The Republicans’ Health Care Problem

It could be their Achilles heel.

Take a look at this graphic from the recent New York Times/Ipsos poll. Quick quiz: what is the intersection of the two sets “most important issues for themselves personally” and “most important issues for the Democratic Party”?

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That right: it’s health care! There’s no other overlap between the two sets. Health care is the #2 issue for the public and at least makes the leaderboard—at #5—on what respondents think is most important to the Democratic Party. The Republican Party, on other hand, is viewed as sharing three of the public’s top five priorities—the economy, immigration, and taxes—but not health care.

You may see where I’m going with this. High salience issues on which Democrats have a clear advantage are thin on the ground these days—but health care definitely qualifies and has stood out as a robust Democratic advantage for quite some time. Consider these data.

Democrats are consistently the party voters trust more to handle health care. Typically their lead over the Republicans on the issue has been in the double digits.

That trust extends to various health care issues. Kaiser Family Foundation (KFF) polling in 2024 found that respondents trusted Biden over Trump by a 12-point margin on determining the ACA’s future, by a 12-point margin on protecting people with preexisting medical conditions, by an 11-point margin on ensuring access to affordable health insurance, and by an 8-point margin on determining Medicare’s future.

After a famously rocky and unpopular start, Obama’s ACA has steadily gained favor. The split of favorable versus unfavorable views on the Democratic-identified health care reform bill is 64 percent to 36 percent in 2025 KFF polling.

On the broad question of the government’s responsibilities for health care, sentiment has shifted back to a strongly pro-government position after dipping during Obama’s second term. According to Gallup, 62 percent of voters now say the government is responsible for ensuring all people have health care coverage, compared with 36 percent who disagree. This sentiment obviously favors the Democrats.

Health care is important to American voters. In a 2023 AEI/NORC survey, 88 percent of voters thought health care affordability is a very or moderately big problem in the country today. That represents the largest consensus on any issue tested in the survey, except inflation. And the sentiment was uniform across most demographics, including the white and non-white working class.

In a 2024 Liberal Patriot/Blueprint/YouGov survey that tested support or opposition to a wide variety of proposals associated with the Democratic or Republican Party, the top-performing proposals—which performed remarkably well—were almost all health care related. In order of net support (support minus opposition), the health care proposals were:

• Increase the number of prescription drugs that Medicare can negotiate the price of for seniors. (Net support was 75 points.)

• Require pharmaceutical companies to charge American consumers the lowest price they charge consumers in foreign countries. (Net support was 75 points.)

• Cap the cost of insulin at $35 a month for every American who needs it. (Net support was 74 points.)

• Protect Medicare and Social Security from funding cuts or increases in the age of eligibility. (Net support was 72 points.)

• Permanently extend the Affordable Care Act (ACA) protections for those with pre-existing conditions. (Net support was 59 points.)

• Cap prescription drug costs at $2,000 per year for all Americans. (Net support was 51 points.)

Support for these policies is strong across demographics but tends to be stronger among working-class voters, particularly white working-class voters. Democrats’ opportunity to cut into the GOP’s coalition through this issue is clear. Remember that in the 2018 elections, when the Democrats performed so well, health care issues were absolutely central to congressional campaigns.

But Democrats face challenges on this front too. One is that elevating health care comes with an opportunity cost that Democrats, with their fervent commitments to “saving democracy,” abortion rights, and climate change, may not be willing to pay. More attention to health care means less attention to these other causes. The Democrats’ educated, liberal base and infrastructure may resist that—even if a net enlargement of their coalition would result.

Consider the Inflation Reduction Act, which included significant health care–related spending on insurance subsidies and instituted Medicare price bargaining and other cost-control measures for some prescription drugs. The act was publicized and understood as involving climate change, renewable energy, and electric vehicles, which completely overshadowed its health care provisions. To this day, the overwhelming majority of voters are not even aware of these provisions, according to KFF polling.

Given all this, surely Republicans would not be so foolish as to hand the Democrats a new opportunity to leverage their big advantage in this area. Or would they? The budget passed on a party line vote in the the House and shortly to be taken up by the Senate implies the need for drastic spending cuts to balance big tax cuts included in the budget. Medicaid is in the cross-hairs for these spending cuts, perhaps to the tune of almost a trillion dollars.

This is a genuinely terrible idea! And it is potentially far more serious than the furor around DOGE/Musk, which is already costing Trump and the GOP some good will. Rachael Bade of Politico reports:

Two…vulnerable GOP lawmakers I spoke to over the weekend were ready to brush off the anti-Musk backlash.

“I’m all in on DOGE,” Rep. Tony Gonzales (R-Texas) told me Sunday night, arguing that cutting the federal workforce is “wildly popular” with Republicans in his swingy district and “weirdly a non-factor” for everyone else except hardcore Democrats. Another vulnerable member from a drastically different kind of district in another part of the country, who was granted anonymity to speak candidly, dismissed last week’s protests as “pearl-clutching” by the media and Democrats.

For both, however, Medicaid is a different story.

“That’s where the battle’s coming,” said Gonzales. “There’s no doubt that there’s waste, fraud and abuse in every program in the government, including Medicaid — but at what point do you stop cutting into the fat and start cutting into the bone? You can’t pull the rug out from millions of people.”

Gonzales, who has a large constituency enrolled in the program, already co-authored a letter with seven other House Republicans representing large Hispanic populations asking Johnson to rethink where the GOP is headed on Medicaid.

This makes sense. Medicaid is an enormous program, whose enrollment has been expanded far beyond the truly indigent by the ACA. According to KFF, two-thirds of American adults have a personal (self, family, close friends) connection to Medicaid through receiving health care coverage, receiving support for pregnancy/home health/nursing home care, or assistance with Medicare premiums.

Small wonder that Medicaid is hugely popular with the public, with 77 percent having a favorable view of the program, including 85 percent of Hispanics, 82 percent of those with under $90,000 in household income, and even 63 percent of Republicans. Just 19 percent think we are currently spending too much on Medicaid and 81 percent are opposed to cutting the program (including 74 percent of Republicans).

Even the shambolic Democrats, who can’t figure out a way to dissociate themselves from the unpopular policies that are dragging them down, might not blow this one! As former Democratic operative Evan Barker notes in a piece on Lee Fang’s Substack, the attack ads practically write themselves:

I predict this is precisely what they will look like: Elon Musk is on stage at CPAC, waving a chainsaw in slow motion, with doom music in the background; cut to a frame with Donald Trump promising no cuts to Medicare, Medicaid, or Social Security, and a final quick transition to a man speaking directly to the camera: "I lost my job, and when I tried to apply for Medicaid, I was turned down. Two weeks later, I got brain cancer. Now I'm homeless because I had to sell my house to pay for chemo." It sounds dramatic—but the drama is how Dems roll. These ads will be blasted in key swing states in 2028, with the numbers of those who lost healthcare coverage since 2024 tallied on the screens.

Ouch. Of course Trump many times has said he has no interest in making cuts to Medicaid. His cagey political instincts and his “brand” as a working class-oriented populist Republican would appear to lead him against such a move. Judging from the debate in Congress and the views of many in his party, he has his work cut out for him. If he doesn’t succeed, health care really could turn out to be the Achilles heel of his second administration.