Candidates seeking the 2020 Democratic presidential nomination got unusually specific in the first two primary debates about the differing ways they’d achieve universal health coverage if elected.
Former congressman Beto O’Rourke of Texas said people could keep their workplace coverage or get automatically enrolled in Medicare.
Sen. Kamala Harris of California said she’d let private insurers sell Medicare plans “if they comply by our rules.”
Former Colorado governor John Hickenlooper said he wants “a public option that allows some form of Medicare that maybe is a combination of Medicare Advantage and Medicare, but people choose it.”
Mayor Pete Buttigieg of South Bend, Indiana, said he backs “Medicare for all who want it.”
But do voters understand all these differences? New research suggests they might not. And it could have implications for the next debate and the race as a whole, where candidates are engaging in a pit fight over the details of their plans instead of focusing on the broad strokes that might actually sway voters.
When respondents to an Urban Institute survey were asked how they feel about several approaches to expanding health coverage – including Medicare-for-all – more expressed ambivalence than expressed either opposition or support.
The participants were presented with four approaches to closing the country’s persistent uninsured gap:
1. Increasing subsidies to lower premiums and out-of-pocket costs: 51.4 percent said they neither support nor oppose.
2. Giving Americans the option to enroll in a government-run “public option” plan: 45 percent said they neither support not oppose.
3. Enrolling all Americans in a single “Medicare-for-all” plan: 40.7 percent said they neither support nor oppose.
4. Enrolling all Americans in either a government-run or private health plan: 46.2 percent said they neither support nor oppose.
The results are striking, because most polls on expanding health coverage have only gauged a favorable versus an unfavorable view and the strength of that view. This latest survey reveals there’s a lot to learn by allowing respondents to indicate they don’t have a preference – and the extensive ambivalence is shared by both Republicans but also Democrats.
One could interpret the results a few ways. It could be that voters simply don’t care about how everyone gets health coverage – they just want assurance they can afford to visit doctors or hospitals when they or a family member needs help. Polls have shown Americans’ top concern is for elected officials to lower their out-of-pocket costs and ensure they can receive coverage despite any preexisting conditions.
Or the ambivalence could have to do with a lack of knowledge about how each approach would affect the cost, quality and availability of medical care. The Democratic candidates are backing a range of approaches, from a complete Medicare-for-all overhaul to merely adding a public option to the individual marketplaces. This is the first U.S. election in which these options are being extensively discussed, and there’s a huge learning curve for most voters.
That’s how John Holahan, a health policy fellow for Urban, sees it.
“I think it’s just uncertainty about what the policies would do and how they’d be affected by it,” Holahan told me. “For a whole lot of people, this is pretty mysterious stuff.”
And it’s unlikely the debates have brought voters much enlightenment, at least so far. They might be confused even more. While the topic of health care played a prominent role – consuming the first half-hour in both nights of debate last week – so many varying approaches to health insurance were aired that detangling them all practically requires a degree in health policy (if you want an easy overview on where the candidates stand, check this out).
Voters do tend to know a lot more about their own health insurance than about other policy issues, such as how much they pay in taxes, said James Kvaal, who served as policy director for President Barack Obama’s 2012 reelection campaign.
“They may not know the difference between Medicare and Medicaid, but they know a lot about what their current situation is and how that’s changed over time,” Kvaal said.
It might be an uphill battle for candidates to either explain different options for delivering insurance in a debate format – even big picture. The recent debates featured 10 people onstage at once, and each had to compete for a few seconds of speaking. Their speaking opportunities will likely increase in the coming debates, as candidates start dropping out of the race.