care Act (ACA) to 37 [9].

Healthcare also played a crucial role in the Arizona Senate race between McSally and Sinema. McSally, who voted to repeal the ACA last year, ran with the intention “to start fresh” on healthcare. On the other hand, Sinema promised to improve parts of the ACA, while keeping key protections. This included her pledge to stop increases in health insurance costs for individuals aged 50-64 [10]. Many experts believe the battle between Sinema and McSally boiled down to the candidates’ positions on healthcare.

Protections for pre-existing conditions has emerged as one of the most popular parts of the ACA, and a crucial election issue. Senators Claire McCaskill and Joe Manchin both placed campaign ads that strongly voiced their support for insuring individuals with pre-existing conditions [11]. Even President Trump took to Twitter before the elections to say that “Republicans will totally protect people with pre-existing condition, Democrats will not! Vote Republican.” Democratic Minority leader Chuck Schumer quickly responded that this was a lie [12].

At the same time, Trump’s claim to protect pre-existing conditions contradicts the administration’s lawsuit against the ACA [13]. The lawsuit aims to repeal the ACA’s guaranteed protections for people with pre-existing conditions and the individual mandate penalties—set to expire in 2019 regardless of the lawsuit. Trump told Axios that if they terminate Obamacare, they will “reinstitute pre-existing conditions.” The administration also recently introduced loopholes to the ACA, which allow states to offer plans that do not cover mental health, cancer treatment, or prescription services, and still call it insurance [14].   

An important note is that healthcare policy cannot maintain protections for preexisting conditions without enforcing an individual mandate. It comes down to the idea of “adverse selection” in the insurance markets. Adverse selection occurs when more unhealthy people (“high risk”) buy health insurance than healthy people (“low risk”). Because unhealthy people will need to utilize their insurance more than healthy people, this drives up the cost of premiums in the markets. Eventually, healthy people will leave the market, leaving unhealthy people with worthless insurance. Thus, the individual mandate is essential for protecting pre-existing conditions [15].  The Republican’s message that they can effectively cut the individual mandate while protecting pre-existing conditions could mislead voters.

The Future of Healthcare and 2020

In Arizona, the uninsured rate has dropped from 19% in 2013 to 10% since the ACA took effect [10]. Although the ACA has expanded health insurance coverage, 30 million Americans still lack coverage. While the Republicans support repealing the ACA, some Democrats have shifted towards an “universal health coverage” and others to a “Medicare for all” approach. Democrats Beto O’Rourke, Elizabeth Warren, and Kamala Harris have all come out in support of these ideas [16,17].  

For better or worse, the politics of healthcare often gains more media coverage than the policies of healthcare. Tackling healthcare will remain a key issue for voters and politicians in the 2020 presidential election. For now, we must watch how our divided government puts aside their differences to improve the health of all Americans.

Tina Samsamshariat

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Tina Samsamshariat is a member of the class of 2022 at the University of Arizona College of Medicine - Phoenix. She received her Bachelor of Science from the University of California, Los Angeles and her MPH from the University of Southern California. She enjoys surfing, climbing, and rap music. Twitter: @TSamsamshariat

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