Background Brief

Health care has emerged as a major issue in national debates leading up to the 2008 presidential election, with surveys finding that it ranks among the top three issues for voters, after the economy and the war in Iraq. [1] For some voters, health care costs also play a role in economic anxieties, so that economic and health care concerns are expanding the reach of the issue. [2] At least in part because of public interest in the issue, the presidential candidates have developed plans to address the challenges of the rising uninsured rate in the nation and the unabated growth in health care costs.
 
Exit polls from previous elections suggest that health care has been one of the top five issues affecting Americans’ votes in three out of four presidential contests since 1992, while the economy and jobs has almost always been the number one issue. Specifically, health care ranked fifth in 2004, and combined with Medicare and prescription drug-related issues, it tied for second place in 2000. [2] It is, however, useful to remember that candidates' stance on issues are only one factor that influences people's votes.

The public’s current interest in health care focuses on two main concerns: the cost of health insurance and the problems of the uninsured. Both Democratic and Republican presidential candidates have set forth proposals to expand health coverage to the uninsured, control health spending, and promote the delivery of high-quality care.

Democratic and Republican candidates are taking considerably divergent approaches to address these concerns: [3]

(1) The goal of health reform: Universal coverage is the primary goal for Democrats, although there are differences within the party on how to get there. Democratic voters are more likely to rank covering the uninsured a higher priority than controlling costs (though costs are a leading concern for Democrats as well). In contrast, the major goal for Republicans is to improve the efficiency and competitiveness of the insurance market promoting affordability and expanding consumer choice. Public opinion surveys find that a higher share of Republicans places a greater priority on controlling costs over expanding coverage. 

(2) The organization of the health insurance system: Democrats would build on the existing employer-based system and expand public programs like Medicaid and SCHIP, even developing an option for consumers to buy into a public plan, similar to the Federal Employees Benefits Program. They would also increase regulation of the individual or nongroup market. In comparison, Republicans would expand the role of the individual insurance market, making it more affordable for individuals to purchase insurance on their own through tax subsidies, and promote options to enhance competition among plans, even across state lines.

(3) The role of health coverage: This is yet another area where there are major underlying philosophical differences between the two parties. The Democrats would provide insured individuals with front-end protection, which they believe would promote use of preventive service and primary care and shield families from the potentially devastating costs of medical care. The Republican approach would provide more back-end protection against catastrophic costs, relying more heavily on high-deductible plans coupled with tax-preferred health saving accounts used to pay for routine care.

This 2008 presidential election has begun to stimulate a dialogue in the nation about health reform, but it remains to be seen how big and hot the debate about health will be in the general election. Candidate proposals on key aspects of health care are raising the profile of health care reform and beginning to shape the policy agenda of the next presidential administration. The real challenge will come in 2009 and will depend on whether the new president will make health care a top priority and whether Congress will engage in a meaningful health reform debate and be able to find a way to pay for health reform and bridge long-standing ideological differences. At this early stage, it is impossible to predict what the outcome will be: comprehensive reform legislation, incremental action, or even no action at all. [4]

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[1] Kaiser Family Foundation, Kaiser Health Tracking Poll: Election 2008. April 2008.
[2] Kaiser Family Foundation, Kaiser Public Opinion Spotlight: Health Care and Elections. April 2008.
[3] Altman D, Kaiser Family Foundation. Pulling it Together: Separating the Forest from the Trees in the Health Reform Debate. February 2008.
[4] Altman D, Kaiser Family Foundation. Pulling it Together: Critical Path to Health Reform. March 2008.


Acknowledgements: This issue module was prepared by Jane An, Alina Salganicoff and Usha Ranji of the Kaiser Family Foundation.

Updated: August 2008