Democratic campaign promises of Medicare for All are resonating with many American voters who cite the rising cost of health care as a top issue in the upcoming U.S. midterm elections, despite concerns over possible tax increases to fund a universal health care program.

During the Obama presidency, Republicans successfully ran against the perceived threat of a government takeover of the health care industry to gain control of Congress.

But a recent Reuters/Ipsos poll shows 58 percent voter support for keeping former President Barack Obama’s signature legislative achievement, the Affordable Care Act (ACA), and that 8 in 10 likely voters from each major party want to protect coverage for people with pre-existing conditions, such as heart disease, diabetes or cancer.

​Democrats on offense

Many Democrats running for office this year, like New York congressional candidate Alexandria Ocasio-Cortez, are advocating for nationalized health care legislation that was proposed in the Senate by Vermont Sen. Bernie Sanders, who lost the 2016 Democratic nomination for president to Hillary Clinton. Sander’s plan would expand Medicare, a government funded health care program for senior citizens, to cover all Americans.

Others Democratic contenders like Rep. Beto O’Rourke, a Democratic candidate for Senate in conservative-leaning Texas, are calling for increased federal regulation to hold down health care costs but are not calling for a complete government health care takeover.

“The thing that is common among these different reforms is the structure of a government administered insurance plan that really controls or limits, to some respect, the payment rates that are paid to health care providers,” said Linda Blumberg, an Institute Fellow in the Health Policy Center at the Urban Institute.

​Republicans on defense

Republicans are on the defensive after failing to repeal the Affordable Care Act, also known as Obamacare, which was enacted in 2010. Many are now claiming to support tenants of the ACA legislation that require insurance companies to provide coverage to patients with pre-existing conditions.

However, Blumberg says, it is disingenuous of many Republicans to make these claims while also supporting policies in the past that would separate the sick and elderly into separate “risk pools” with very high insurance rates that few could afford while charging lower coverage rates to younger, healthier people.

Four states will also vote on Medicaid expansion ballot initiatives offered under Obamacare that would extend health coverage for the poor, with 90 percent of funding coming from the federal government. The conservative governor of Idaho, C.L. Otter, has come out in favor of expanding Medicaid in his state despite concerns the costs to the state would greatly increase over time. Thirty-three states and the District of Columbia have voted to expand the ACA Medicaid coverage, while other states with Republican governors or legislatures have declined to take advantage of the program until now.

Opponents of government intervention in private industry argue that public support for universal health care will decrease significantly when confronted with the prospect of increased payroll taxes, the rationing of coverage, and bureaucratic delays that would likely result from a national health insurance plan.

“This is what happens when you have the government controlling health care costs, because now it is a singular consolidated entity making decisions on behalf of 300 million Americans,” said Meridian Paulton, a domestic policy studies researcher at The Heritage Foundation.

​Regulation versus competition

Conservatives continue to argue that promoting increased free market competition and innovation will work best to improve coverage and contain costs. However, the lack of health providers in many rural areas can limit competition.

President Donald Trump has attacked Democratic health proposals as socialism that would strip away funding from seniors who have paid Medicare taxes all of their working lives.

“Democrats support a socialist takeover of health care that would totally obliterate Medicare. Republicans want to protect Medicare for our great seniors who have earned it and who have paid for it all their lives,” Trump said.

Opinion polls show Democrats having a good chance to gain a majority of seats in the House of Representative in next Tuesday’s election, but not likely to take control of the Senate.

In a divided Congress, Democrats are not expected to have the votes to pass major health care legislation such as Medicare For All, but the election momentum could increase support for a compromised approach that regulates costs but also fosters private sector competition and innovation.

“We look at industrialized nations all over the world, many of them doing a mix of private and public insurance but making sure that there is a floor of care in coverage for everybody in the country, and those countries still take advantage of innovation,” Blumberg said.
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