This November midterm election could be a bloodbath for Republican candidates. The party that wins the White House tends to suffer more losses in the midterm election, especially if the campaign was acrimonious. President Trump’s divisive governing style is unlikely to be an advantage. War with Iran and picking trade fights with our allies does not help either. Buddy Mattews discusses the history of midterms here.
The Kaiser Family Foundation looks at the issues and makes some interesting observations. Health care is the top economic concern, according to polls of voters. The share of voters who are very worried about health care costs:
- Total voters 31%
- Democrats 33%
- Independents 36%
- Republicans 25%
What is most worrisome about this is independents. Democrats are likely to vote for Democratic candidates (probably in large numbers). Republicans are likely to vote for Republican candidates (or stay home). Independents are the group most likely to swing an election left or right because they often do not hold strong partisan views. Will they stay home as they often do? Or will they turn out to vote? Independents have stronger fears about health care costs (36%) than either Republicans or Democrats. Independents also have economic concerns that outweigh those or Democrats or Republicans in other areas of the economy.
KFF reports that over the years voters tended to trust Democrats to control medical costs more than Republicans. In 2012 46% of voters reported trusting Democrats more than Republicans to lower medical bills. By 2023 that had risen to 56%. While the cost of groceries was a top concern in 2024, health care is now the top concern. One caveat is that independent voters tend to trust neither major party to effectively control medical costs.
Republicans have historically held an advantage on economic concerns according to KFF. Democrats have historically held an advantage when it comes to health care issues. Even bad policy like Obamacare is considered progress, even when it was a step backward. Yet, Republicans have not done enough during President Trump’s tenure in the White House. PBM abuse is seen more as a Democratic issue than republican issue. The top three PBMs control about 80% of the drug market. They use the power to feather their own nests, rather than pass on savings to patients and clients. Something nobody talks about is group purchasing organizations, the PBMs of the hospital supply market. The three biggest GPOs control about 60% of the market for hospital supplies. It is tough to break into the hospital supply market even if your product is better than existing ones. The problems caused by excessive hospital consolidation and the need for site neutral payments are championed by neither party aggressively. The No Surprises Act protects patients from balance billing but not payers from surprise medical bills. Price transparency is a great start but is not enforced and was not implemented in ways that allows patients to compare prices. Republicans champion the use of short-term medical plans but have not tried to rein-in unlimited benefits in ACA plans that make them unaffordable. Admittedly, it would be a tough balancing act to argue less is more affordable. While most patients will never need a $1 million drug, taking that away may still cause bad publicity. The recent push to raise deductibles to $31,000 per family is hardly going to be popular with cash-strapped Americans. What most Americans want is to be able to see a doctor when they are ill. Anything that makes seeing a doctor (or nurse practitioner) easier will boost access to care. Republicans must make headway and explain it in simple terms that voters can understand.
The report is worth reading, KFF: A Preview of the Role Health Care May Play in the 2026 Election