Following today’s news that the Trump Administration will propose a 95% cut to the Office of National Drug Control Policy charged with coordinating the federal response to the nation’s raging opioid crisis, Protect Our Care Campaign Director Brad Woodhouse released the following statement:
“For Americans fighting the opioid crisis who had hoped that President Trump might finally address this raging epidemic with the urgency it deserves, today’s proposed ONDCP cuts are yet another blow. This Administration has done nothing to facilitate treatment for Americans struggling with addiction, and its attacks on Medicaid and the ONDCP stand to make the situation worse. By trying to gut the office charged with coordinating the federal opioid response, the Trump Administration is not only continuing its pathetic response to the nation’s most urgent public health crisis: it is now actively sabotaging the communities that are fighting so hard to turn the tide on this deadly epidemic.”
During his calamitous first year in office, President Trump broke his health care promises again and again, taking a hatchet to the American health care system. With enthusiastic cooperation from Congressional Republicans, Trump’s Administration embarked on a campaign to sabotage and weaken our care that has already driven 3 million Americans into the ranks of the uninsured and spiked premiums for millions more.
“If there’s one thing President Trump’s first year in office made clear, it’s that Americans cannot and should not trust Republicans to protect our care. President Trump has spent the past twelve months systematically breaking every health care promise he made to the American people. As President Trump and his Republican allies ratchet up their war on our care in 2018, Americans must stand up to their outrageous sabotage of the American health care system,” said Brad Woodhouse, Campaign Director for Protect Our Care.
THE REALITY: Trump supports dramatic cuts to Medicaid included in Republicans’ failed repeal bills and his Administration encourages states to embrace policies that reduce Medicaid enrollment.
TRUMP’S PROMISE: “Everybody’s going to be taken care of much better than they’re taken care of now.”
THE REALITY: The Trump Administration embarks on a campaign of systematic sabotage:
January 2017
On his first day in office, President Trump signs an Executive Order directing the administration to identify every way it can unravel the Affordable Care Act.
February 2017
The Trump Administration proposes a rule to weaken Marketplace coverage and raise premiums for millions of middle-class families.
March 2017
The Trump Administration sends a letter to governors encouraging them to submit proposals that include provisions such as work requirements that make it harder for Medicaid beneficiaries to get affordable care and increase the number of people who are uninsured.
April 2017
The Trump Administration cuts the number of days people could sign up for coverage during open enrollment by half, from 90 days to 45 days.
May 2017
House Republicans vote for and pass a health care repeal bill that would cause 23 million people to lose coverage and gut protections for people with pre-existing conditions.
June 2017
Senate Republicans embark on a monthslong failed attempt to pass BCRA, Skinny Repeal and Graham-Cassidy, all repeal bills that would cause millions of Americans to lose their health coverage and raise premiums by double digits for millions more.
July 2017
The Trump Administration uses funding intended to support health insurance enrollment to launch a multimedia propaganda campaign against the Affordable Care Act.
August 2017
The Administration cuts the outreach advertising budget for Open Enrollment by 90 percent, from $100 million to just $10 million – likely to result in 1.1 million fewer people getting covered.
September 2017
The Administration orders the Department of Health and Human Services’ regional directors to stop participating in Open Enrollment events. Mississippi Health Advocacy Program Executive Director Roy Mitchell said, “I didn’t call it sabotage…But that’s what it is.”
October 2017
The Trump Administration takes direct aim at birth control by rolling back a rule that guaranteed women access to contraception. (A court has since questioned the legality of the action.)
President Trump signs an Executive Order to roll back key consumer protections that will result in garbage insurance, raise premiums, reduce coverage, and again expose millions of Americans to discrimination based on pre-existing conditions.
The Trump Administration dramatically cuts in-person assistance to help people sign up for 2018 health coverage.
After threatening for months to stop funding cost-sharing reductions (CSRs) that help lower deductibles and out-of-pocket costs, the Trump Administration stops the payments altogether. The CBO finds that failing to make these payments will increase premiums by 20% and add nearly $200 billion to the debt.
November 2017
Republicans refuse to move forward on the bipartisan Alexander-Murray bill to address the CSR crisis even though it had a filibuster-proof majority in the Senate.
December 2017
The Trump Administration proposes a rule to expand association health plans, which would gut consumer protections, raise costs for people with pre-existing conditions and further destabilize the insurance markets.
Congressional Republicans pass their tax scam, which doubles as a sneaky repeal of the Affordable Care Act by kicking 13 million people off of their insurance and raising premiums by double digits for millions more.
January 2018
The Trump Administration announces that it will support states that impose onerous work requirements on Americans covered by Medicaid, and approves Kentucky’s worst-in-the-nation waiver the next day.
The week, as much of the focus in Washington shifted to DACA and negotiations in Congress over a continuing resolution, the Trump Administration continued its unprecedented assault on the American health care system.
While your attention was focused elsewhere, here’s a summary of what happened this week in sabotage:
ATTACKS ON MEDICAID
As the dust settled around the Trump HHS’s approval of Kentucky’s worst-in-the-nation Medicaid waiver, experts dug into the fundamental ways it signals an end to Medicaid’s legacy:
As Margot Sanger-Katz notes: “Kentucky’s new Medicaid waiver will ask low-income people to jump over hurdles to keep their coverage. Evidence suggests that many will fail … Kentucky officials argue that the changes will give beneficiaries more dignity and promote personal responsibility. But they also estimate that around 100,000 fewer people will be enrolled in the program by the end of five years.”
Meanwhile, Republicans opened a new front in their war on Medicaid. Yesterday, Senator Ron Johnson held a sham hearing to try to smear Medicaid by blaming it for the opioid crisis — when in fact Medicaid is one of our most important tools to curb the epidemic. Fortunately, few were fooled:
Newsweek: “The Republican argument is flawed because the Medicaid expansion began in 2014, and opioid addiction was declared an epidemic by the Centers for Disease Control and Prevention in 2011.”
Washington Post: “While conservatives have noted that overdose deaths are much higher among people inside the program than those outside it, according to the Centers for Disease Control and Prevention, they’ve not been able to prove Medicaid actually leads to opioid abuse.”
Los Angeles Times: “The Republican campaign against Medicaid could only make the opioid crisis worse. That’s because Medicaid pays for a huge proportion of opioid treatments, covering fully one-third of those with addiction problems … Johnson and his fellow Republicans in Congress seem determined to impose cuts on the program, even though the benefits it renders are crystal-clear. Wednesday’s hearing did achieve one benefit, for all that: It showed how threadbare their arguments are.”
ATTACKS ON EMPLOYER COVERAGE
On Monday, New York Times reported that the GOP’s next health care sabotage scheme will remove the requirement that employers of over 50 workers offer health coverage for their employees. Such a move could yank care away from millions more Americans, while increasing government spending:
“The Affordable Care Act was built on a framework of shared responsibility … If you get rid of the employer mandate, you will see people lose coverage from their employers.”
ATTACKS ON CRITICAL HEALTH PROGRAMS
Congressional Republicans released a Continuing Resolution proposal that continues their heartless strategy of using children’s health insurance as a bargaining chip. Their bill also attempts to delay Affordable Care Act taxation provisions that benefit big corporations, while ignoring critical expired programs that support essential providers. These include community health centers and hospitals that serve lower-income communities. Some of these critical provider systems are facing threats of closure due to the ongoing uncertainty caused by the Republican Congress..
As Politico reported, GOP Congressional leaders considered including the badly-needed funding – then decided not to:
Knowing the vote is close, Ryan, House Majority Leader Kevin McCarthy of California and other GOP leaders debated on Wednesday morning whether to add more provisions to the package, such as funding for community health centers. In the end, they decided to move ahead with the package as is.
As this week’s CR brinksmanship showed, Republicans continue to prioritize partisan politics over their constituents’ health care.
SABOTAGE TAKES A TOLL
On Tuesday, Gallup found that America’s uninsured rate jumped during Trump’s first year in office for the first time in a decade, causing 3.2 million Americans to lose their care.
If this week’s news is any indication, that number could climb as the Republican war on health care continues into 2018.
This morning, Sen. Ron Johnson held a hearing at his Homeland Security & Governmental Affairs Committee ostensibly to discuss the opioid epidemic. Instead, it quickly delved into a showing of right-wing talking points, falsely claiming that Medicaid expansion – ensuring more access to health care – is causing this epidemic.
What are the problems with this Republican theory?
CDC: “There Is No Evidence Medicaid Leads To Opioid Abuse.” “The Republican argument is flawed because the Medicaid expansion began in 2014, and opioid addiction was declared an epidemic by the Centers for Disease Control and Prevention in 2011. The federal science agency has also said there is no evidence that Medicaid leads to opioid abuse.” [Newsweek, 1/17/18]
Vox: “This Claim Runs Into A Basic Problem: The Concept Of Time.” “But this claim runs into a basic problem: the concept of time. Medicaid didn’t expand under Obamacare until 2014 — well after opioid overdose deaths started rising (in the late 1990s), after the Centers for Disease Control and Prevention in 2011 declared the crisis an epidemic, and as the crisis became more about illicit opioids, such as heroin and fentanyl, rather than conventional opioid painkillers. ‘It’s pretty ridiculous,’ Andrew Kolodny, an opioid policy expert at Brandeis University who’s scheduled to testify at the Senate hearing, told me.” [Vox, 1/17/18]
David Wyman, Georgetown University Law Center: “Just Because A Precedes B Doesn’t Mean That A Causes B. That’s Statistics 101.” “The witnesses included one anti-Medicaid ideologue, two local prosecutors who testified that they’ve seen a lot of addicts in their work and lots of them seem to be on Medicaid, and two experts who, tactlessly, pointed out that the causes of the opioid epidemic are many and complex, that it started years before Medicaid expansion, and that it involves patients and doctors in Medicare and private insurance as well as the uninsured… Efforts to demonize Medicaid expansion because it was launched as the opioid crisis really took off confuse correlation with causation, David Hyman of the Georgetown University Law Center warned Johnson’s committee. ‘Just because A precedes B doesn’t mean that A causes B,’ he said. ‘That’s statistics 101.’” [Los Angeles Times, 1/17/18]
Do Republicans pushing this theory have any actual evidence to back it up?
Washington Post: “They’ve Not Been Able To Prove Medicaid Actually Leads To Opioid Abuse. On The Contrary, [Medicaid Expansion] Has Given More Americans Access To Addiction Treatment.” “So, who’s right here? There’s little data to draw from, since Medicaid was expanded only recently under the ACA. But while conservatives have noted that overdose deaths are much higher among people inside the program than those outside it, according to the Centers for Disease Control and Prevention, they’ve not been able to prove Medicaid actually leads to opioid abuse. On the contrary, as Medicaid advocates note, expanding the program to include childless adults earning up to 133 percent of the federal poverty level has given more Americans access to addiction treatment. The program, which provided coverage to 3 in 10 people dealing with opioid addiction in 2015, covers outpatient treatment and inpatient detoxification, among other services, for substance use disorder.” [Washington Post, 1/17/18]
Could this theory lead to drastic conclusions which are squarely at odds with public health?
Katherine Baicker, University Of Chicago Harris School Of Public Policy Dean: “I Don’t Think Anybody Would Suggest Because Overprescribing Of Opioids Poses A Series Health Risk, People Shouldn’t Go See The Doctor.” “If [Republicans] argue against Medicaid based on the idea that it potentially allows more patients to get prescriptions for opioids, they could use that same reasoning to oppose expansion of private health insurance. Expanding health insurance of any variety increases people’s access to health care. Much of that care is beneficial; some may not be, Katherine Baicker, dean of the University of Chicago’s Harris School of Public Policy, told me. ‘I don’t think anybody would suggest because overprescribing of opioids poses a series health risk, people shouldn’t go see the doctor,’ Baicker said.” [Washington Post, 1/17/18]
What did the hearing accomplish?
Los Angeles Times: Wednesday’s Hearing “Showed How Threadbare [Republicans’] Arguments Are.” “The Republican campaign against Medicaid could only make the opioid crisis worse. That’s because Medicaid pays for a huge proportion of opioid treatments, covering fully one-third of those with addiction problems. Most of that spending is in expansion states — in fact, it’s possible that the prevalance of opioid addiction in some states may have helped prompt them to accept expansion (another example of how the relationship between addiction and Medicaid may have been misread). The necessity of continuing Medicaid expansion to address the opioid crisis was made forcibly by Ohio Gov. John Kasich and Arizona Gov. Doug Ducey, both Republicans, last year when congressional Republicans were working hard to eviscerate the program. Johnson and his fellow Republicans in Congress seem determined to impose cuts on the program, even though the benefits it renders are crystal-clear. Wednesday’s hearing did achieve one benefit, for all that: It showed how threadbare their arguments are.” [Los Angeles Times, 1/17/18]
Ultimately then, why did this hearing take place?
Newsweek: Sen. Johnson “Read An Article In Commentary, A Neoconservative Magazine.” “But in the end, even Senator Johnson acknowledged that the purpose of the hearing was a bit baffling. ‘People may be scratching their heads saying, ‘Why is Department of Homeland Security holding a hearing on the opioid crisis and Medicaid?’’ he said at the beginning of the meeting. He went on to explain that he had read an article in Commentary, a neoconservative magazine, that piqued his interest on the topic and asked his staff to compile a report and schedule a hearing on the topic.” [Newsweek, 1/17/18]
Most importantly, does this theory have the potential to cause significant damage to a population in urgent need of care?
Vox: “Republicans May Be In Fact Undermining A Potential Solution To The Overdose Crisis.” “Other evidence, meanwhile, suggests that Medicaid could actually act as a solution to the opioid crisis — because Medicaid, by expanding access to addiction treatment, could help stem the tide of addiction and overdose deaths. So by using this new hearing and report to potentially attack Medicaid, Republicans may be in fact undermining a potential solution to the overdose crisis.” [Vox, 1/17/18]
So there you have it. While millions of Americans struggle with the scourge of opioid addiction, and the White House leaves this epidemic in the hands of a lying, underqualified 24-year-old, Sen. Johnson continues to pontificate right-wing talking points he read in a magazine. Perhaps moving forward he’ll listen to the experts instead of pushing forward a false, ideologically-driven narrative that harms Americans.
Last night, Democrat Patty Schachtner, the chief medical examiner of St. Croix County, Wisconsin, won a special election for an open state Senate seat by 9 points. Voters in the district supported Donald Trump by 17 points just 15 months ago, and the seat had not been held by a Democrat since the turn of the century.
One of the big issues in the race was health care, and below is an example of direct mail Schachtner’s campaign used extensively to highlight the consequences of the GOP’s health care repeal. Just like in Virginia, where health care was the top issue for voters and Democrats came away victorious, voters are rejecting Republicans who embrace the GOP war on health care. In fact, recent national polling conducted by Hart Research and Protect Our Care found that health care was the number one issue among voters surveyed.
If Republicans want to stop losing, they should stop their war on health care.
Washington, DC – After Congressional Republicans released a Continuing Resolution proposal that takes aim at Affordable Care Act provisions while ignoring critical expired health care programs, Protect Our Care Campaign Director Brad Woodhouse released the following statement:
“Today’s Continuing Resolution proposal from Congressional Republicans shows that they care more about taking potshots at the Affordable Care Act and providing tax giveaways to big corporations than they do about being sure that community health centers and hospitals serving low-income people have the funds they desperately need just to keep their doors open. Republicans should be ashamed that they have once again put tens of thousands of Americans’ health care at risk in order to continue their partisan war on the Affordable Care Act and keep giving tax breaks to big corporations.”
BACKGROUND
Today’s Republican Continuing Resolution includes delays of the Affordable Care Act’s medical device, high-cost plan (Cadillac), and health insurance (HIT) taxes.
The CR does not include funding for Community Health Centers or Disproportionate Share Hospitals — essential sources of care for millions of Americans — which expired last October, causing some of these critical provider systems to now face threats of closure.
Ahead of this morning’s farce Senate hearing on Medicaid and the opioid crisis, Protect Our Care Campaign Director Brad Woodhouse released the following statement:
“In American communities hit hard by the deadly opioid epidemic, Medicaid is a lifeline that connects those struggling with addiction with needed care. Today’s outrageous stunt hearing from Senator Johnson ignores that reality by blaming Medicaid for the opioid crisis that was inflamed by Big Pharma, when in fact Medicaid is one of our most important tools to curb the epidemic. As Republicans train their sights on Medicaid as the latest front in their war on our health care, Americans must reject insidious untruths like those being pushed at today’s hearing.”
BACKGROUND
PolitiFact, 10/23/17: “No evidence to prove Medicaid expansion is fueling the opioid crisis.”
Center on Budget and Policy Priorities, 10/5/17: “Expansion states have reduced the unmet need for the treatment of substance use disorders by 18 percent. All states’ Medicaid programs cover at least one medically assisted treatment medication, and the Medicaid expansion has granted health coverage to an estimated 99,000 people with an opioid use disorder.”
Health Affairs,8/23/17: “The opioid epidemic started decades before Medicaid expanded … Expansion states did have relatively more drug deaths than non-expansion states in 2015, but the upward trend in deaths in expansion states started in 2010, four years before the Medicaid expansion began. The results are the same if we exclude the six early expansion states. By the simplest criterion for causality, that causes must precede effects, these results cannot be taken as evidence of Medicaid expansion causing these deaths.”
Kaiser Family Foundation, 7/14/17: “Medicaid plays an important role in addressing the epidemic, covering 3 in 10 people with opioid addiction in 2015. Medicaid facilitates access to a number of addiction treatment services, including medications delivered as part of medication-assisted treatment, and it allows many people with opioid addiction to obtain treatment for other health conditions.”
State Health Reform Assistance Network,7/16: “Medicaid is the most powerful vehicle available to states to fund coverage of prevention and treatment for their residents at risk for or actively battling opioid addiction….The greatest opportunity to address this crisis is in those states that have elected to expand Medicaid, given the greater reach of the program, additional tools available, and the increased availability of federal funds.”
In advance of this morning’s Senate Finance Committee vote on the nomination of former Big Pharma executive Alex Azar to lead the Department of Health and Human Services, Protect Our Care has released a digital ad highlighting the newly uncovered Trump HHS plot to sabotage American health care, which has already claimed 3.2 million Americans’ coverage and counting.
As revealed by last week’s bombshell Politico report, Trump HHS officials planned to sabotage the Affordable Care Act from the very first days of the new Administration. That news came a day after Mr. Azar’s confirmation hearing, during which he refused to promise an end to the sabotage if appointed to lead HHS.
“The Trump HHS has been secretly sabotaging the American health care system from the very beginning, and now 3 million Americans have lost their coverage,” said Protect Our Care Campaign Director Brad Woodhouse. “Now that they’ve been caught red-handed, the Trump Administration and its HHS nominee must promise to end these attacks on our care.”
From: Brad Woodhouse, Campaign Director, Protect Our Care
Subject: Enough is Enough: the Trump Administration’s Sabotage of Our Health Care Must Stop
Date: January 16, 2018
Since taking office last year, President Trump, his Administration, and allies in Congress have waged an unrelenting war against our health care. Their twin weapons have been repeal and sabotage: the innocent victims, the American people. Their agenda takes health care away from millions, raises premiums by double digits for millions more, guts protections for people with pre-existing conditions and attempts to destroy the insurance markets.
As research released today by Gallup shows, the consequences of the GOP agenda of sabotage are abundantly clear – President Trump has overseen the largest-ever one-year increase in the uninsured rate since Gallup began tracking:
The percentage of U.S. adults without health insurance was essentially unchanged in the fourth quarter of 2017, at 12.2%, but it is up 1.3 percentage points from the record low of 10.9% found in the last quarter of 2016. The 1.3-point increase in the uninsured rate during 2017 is the largest single-year increase Gallup and Sharecare have measured since beginning to track the rate in 2008, including the period before the Affordable Care Act (ACA) went into effect. That 1.3 point increase represents an estimated 3.2 million Americans who entered the ranks of the uninsured in 2017.
As the Obama Administration came to a close after the fourth quarter of 2016, the uninsured rate reached an all-time low. When the Trump Administration took over, it had all the tools it needed to continue that progress and keep driving down the uninsured rate. Instead, as last week’s bombshell report from POLITICO revealed, Trump’s HHS did the opposite:
Early last year, as an Obamacare repeal bill was flailing in the House, top Trump administration officials showed select House conservatives a secret road map of how they planned to gut the health care law using executive authority. The March 23 document, which had not been public until now, reveals that while the effort to scrap Obamacare often looked chaotic, top officials had actually developed an elaborate plan to undermine the law — regardless of whether Congress repealed it.
Top administration officials had always said they would eradicate the law through both legislative and executive actions, but they never provided the public with anything close to the detailed blueprint shared with the members of the House Freedom Caucus, whose confidence — and votes — President Donald Trump was trying to win at the time. The blueprint, built off the executive order to minimize Obamacare’s “economic burden,” which Trump signed just hours after taking the oath of office, shows just how advanced the administration’s plans to unwind the law were — plans that would become far more important after the legislative efforts to repeal Obamacare failed.
President Trump famously said “the best thing we can do…is let Obamacare explode,” and “let it be a disaster because we can blame that on the Democrats.” But the newly revealed HHS document shows just how low this Administration is willing to go in order to sabotage the law – literally putting on paper a calculated plan to take away health insurance from Americans. The plan went high up: according to POLITICO, the document was “a key part” of a meeting with Speaker Paul Ryan and former HHS Secretary Tom Price, whose job was ostensibly to protect the health of the American people. President Trump and his Republican allies in Congress are not simply letting Obamacare fail – they are making Obamacare fail.
The increase in the uninsured rate is the most clear evidence yet that Republicans’ sabotage plan is having its intended effect: taking away Americans’ coverage. Here are some of the other ways the Trump Administration sabotaged health care in 2017:
On his first day in office, President Trump signed an Executive Order directing the administration to find any ways they could to unravel the Affordable Care Act.
The Trump Administration cut the number of days people could sign up for coverage during open enrollment by half, from 90 days to 45 days.
House Republicans voted for and passed a health care repeal bill that causes 23 million people to lose coverage and guts protections for people with pre-existing conditions.
The Administration cut the outreach advertising budget for open enrollment by 90 percent, from $100 million to just $10 million – likely to result in 1.1 million fewer people getting covered. Advertising is a critical way for people to know when and how they can get covered.
Republicans refused to move forward on the bipartisan Alexander-Murray bill even though it had a filibuster proof majority in the Senate.
Senate Republicans tried but failed to pass BCRA, Skinny Repeal and Graham-Cassidy, all of which would cause millions to lose their health coverage and raise premiums by double digits for millions more.
The Administration ordered the Department of Health and Human Services’ regional directors to stop participating in open enrollment events. Mississippi Health Advocacy Program Executive Director Roy Mitchell said, “I didn’t call it sabotage…But that’s what it is.”
The Administration dramatically cut in-person assistance that helped people sign up for 2018 coverage.
The Trump administration took direct aim at birth control by rolling back a rule that guaranteed women access to contraception. (A court has since delayed their effort.)
After threatening for months to stop funding cost-sharing reductions (CSRs) that help lower deductibles and out-of-pocket costs, the Trump Administration stopped CSR payments altogether in October. The CBO found failing to make these payments would increase premiums by 20 percent and add nearly $200 billion to the debt.
President Trump signed an Executive Order that would roll back key protections and result in garbage insurance, raise premiums, reduce coverage and expose millions of Americans again to discrimination based on pre-existing conditions.
House and Senate Republicans repealed the individual mandate in their tax bill in order to pay for massive tax breaks to the ultra wealthy and big corporations. CBO predicts millions will lose coverage and premiums will go up double digits.
And they aren’t done yet. Just last week the Trump Administration announced so-called “work requirements” to Medicaid, which will have the effect of removing millions of Americans – nearly all of whom are already working – from their health insurance. And Republicans have promised to go after Medicare, which insures 44 million Americans, and have their sights on the Affordable Care Act, too.
While the Trump Administration and Republicans in Congress want to keep up this war on health care in 2018, the American people are saying “Enough is Enough.” Nearly 9 million people just signed up for coverage through HealthCare.gov despite all the sabotage efforts. The Affordable Care Act is more popular than it has ever been. And millions of people across the country made their voices heard at rallies, town halls and through calling their Member of Congress to fight these repeal efforts.
Our newly completed survey among a representative national cross section of voters clearly shows that healthcare will be a defining issue in the 2018 elections and the healthcare policies of President Trump and the Republican Congress will be a very significant liability for GOP candidates.
These findings are based on 1,000 interviews nationwide conducted January 3 to 7, 2018, among a sample of 2016 voters, 49% of whom say they voted for Hillary Clinton and 46% of whom say they voted for President Trump.
1. Healthcare far exceeds any other issue as an important driver of voting preferences, with over half of all voters identifying healthcare as one of their top priorities in the 2018 congressional elections.
Fully 54% choose healthcare as one of the two issues that will be the most important to them in deciding how to vote for Congress, compared with 29% for the economy, 28% for taxes, 18% for immigration, 18% for education, 17% for government spending, 12% for national defense, and 11% for terrorism.
These results highlight the durability of healthcare as a powerful concern for voters, even when healthcare legislation is not front and center in the news. In our two previous readings in May 2017 and August 2017, 55% and 57% respectively selected healthcare as one of their top two issues.
Healthcare is the most frequently cited priority among Democrats (68%), independents (54%), and Republicans (38%). It is particularly important to African-American voters (66%) and to white women voters, whether they are college graduates (62%) or non-college graduates (59%).
2. Along with the tax bill, healthcare policies are a top-of-mind reason that many voters disapprove of the job Republicans are doing as the majority party in Congress. Indeed, there is widespread disapproval of Republicans in Congress with regard to their handling of healthcare, even among many rank-and-file Republican voters.
Even after the passage of the tax bill, fully 61% of voters disapprove of the job Republicans are doing as the majority party in Congress. When those who disapprove are asked to volunteer why, they most frequently mention Republican tax policies (43%), Republican healthcare policies (36%), and the Republicans’ general lack of concern for average Americans (11%).
While disapproval for the Republicans’ overall performance is high, disapproval for the GOP’s performance on healthcare is even higher (72%). Negative opinions about the way Republicans in Congress have handled healthcare cross party lines, with 93% of Democrats, 78% of independents, and 45% of rank-and-file Republicans expressing disapproval.
3. Republicans’ efforts to repeal and replace the Affordable Care Act are unpopular with voters and a political drag on them in this election year. Democrats increase their electoral advantage when they highlight their position of making improvements in the ACA while keeping what works. And it is clear that continued GOP efforts to repeal the ACA will exacerbate their political problems, given that two-thirds of voters agree on this issue that, “enough is enough.”
Just 35% of voters say they have a favorable opinion of the bills proposed by Republicans in Congress to repeal the Affordable Care Act, while 52% have an unfavorable opinion of them. By 47% to 38%, voters say they would be less likely to reelect their members of Congress if they voted for the bills by President Trump and Republicans in Congress to repeal and replace the ACA. Voters who are undecided on how to vote for Congress this year say by 12 points that they would be less likely to reelect someone who voted for repeal and replace.
Additionally, the poll results indicate that there is widespread frustration with Republicans’ repetitive efforts to repeal the Affordable Care Act. Fully 68% of voters agree with this statement: “Enough is enough—President Trump and the Republicans in Congress should stop trying to repeal and undermine the Affordable Care Act and start working across party lines on commonsense solutions that build on the current law.” Fifty-three percent (53%) strongly agree. There has been a 10-point increase in the share of voters who see President Trump as actively trying to make the Affordable Care Act fail (to 52%, with 28% saying he is not trying to make it fail and 20% not sure). By 55% to 45%, voters say problems with the Affordable Care Act are occurring mainly because Trump and Republicans in Congress are trying to sabotage the law rather than because it is a bad law.
As other polls have shown, Democrats head into the 2018 midterm elections with a clear advantage. In this poll, among all voters who cast ballots in the 2016 presidential election, Democrats have a seven-point margin (44% Democrat, 37% Republican) in a generic trial heat. The Democrats’ true advantage likely will be much greater, given that 75% of Clinton voters say they are certain to vote in 2018, compared with just 60% of Trump voters.
An election that focuses on healthcare and GOP repeal efforts would widen the Democrats’ margin. When given a choice between a Democrat who wants to keep what works in the Affordable Care Act and make improvements in it and a Republican who wants to repeal and replace Obamacare, voters prefer the Democrat by 18 points (59% to 41%). Those who are undecided in the generic trial heat prefer the Democrat in this match-up by 68% to 32%.
4. The Republicans have a long list of severe vulnerabilities on healthcare that go beyond their repeated efforts to repeal the Affordable Care Act, and their healthcare policies on many fronts create very major concerns among large majorities of voters. These are the highest testing criticisms of the healthcare policies of President Trump and the Republicans in Congress.
These are the highest testing criticisms of the healthcare policies of President Trump and the Republicans in Congress.
Sixty-nine percent (69%) of women voters voice very major concerns about GOP policies that would allow insurance companies to charge women more than men for their health insurance. Other Trump policies are widely rejected by voters. The reaction is especially negative, for example, when voters are informed that, “the Trump administration is allowing insurance companies to sell plans that do not meet the requirements of the Affordable Care Act because they do not have to cover essential health benefits such as cancer treatments and maternity care and can deny coverage altogether for preexisting conditions.” Three quarters of all voters disapprove of this policy, including 53% who strongly disapprove.
5. The litany of bad Republican policies on healthcare ladders up to a very damaging overarching narrative for the GOP. Indeed, a large majority agree that the sum of the Trump-GOP policies shows that there is a “Republican war on healthcare.” Just as important, the healthcare issue focuses attention on two dominant weaknesses for the Republicans—their reputation for catering to special interests, and their support for a tax bill that gave huge cuts to the wealthy and large corporations.
Seventy-four percent (74%) of voters agree with the following statement, including 51% who strongly agree: “When you add it all up—taking away coverage from millions of people, weakening protections for people with preexisting conditions, allowing insurance companies to charge more if you are older or a woman, and making big cuts to Medicare and Medicaid—there is a Republican war on healthcare today.” Even 48% of Trump voters agree that there is a Republican war on healthcare.
The notion of a Republican war on healthcare is credible to voters because it speaks to two other important conclusions voters have about Republicans:
They take huge amounts of campaign funding from the insurance industry and the pharmaceutical industry, and they are catering to the special interests that give them money (77% say this is believable, including 51% who say it is very believable).
They want to cut funding for healthcare in order to pay for the huge tax cuts they passed for the wealthy and large corporations (72% say this is believable, including 48% who say it is very believable).
While voters also believe that Republicans in Congress are motivated by a desire to undo everything that President Obama did while he was in office, even more concerning to them are the GOP’s focus on cutting taxes for the wealthy and the large corporations and its desire to cater to the special interests that fund their campaigns.
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