Democrats have already accomplished their initial health care messaging goal of the President Trump era: Present a united front as Republicans attempt to immediately repeal the Affordable Care Act and help make the Republican bill so unpopular that it becomes a political liability.
Now comes the hard part. With members of Congress home for a two-week recess, Democrats are divided about where the party’s message on health care should go next.
The options include defending the Affordable Care Act and attacking Republicans for their unpopular replacement bill, or going on offense with a new proposal to expand the government’s role in providing health insurance, such as through a single-payer proposal.
“The first line, which obviously we accomplished, was we can’t throw 24 million people off insurance,” Democratic pollster Celinda Lake said. “Now the pressure is on us to talk about what the alternative is.”
To some Democrats, the way forward is obvious: the Affordable Care Act. The Obama-era health care law has become significantly more popular in polling since the 2016 elections, while a Quinnipiac poll last month found just 17 percent of registered voters approved of the Republican replacement plan.
Danny Franklin, a Democratic pollster and the managing partner at Benenson Strategy Group, noted that with no chance of making it even more progressive with Trump as president and the GOP in control of both chambers of Congress, Democrats need to continue to highlight the positives of the 2010 law.
“The last two months have proven that defending the ACA is a winning message,” Franklin said. “I think Democrats will realize soon that going beyond ACA has some risks [and] presents risks to ACA, because if it’s not being defended, it’s vulnerable to attack.”
Several Democrats said the failed Republican proposal has made defending ACA a more popular proposition for Democrats, because they can focus on a contrast with the Republican plan instead of defending the bill in a vacuum. Jen Psaki, a former White House communications director for President Obama, said she would advise Democrats thinking through how to talk to voters about health care over the recess to “keep it simple.”
“What I mean by keep it simple is: Republicans in Congress are trying to take away your health care, whatever that means to populations: maternity care, access to treatments, preventative care,” Psaki said.
Others argued that the party needs to put forward a more aggressive proposal. Sen. Bernie Sanders of Vermont, who has taken on an increasingly visible and powerful role within the party since his presidential campaign, plans to introduce a Medicare-for-all proposal of the type he advocated for in 2016. Sen. Elizabeth Warren of Massachusetts recently told a town-hall audience that she is open to such a proposal, or a public option.
Support for these ideas is not limited to the Sanders-Warren wing of the party. Sen. Kirsten Gillibrand of New York recently told New York Magazine that she is enthusiastic about supporting Sanders’s bill, and Montana musician Rob Quist, the Democrats’ special-election House candidate for the Republican-leaning state’s at-large House district, recently said, “everybody should have a system like Medicare, where you walk in, show your card and you’re covered, no questions asked.”
“There are a lot of people who have started to talk about this who are very prominent voices in the party,” Psaki said. “That tells you something. Clearly they’re hearing from people.”
Advocates see a political advantage in this kind of proposal. Offering an aggressive expansion would, they said, mobilize Democratic supporters and insulate Democratic candidates from attacks on ACA which, though growing in popularity, still has many detractors.
“Just plain defense is not a winning strategy,” said Kaitlin Sweeney, press secretary at the Progressive Change Campaign Committee, which advocates for a single-payer proposal. “The ACA has real flaws, it’s not a perfect piece of legislation. Voters expect and want Congress to offer up real solutions.”
Lake said it’s important for Democrats to offer a robust alternative because just defending ACA “sounds like status quo, and we need to be for change—that’s how we lost the last election,” and because voters are “looking to Democrats for solutions.”
“We need to move from resistance to reasons,” she said.
Which Democrats take which approach will depend in part on personal beliefs and in part on the political makeup of their constituencies, Lake said, emphasizing that policy proposals such as a public option or negotiating drug prices might offer Democrats in more-moderate districts a way to separate themselves from the status quo while not going as far as Sanders.
Personal political timeframes may be another important consideration in what Democrats say on the issue. Caitlin Legacki, a Democratic strategist, said she expects Democrats running for reelection in more-conservative areas—who will dominate much of the political coverage in 2018—will focus on defending the Affordable Care Act’s most popular provisions. However, she said, as the 2020 election draws nearer, prospective presidential candidates may begin raising the profile of proposals that go further.
“We’ve got two elections we’re looking at,” Legacki said. “The Democrats who are up in 2018 have … room to stake out their own positions based on the needs and opinions of their states without getting chained to what someone in another state is saying. In 2020, you’re going to hear a lot about Medicare for all in the presidential primary, simply because that’s where I think the base is going.”
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Republican opposition to the GOP health care bill swelled to near-fatal numbers Sunday as Sen. Susan Collins all but closed the door on supporting the last-ditch effort to scrap the Obama health care law and Sen. Ted Cruz said that "right now" he doesn't back it. White House legislative liaison Marc Short and Sen. Lindsey Graham, R-S.C., one of the measure's sponsors, said Republicans would press ahead with a vote this week." Collins said she doesn't support the bill's cuts to Medicaid, while Cruz said it wouldn't do enough to lower premiums.