The early stages of a presidential contest are very much an elite sport, played by and for people who do not much worry about their insurance coverage. As the game broadens and widens, however, it will involve an ever-greater number of people for whom the risk of loss of health coverage will be an overwhelming consideration. It would seem an obviously urgency for Republicans to relieve as much of their anxiety as they can. Yet few Republicans perceive that urgency and even fewer are acting on it.

I’m going to put down a marker here. The next presidential election, like the last, will be decided by whether Democratic-leaning groups show up at the polls in large numbers—and maybe, at the margins, by whether the last few single percentage points of undecided voters choose “change” or “more of the same.” For those economically stressed toss-up voters—for the younger voters who sometimes show up and sometimes vote—the tipping point issue won’t be foreign policy. It won’t be ethics. It won’t be healthcare. It won’t even be the overall performance of the economy, which will be better, but still unwonderful. It will be that single haunting question, “Will I lose my insurance?”

If they don’t hear a clear and convincing “No,” they’re going to assume the answer is “Yes”—and most likely, vote accordingly.