Reuters poll: Voters want action on healthcare first

Consider this yet another data point emerging about an undeniable mandate from the 2016 election. A new Reuters/Ipsos poll puts health-care reform at the top of the domestic-policy agenda list for Donald Trump’s first 100 days in office. It outstrips both jobs and immigration outside the margin of error for the top spot, and makes the upcoming fight over ObamaCare the likely centerpiece of Trump’s opening quarter:

Healthcare is the top issue Americans want Donald Trump to address during his first 100 days in the White House, according to a Reuters/Ipsos poll released on Thursday, an apparent rebuke of outgoing President Barack Obama’s signature reform, Obamacare.

Some 21 percent of Americans want Trump to focus on the healthcare system when he enters the White House on Jan. 20, according to the Nov. 9-14 poll, conducted in the week after the Republican won the U.S. presidential election.

Jobs took second place with 16 percent of Americans hoping it would be Trump’s first agenda item, while immigration came third – picked by 14 percent of Americans, according to the poll. Some 11 percent picked race relations.

Reuters hasn’t released the toplines or crosstabs on this poll, but they do have some of the data in a graphic that breaks down the main demographics. One of the more intriguing aspects of this graphic is the diversity of response on healthcare and immigration, and the lack of it on jobs. Jobs and the economy get top priority from 16% of all respondents, and every demo has either 15% or 16% with that priority as well. Healthcare demos range from 12% to 29%, and immigration demos range from 8% to 22%.

Even with that, though, it’s clear that healthcare gets a bigger priority among nearly everyone, including 14% of Democrats — almost the same percentage as jobs for that demo (15%, a virtual tie). Republicans are the strongest demo at 29%, but those aged 40 and above come in right behind at 28%. No other demos on other issues come within the MoE of those, although 22% of Republicans did choose immigration. That’s a mighty big rebuke to Barack Obama and Democrats, who have been arguing since 2010 that they fixed the problems with healthcare with the Affordable Care Act.

Reuters argues that this doesn’t make for a mandate to repeal ObamaCare, citing a Kaiser Health poll from October putting support for repeal at 37%. That’s a strange way to analyze this, especially after Republicans not only won the White House on a repeal message, but also beat long odds to maintain control of the Senate, too. As I argued a week ago for The Fiscal Times, the Senate defeat had a direct connection to ObamaCare’s failures:

That became almost the only policy issue Trump discussed down the stretch as news of massive premium hikes began emerging as the general election kicked off. By the last week of the campaign – when consumers saw the havoc wreaked on their insurance after open enrollment began – Trump kept hammering Obamacare as the central policy argument for rejecting the political establishment in Washington DC.

Don’t just take Trump’s word for it, though. Democrats were poised to take back control of the Senate, having a historic opportunity with Republicans defending 14 more seats. Combined with the normal turnout dynamics of presidential election cycles, predictions about the post-election landscape focused on how Democrats could leverage their Senate majority with a Hillary Clinton presidency.

Instead, Democrats lost almost every pickup opportunity they had – even in two states where they brought back popular former Senators to run for their old seats. In states where the premium hikes have hammered voters hardest, Republican Senate candidates outperformed Trump – states like Florida, Pennsylvania, Wisconsin, and Ohio, among others.

Two months ago, I predicted that the GOP might stun Democrats over Obamacare, and prices were only one reason. “Voters in almost all key battleground states have at least one insurer pulling out of the exchanges,” I noted. Polls showed that losers far outstripped winners (43 percent to 8 percent) in the Affordable Care Act.

Kaiser’s poll certainly looks interesting, but the 131-million-voter sample and Electoral College poll shows a far more significant and reliable conclusion. Americans want action on ObamaCare, and they want it now — and action in this case means repeal and replace. Tinkering around the edges won’t work, as I explained yesterday:

That is precisely why “amending” the ACA as the means to deal with pre-existing conditions will fail. Obamacare includes three mandates which form the heart of the program: an individual mandate for comprehensive policies (including specific coverage mandates), a mandate on insurers to sell policies to those with pre-existing conditions (guaranteed issue), and a community rating mandate which prevents insurers from putting the risk burden on those with pre-existing conditions. The latter only allows deviations from normal pricing on age, location, family size, and tobacco use, and places strict limits on price changes even on those factors.

This results in a severe distortion of the risk pool, one that forces everyone within it to bear the costs of that risk regardless of whether they contribute to the risk of excess utilization or not. Obamacare forces younger and healthier consumers to buy comprehensive insurance policies, which they will almost certainly never use, to fund that risk – essentially creating a wealth transfer from younger, healthier, and less wealthy consumers to those older, less healthy, and more wealthy. The failure to convince healthier consumers to absorb that risk has resulted in risk-pool distortions that necessitated massive increases in premiums and deductibles.

Those mechanisms can’t be “amended” out of Obamacare; they are Obamacare. The mandate for guaranteed issue and the way in which the federal government forces insurers to handle that risk cannot exist without the other mandates. Eliminate the individual mandate, and especially the limitation requiring comprehensive policies, and you eliminate the wealth transfer necessary to subsidize older and less healthy consumers.

Republicans in Congress plan to make this a fait accompli by passing a repeal measure in the first days of the next session in early January. After more than six years of embarrassing failures, skyrocketing costs, and disappearing choices, voters deserve quick action to dismantle ObamaCare. If Trump is listening, that’s exactly what he’ll give them.