Health care gives Democrats advantage heading into 2020

Off-year elections — even high profile contests — aren’t always reliable predictors of things to come.

But election results in Kentucky, Louisiana and Virginia confirm a lesson that we learned in Maine in 2017: The No. 1 issue in the mind of voters is health care.

After nearly a decade of obstruction by former Gov. Paul LePage, Maine votes took matters into their own hands in 2017 and passed Medicaid expansion using a citizens’ initiative.

In this Nov. 7, 2017, file photo supporters of Medicaid expansion celebrate their victory, in Portland, Maine. (AP Photo/Robert F. Bukaty, File)

During the 2018 gubernatorial election, health care remained the most important issues for voters and helped now Gov. Janet Mills handily defeat Republican Shawn Moody.

Once Mills took office, the law was finally and quickly implemented, and the impact has been real.

As of Nov. 22, more than 42,000 more people more now have access to quality, affordable health care in Maine through Medicaid.

Lives are getting better. Real people are getting the care they need, but until Medicaid expansion couldn’t afford.

More than 14,000 people have received mental health treatment, and more than 5,000 have been treated for substance use disorder. More than 2,000 people have received treatment for diabetes and another 2,000 for hypertension. More people are being screened for cancer.

Research released in November makes the point even clearer.

“Medicaid expansion saved the lives of at least 19,200 older low-income adults from 2014 to 2017 in states that adopted it, while state decisions not to expand cost the lives of 15,600,” according to the Center on Budget and Policy Priorities, a left-leaning think tank that supports Medicaid expansion and the Affordable Care Act.

As we saw in Maine, voters in red states, such as Kentucky and Louisiana, and purple states such as Virginia, understand the consequences of expanding access to health care and are rewarding political leaders who support the policy.

Writing in the Washington Post, Democratic governor-elect of Kentucky Andy Beshear and Louisiana Gov. John Bel Edwards, put it this way:

“Families in both Kentucky and Louisiana worried that their health-care coverage and our states’ Medicaid expansions were going to be ripped away by a Republican governor.”

It’s a simple formulation: Voters are sick and tired or being sick and tired. They want more people to have access to health care, not less, and they are exhausted about worrying whether an illness or accident will bankrupt them.

They want serious policies that tackle questions of access and affordability, and on that score Democrats have a significant advantage.

Republicans have made clear — through their ongoing and continuing assault against the Affordable Care Act — that they do not believe the government should take steps to help people access and pay for health care.

They are comfortable turning the question of life and death over to a broken marketplace that leaves families broken — and broke — and relying on charity online fundraising.

“When we started in 2010, it wasn’t purposefully set up and built to be a substitute for medical insurance,” GoFundMe CEO Rob Solomon told CBS MoneyWatch. “We weren’t ever set up to be a health care company and we still are not. But over time, people have used GoFundMe for the most important issues they are faced with.”

Democrats, regardless of policy differences and particulars, are united in the belief that the government must do more to ensure families can access health care when they need it most.

Health care has dominated the party’s presidential primary so far, as each candidate lays out their prescriptions for reform. The debate can be boiled down into two general ideas: A Medicare-for-All, single-payer system, or a hybrid system that keeps traditional insurance but adds a public option that gives people choice.

The differences in the policies are real, but the goals are consistent: To expand access to health care, to fix a broken system that costs trillions of dollars but only delivers middling results, and to improve the lives of working people.

Faced with these realities, the best Republicans are able to come up with is “Build that wall” and policy ideas that rely on pitting one group of people against another, less regulation and the magic of competition.

When it comes to health care, they have no answers. And, as Kentucky, Louisiana and Virginia show, that could be their undoing.

David Farmer

About David Farmer

David Farmer is a political and media consultant in Portland, where he lives with his wife and two children. He was senior adviser to Democrat Mike Michaud’s campaign for governor and a longtime journalist. You can reach him at