As important as health care was to the Democratic primary, don’t expect to hear much about it if Hillary Clinton wins the White House.
Sure, Democrats have a long list of health care policies that they support, from minor tweaks to the Affordable Care Act to large-scale reforms such as a public-insurance option and letting Medicare negotiate drug prices. But that doesn’t mean—even with a Democratic president and a Democratic Senate—that the party would wade back into the treacherous politics of health care.
“Health care hasn’t been a pure political positive for the Democrats in recent years,” said Larry Levitt, a Kaiser Family Foundation senior vice president. “The ACA has taken up a lot of time and political capital for the White House and Democrats on the Hill. Getting the law passed was tough, and then the meltdown of HealthCare.gov and all the aftermath of that, so I think there’s likely a desire among Democrats to move onto other issues.”
Democrats had their big shot on health reform at the beginning of the Obama administration, and they won. But it sapped the party’s political capital. The yearlong legislative battle ultimately put every Senate Democrat on the line, following a protracted intra-party fight over a public option and helping to usher in the GOP wave of 2010. And if Democrats are fortunate enough to see the beginning of another Democratic administration, with a Democratic majority in the Senate, they may be keeping larger health reforms at arm’s length this time.
Chris Jennings, a former senior health care adviser for the Obama and Clinton administrations, said he sees advantages of other issues coming into the political spotlight—and taking some of the heat off of health care. The hope is that could lead to more focus on actual health policy and less on its contentious politics. (Clinton has already promised that, if elected, she would send Congress comprehensive plans to reform the country’s immigration system and fix its crumbling infrastructure within the first 100 days of taking office.)
Health-policy experts say a Clinton administration would likely focus instead on administrative changes including delivery-system reforms, ways to better care for the chronically ill, and certain tweaks to the Affordable Care Act.
If Congress and the White House do take a serious stab at health care legislation, they said, the cost of prescription drugs would be the most likely target. It’s an issue that hits consumers directly, and that both Republican and Democratic presidential hopefuls discussed on the campaign trail.
Must-pass reauthorizations will ensure that health care has some time on the House and Senate floor. The Children’s Health Insurance Program—which Clinton helped create—needs to be reauthorized next year. So do the user fees that the Food and Drug Administration collects from pharmaceutical companies to help expedite the drug-approval process.
The latter “presents the opportunity for Democrats, and a source of leverage, to demand concessions from the drug industry on policies to address drug costs,” Topher Spiro, Center for American Progress vice president for health policy, wrote in an email.
Democrats could package this with the 21st Century Cures bill—a stalled but largely bipartisan measure to streamline the drug-approval process—“as an enticement,” he wrote. (The House passed its biomedical innovation bill 344-77 and is eager for the Senate to do the same, yet the upper chamber’s version has been stuck over a funding dispute.)
Health care was one of the defining debates of the Democratic primary. Sen. Bernie Sanders ran on a platform to fundamentally change health care, moving the U.S. to a federally administered, single-payer system providing coverage to every American. And Clinton has reiterated her support for a public option, competing alongside private insurers, as part of her effort to win over Sanders’s supporters.
But Clinton’s upcoming coronation as the party’s nominee gives a sense of where Democrats could head on health care. She prefers building incrementally on Obama’s signature health care law.
Her wish list includes: capping out-of-pocket prescription-drug costs at $250 per month, letting Medicare negotiate drug prices, making more services available without any cost-sharing for patients, and more steps to rewarding quality of care over quantity.
The nonbinding Democratic platform notes that the party “will tackle the problems that remain in our health care system.” It highlighted combatting prescription-drug prices, reforming the mental-health system, and letting those over 55 opt into Medicare as several important measures. But it also included at least two that could garner bipartisan support: repealing the tax levied on pricey employer-sponsored health coverage and recognizing the importance of an adequately funded National Institutes of Health.
But if Republicans control both the White House and Congress, this will all be a different story. A House Republican task force comprised of four high-ranking chairmen has already released a 37-page broad outline of what their version of a health care system would look like, and they plan to put it into legislative text next year. House Speaker Paul Ryan also supports a dramatic overhaul of Medicare and Medicaid; Donald Trump has said he does not want to cut entitlement programs.
No matter how much attention health care gets next year, it’s an issue that’s never entirely going away. Republicans are likely always going to bash Obamacare, and health tends to seep into debates on other agenda items, such as the budget or tax reforms or even immigration.