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Democrats Debate Next Steps for Health Care Messaging

BSG’s Danny Franklin joins other pollsters and communication experts offering their thoughts on how Democrats should handle healthcare messaging going forward.

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

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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