By: Ron Peck, Esq.

Donald Trump recently stated that while he will never give up on repealing the Affordable Care Act (ACA), he was not running on terminating the ACA.  This is likely a smart decision, given that a recent Kaiser Family Foundation (KFF) poll[1] revealed that for Republican voters, repealing Obamacare was an important issue for a very small percentage of respondents. Is this demonstrative of a more widespread loss of interest in healthcare as a political talking point?

As someone whose day-to-day career is centered around health benefit plans, cost containment, and the attempt to ensure plan participants enjoy maximum care for minimal cost, understanding the rules and regulations that dictate and control what payers pay and providers of health care can and cannot do, is – for me – always top of mind. As an American, however, I cannot help but notice how little “airtime” healthcare seems to be getting during the ongoing presidential campaigns.  Compared to the 2020 and 2016 elections, during which healthcare was one of the top issues (including but not limited to the repeal and replacement of Obamacare), for the 2024 election it seems as if healthcare is an afterthought.

Recognizing that abortion, LGBTQIA+, and gun violence all relate to healthcare, and are certainly top issues during this presidential race, please note that when I suggest that “healthcare” isn’t the most pressing topic (compared to past elections), I am referring to general healthcare costs.

It would seem, based on the aforementioned KFF poll, that I am not far off. That poll revealed that for American voters, only 5% consider “healthcare costs” to be their top issue. When asked to specifically rank healthcare issues by importance to them, 21% to 24% of Democrats and Republicans (respectively) indicated that the cost of healthcare is the most pressing healthcare issue, followed by prescription drug costs (which 9% to 12% of respondents – Republicans and Democrats respectively – felt was the most urgent healthcare topic). 

Herein lies my concern. According to the same poll, four in ten voters stated that the economy and inflation is the most important issue. Yet, if healthcare costs are allowed to increase without checks and balances, it will impact individual and societal spending – thereby affecting the economy like nothing else.  Indeed, according to the Centers for Medicare and Medicaid Services (CMS), 17.3% of our nation’s spending is attributable to healthcare costs[2]. As a basis for comparison, various sources indicate that our national spending on the military ranges between 3.4% and 3.5%. 

This reveals the first misunderstanding on the part of the American voter. Specifically, that if you care about the economy, you must care about the cost of healthcare. As for the second misunderstanding on the part of the American voter, that would be understanding the difference between healthcare costs and premiums.

For many years, I have spoken at length about how people (and especially politicians) will refer to the “cost of healthcare” when in fact they are talking about premiums. Time and time again, a politician will claim to have “lowered the cost of healthcare” when they, in truth, only capped what an insurance carrier can charge in the way of premium. The actual price being charged by the provider of healthcare services (i.e., the doctor or hospital) hasn’t been addressed or reduced. The insurance carrier is merely being forced to pay a greater share of that cost without offsetting that cost onto their insureds in the form of higher premiums. This would seem to be a win for the premium-paying-populace – until they see an increase in co-pays, co-insurance, and deductibles – coupled with reduced benefits and coverage. As my grandmother used to say, “Nothing is free.  The money needs to come from somewhere!”

I have often assumed that the politicians mentioned above honestly don’t understand the difference between the cost of healthcare and the cost of health insurance. The KFF poll, however, has me wondering whether I may have been mistaken. In that poll, the same people who advised that – of healthcare topics “health costs” is far and away the most pressing issue (over 20%) – a mere 6% felt that “premium costs” are the most important healthcare topic. So – if 20% or more of my constituents want to hear that I am doing something about the cost of healthcare, but only 6% care to hear about my efforts to reduce health insurance premiums . . . and all I’ve done is reduce health insurance premiums . . . do I tell the truth and appease the 6%? Or do I equate health insurance premiums with the “cost of healthcare,” communicate that my reduction of health insurance premiums is actually a reduction of healthcare costs, and satisfy the 20%? The latter is the obvious, if disingenuous, answer.

The fact of the matter is that unless the actual cost of healthcare (that being the cost incurred by providers when they provide care, and the cost payers – both insurance and patients – pay when they receive care) is reduced, we will all pay that cost one way or another.  When I see, for instance, Vice President Harris’ campaign website celebrate a $35 “cap” on insulin prices, I am left wondering how many people realize that this doesn’t mean the insulin manufacturer is accepting a grand total of $35 for the insulin. Rather, patients’ out of pocket responsibility may in some instances be capped, and/or Medicare may be able to pay less, but the drug manufacturer is still going to be paid as much – or more – than they were receiving prior to the implementation of such a cap; even if it means charging commercial payers more to make up the difference. Commercial payers from whom many Americans receive their insurance (even those who were convinced to move to the ACA and State exchanges), and who – therefore – will pay the cost.

For those voters who say that the economy is the biggest issue, healthcare costs is a lesser issue, and premium costs are a smaller issue still . . . I wonder what they would say if I told them that these and so many other issues are actually different sides of the same coin?

The cost of healthcare may not be America’s hot topic anymore . . . but it likely should be.