An in-depth analysis of results from 14 national public opinion polls that looked at how Republican and Democratic likely voters in the 2016 presidential election view the health policy issues raised during the election campaign shows that the two parties’ voters have markedly different values, priorities, and beliefs about the future of health policy.
The article, which examines the potential effect of the 2016 election on the future of health policy in the United States, appeared in the October 27 issue of the New England Journal of Medicine.
“Narrow discussions of policy that appear in the media often miss these widespread differences in views,” says Dr. Robert J. Blendon, Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health and lead author of the article. “With the country polarized over health care issues, future policies will be heavily influenced by which party holds the presidency and a majority in Congress.”
The political parties fundamentally differ over the role the federal government should play in intervening in the U.S. health care system (see chart below) and working to achieve universal health insurance coverage in the future, how great an effort should be made to try to narrow health care gaps between rich and poor, and the future role of the federal government in funding abortion services.
These broad divisions can be seen when focusing on the future of the Affordable Care Act (ACA). Based on the reported statements by each of the political parties’ leaders, the following would likely happen. If the Democrats have control of both Congress and the presidency, they will continue implementation of the ACA and try to expand the number of currently uninsured people covered by the program. They will also probably try to fix many of its insurance actuarial problems. In addition, Democrats are likely to seriously consider pursuing the addition of a public option, a government-sponsored health insurance program that would compete with private health insurance plans and would be available only for those eligible for subsidized health insurance through the ACA. If the Republicans win, they are not likely to see their mission as making the ACA work. They are not likely to replace the ACA in total, but would be likely to attempt to reduce the scale and scope of the law, reduce or eliminate mandates of all types, and decrease federal subsidies. In addition, Republicans are likely to attempt to give much more authority to states to develop or oversee their own health insurance and Medicaid programs, even if this leads to less insurance coverage.
Because there is more bipartisan agreement on the issue of pharmaceutical prices, we are likely to see action on a number of policies in this area. This may lead to the federal government being involved with price review, negotiation of the price of prescription drugs, and faster Food and Drug Administration drug-review procedures.
In terms of abortion, if either party has the presidency and the majority in both houses of Congress, there is likely to be a shift in abortion-related policies. As was discussed in the parties’ campaigns, if Republicans have control, they are likely to continue efforts to curtail federal funding for Planned Parenthood and access to abortion more generally. If Democrats do, they are likely to use their majority support to ensure that Planned Parenthood continues to receive federal funding and to try to expand access to abortion. In the coming years, the Supreme Court will be dealing with a number of key abortion-related cases, and newly appointed judges’ prior decisions on abortion-related issues may affect the outcome of these deliberations. Party control of the presidency and Congress also matters a great deal because it will affect future appointments to the Court and presidential candidates have said that if they hold the presidency they would appoint justices empathetic to one or the other view.
Overall in terms of understanding the implications of the 2016 election for the future of health policy, it is important to recognize that future changes in health policy are related more to the extent of political polarization between the parties on health care issues than to the importance of the issue itself in deciding the 2016 election.