From Public Policy Polling this morning:
Exit Poll of PA-18 Shows Lamb Won Big On Health Care
Date: March 14, 2018
Public Policy Polling conducted a telephone exit poll election survey of voters who cast ballots in Pennsylvania’s 18th Congressional District special election yesterday. Voters who voted in the contest were asked about the role of health care in their decision.
The exit poll shows that health care was a top priority issue to voters in this district and that voters believed Democrat Conor Lamb’s views were more in step with theirs.
In 2016, voters in this district backed Donald Trump by 20 points, but last night they backed a Democrat for Congress in a referendum on the health care plans of the Republican Congress:
- Health care was a top issue to voters. Health care was ranked as a top issue for 52% of voters(15% saying it was the most important issue and another 37% saying it was very important). Only 19% said it was not that important or not important at all.
- Conor Lamb won big especially among voters for whom health care was a top priority. Among voters who said health care was the most important issue for them, Lamb beat Rick Saccone 64-36 and among the broader group of voters who said it was either the most important or a very important issue Lamb beat Saccone 62-38.
- On health care, voters said Lamb better reflected their views by 7 points (45% to 38%) over Saccone. With independents, that gap widened to 16 points with 50% saying Lamb’s health care views were more in line with theirs to only 34% for Saccone.
- Voters were less likely to support Saccone because of the Republican health care agenda. Saccone’s support of the Republican health care agenda made 41% of voters less likely to vote for him and only 28% more likely to support him.
- Voters in this heavily Republican district disapproved of the Republican efforts to repeal the Affordable Care Act by 14 points (53% to 39%).
- 48% of voters believed Republicans are now trying to undermine and sabotage it since they failed to repeal it. Among independent voters, the disparity is even wider with only 33% supporting the GOP’s health care repeal efforts to 63% opposing them.
- In this deeply red district, 44% of voters support the Affordable Care Act while 42% oppose it.
- Only 38% of voters think the best path forward on health care is to repeal the Affordable Care Act, to 59% who think it should be kept in place with fixes made to it as necessary.
PPP surveyed 567 PA-18 voters on March 13th. The margin of error is +/- 4.1%. This survey was a joint project of Protect Our Care and SEIU.
Anyone who reads my site, listens to my presentations or watches my videos should already know this, but the path for 2018 and 2020 on healthcare for Democrats is clear:
Since #USEAHIA is an absurdly stupid acronym/hashtag, I'm terming this bill ACA 2.0 instead.
Before anyone says it: Yes, I realize this would probably be vetoed by Donald Trump; unless some miracle happens and we're blessed with President Pelosi, the odds are 99.9% that we're gonna be dealing with a President Trump or President Pence through January 20, 2021.
However, unlike a total overhaul bill, there's a small chance that Trump might sign such a bill if it's bundled as part of a "must-pass" omnibus/budget bill, the way he signed the 6-year (later 10-year) CHIP extension recently. Stranger things have happened.
If it becomes law, it will stabilize and strengthen the ACA for several years, tiding things over until...
Obviously this is where the real battle lines will be drawn on the left side of the aisle: Folks like myself will push for a CAP/MEFA-style system, while Bernie supporters will push hard for a full-blown, near-immediate M4A/SP bill. If there's a full Democratic sweep, the final version may end up somewhere in between the two.
Alternately, if for some reason 2021 brings a Democratic House/Senate but with a Republican President (which I can only envision if someone like John Kasich manages to "reform" the GOP after Trump is removed from office/etc), then the final bill that's passed will probably be somewhere in between ACA 2.0 and MEFA, I'd imagine...either of which would still be a quantum leap ahead of where things stand today.
Meanwhile, I hope to keep analyzing data and helping people keep track of the never-ending dramatic twists and turns of U.S. healthcare policy, but I’ll need help to keep doing so! If you find my work at ACA Signups of value, please consider supporting it on a recurring basis via Patreon (preferred) or one-time via GoFundMe, thank you!
UPDATE: As I noted in the comments below, here’s roughly how I envision the path of the Dems healthcare strategy under Obama, Trump and in the future:
- 2010 — 2013: ACA 1.0 (as passed)
- 2014 — 2016: ACA 0.9 (weakened via tech screw-ups/other mistakes & pre-Trump sabotage)
- 2017: ACA 0.8 (weakened further via 2017 Trump-era sabotage, such as CSR cut-off, half-length enrollment period, 90% marketing cuts, etc.)
- 2018: ACA 0.7 (weakened further due to Trump’s 2018 sabotage, mainly Mandate Repeal, #ShortAssPlans & Medicaid Work Requirements)
- 2019 — 2021: ACA 2.0 (assuming it can actually get signed)
- 2022/beyond (assuming full Dem sweep): Some MEFA/M4A hybrid
- 2022/beyond (assuming partial Dem wave): Some MEFA/ACA2.0 hybrid
UPDATE x2: I already included the links to my initial takes on both the ACA 2.0 proposal and the MEFA proposal above, but now that I see people are discussing/debating actual proposals in the comments, I just want to reiterate that I strongly urge you to read those posts before getting into the weeds below, as I’ve already answered some of the questions people have started raising below, thanks!
UPDATE x3: In the comments, BradyB is a bit confused about which path I personally prefer. Since it’s so deep in the thread it’s difficult to read the comments, here’s my response:
My ideal eventual end goal has always been and will continue to be a universal, comprehensive coverage healthcare system which involves nominal cost sharing on the part of the enrollees, ideally via a federally-funded single payer provider payment framework.
In other words, M4A.
HOWEVER, just because it’s my personal preference doesn’t mean it’s remotely realistic to achieve within the next 5-10 years. For that matter, it doesn’t mean that it’s absolutely the best framework for the United States. For instance:
- Germany does not have single payer.
- France does not have single payer.
- Switzerland does not have single payer.
- Japan does not have single payer (at least not “pure” SP the way Bernie’s M4A plan is pushing).
In fact, I believe the only nations which have “true” SP a la the M4A plan are Canada, Taiwan and South Korea.
Based on everything I’ve read and learned about how the U.S. healthcare system works (and doesn’t work), I believe that the best path forward for the United States to achieve a Universal, Comprehensive, Quality, mostly publicly-financed healthcare system with low out-of-pocket costs given where we are today would be to first get a suite of ACA fixes/improvements through in the short term (ACA 2.0) and then pass MEFA.
If both were to happen, by 2032 I estimate we’d have around 60% on Medicare Extra, 10% on “traditional” Medicare and 30% still on Employer Insurance. As time went on, the Employer Insurance portion would gradually drop off.
I’m not going to post my full Medicare Extra analysis here since I’ve already linked to it twice, but I will at least add the graphics which show how it would be phased in. Here’s where things would start, call it Year Zero (note that the following charts were created before the short-term ACA 2.0 bill was released last week):
Year Two: The individual market has been shored up/vastly improved and expanded to cover perhaps 10 million of the ~30 million currently uninsured:
Year 4: Medicare Extra has swallowed up the entire ACA-compliant individual market and the BHP program in MN/NY; this would be the point at which the ACA exchanges would disappear. In addition, all newborns would be auto-enrolled into Medicare Extra, as would those turning 65:
Year 6: Medicaid & CHIP are absorbed into the program, and small businesses start making the switch:
Year 8: Large Employers start enrolling in Medicare Extra as well; the vast majority of the country is now enrolled in either Medicare Extra, Legacy Medicare or Employer coverage:
Year 10: By a decade out, things have settled in. Employer coverage is down to ~30% of the population and gradually (or perhaps not so gradually?) continues to shrink from this point, while legacy Medicare drops off as current enrollees die off or choose to switch to Medicare Extra.
So, in the end, who’s left out? “Illegally residing residents”, who I’d imagine would only comprise perhaps 1% of the population if comprehensive immigration reform was also passed at some point, as MEFA assumes (note that MEFA does not say “undocumented” immigrants; it says “not legally residing” which assumes a progressive DACA bill/etc. is passed.
MEFA also specifically states that comprehensive reproductive services would be included—that is, I believe they assume that the Hyde Amendment would also be repealed at some point along the way. Again, this is something which the M4A plan would have to count on as well.