Democrats Debate Next Steps for Health Care Messaging

The party is divided on whether to offer a more progressive proposal in the wake of the Republican plan’s failure.

Sens. Elizabeth Warren and Bernie Sanders greet one another during a rally on March 31.
AP Photo/Steven Senne
April 10, 2017, 8 p.m.

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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