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One of my most surprising moments recently on the health care beat came late last month, when opinion researcher Michael Perry and I were running a focus group with Obamacare enrollees who voted for Trump.
We were in Harrisburg, Pennsylvania, sitting in a sparse conference room at a big white table. Perry, who co-owns the research firm PerryUndem, asked the six-member group a question: Who likes Canada's health insurance system? Who wishes we had something like that?
Half of the hands shot up.
This surprised both of us! We hadn't planned to bring up single-payer health care; the focus group was about the Affordable Care Act. But one Trump voter had raised the idea that we'd be better off if we had a health care system like Canada's — where the government runs one health insurance plan for everyone — and wanted to see who agreed.
"There's a lot of countries that it works very successfully in," Michelle said of a Canadian-style single-payer system. (Focus group participants agreed to have their first names published.)
"Everybody, despite income, should be encouraged to take care of their health," Eric added.
"I actually like socialized medicine," Sharon, another of the focus group participants, told us.
This was ... unexpected. Socialized medicine, Canadian-style health care, single-payer — whatever you want to call it, it's a cause typically championed by the far left. Vermont Sen. Bernie Sanders proposed a single-payer plan during his presidential run. Progressive legislators in California and New York have introduced single-payer bills in their respective statehouses.
But our focus group participants were onto something. Lately, there has been a surprising groundswell of support for universal coverage — and even single-payer — among Trump allies.
And all of this arguably starts with Trump himself, who campaigned on providing health insurance for everybody.
On March 14, Newsmax chief executive Chris Ruddy, a friend of Trump's, wrote a piece encouraging the president to pursue universal coverage based on Medicaid rather than the House GOP bill, which would leave millions uninsured.
"Donald Trump staked out the high moral ground by calling for a feasible system of universal healthcare to replace Obamacare," Ruddy wrote. "He shouldn't retreat from that no matter how much the establishment GOP dislikes it."
Late last week, F.H. Buckley, who teaches at George Mason University's Scalia Law School and is part of the academic group Conservatives for Trump, took things a step further.
"That wasn’t what Trump promised, in any event," he wrote in the New York Post of the GOP bill. "What he said he wanted was a plan that would leave no one uninsured."
This isn't just academics. Polling research finds that conservatives just seem to be gravitating more toward the idea of universal coverage. A January poll from the Pew Research Center found the share of Republicans who think the government ought to make sure all Americans have health coverage has increased from 19 percent in March 2016 to 32 percent in January 2017.
Why do Trump supporters like the idea of a single-payer health care system?
My conversations have been with Trump voters, not advisers and academics. In all these interviews — including the focus group — I didn't ask about single-payer. The people I was interviewing brought it up on their own, often mentioning the Canadian health care system.
The voters I've interviewed like the idea of everybody getting equal treatment, no matter where they live or how much they earn. They generally talk a lot about fairness. This is something Kathy Oller, an Obamacare enrollment worker who voted for Trump, brought up to me when I met her in Kentucky.
"I live in southeastern Kentucky," she said. "I think we need to be like the Canadians and all pay a certain amount."
Some of this idea seemed to grow out of resentment for poor Americans who had enrolled in Medicaid and did not pay premiums, while slightly more well-off people had to spend their own money on the exchanges. Why shouldn't everyone, the thinking went, be allowed to sign up for a program like that?
Does this mean single-payer is the bipartisan health care solution Congress is yearning for — a plan so crazy it just might work?
No. No it does not.
The thing that makes single-payer so difficult is that it requires big tax increases to pay for it. Deep-blue Vermont gave up on its multi-year single-payer effort in 2014 when the governor's office discovered it would need to increase payroll taxes by 11.5 percent and income tax by 9 percent.
This isn't to say that single-payer systems are necessarily more expensive than ours currently is. Many of the efficiencies of a single, government-run health plan would almost certainly drive down costs. But a single-payer system would be undeniably disruptive because it would change how we all pay for our health coverage. It would likely need to ask high-earning Americans, for example, to pay much more in taxes in order to subsidize health care for poor Americans.
That kind of disruption is hard for Congress to swallow, and arguably one of the key reasons why a single-payer system — even if it garners some support from Trump allies — would struggle to get off the ground in Washington.
Kansas legislature fails to override Gov. Brownback's Medicaid veto
You all know I've been following the Kansas Medicaid expansion fight quite closely — and today we learned that the Kansas House did not have enough votes to overcome Gov. Sam Brownback's veto last week.
A quick refresher on Kansas legislative procedure (exciting, I know!): The House needed a two-thirds majority, or 84 votes, to override the veto from the governor. The Medicaid expansion came up again Monday morning, and could only garner 81 votes.
Down but not out? This is obviously not great news for advocates of Medicaid expansion. But it doesn't mean Medicaid expansion is completely dead in Kansas, as I had initially thought. A VoxCare reader from Kansas emails to say there are other key votes coming up this year (the budget, for example, or a court-required school finance plan) where a vote on Medicaid could come up again. So the ball's in your court, Topeka!
Chart of the Day
Lowering individual health care costs is the top priority of both Democrats and Republicans, new survey data from the Kaiser Family Foundation shows. Republicans' second leading priority is Obamacare repeal, whereas Democrats are more focused on reducing prescription drug costs.
With research help from Caitlin Davis
- "Want Medicaid coverage? A drug test should come first, Wisconsin governor says": “If [Gov. Scott] Walker gets his way, Wisconsin would be the first state in the country with mandatory drug screening for Medicaid enrollees. The governor plans to release his proposal in mid-April and submit it to the Department of Health and Human Services by the end of May. The approach — which also would mandate treatment for those testing positive — aligns with the goals of several Republican governors intent on tightening the program’s rules. Although the Obama administration allowed them to place expectations on enrollees, they’re hoping for far more leeway from HHS Secretary Tom Price.” —Paige Winfield Cunningham, Washington Post
- "Hospitals rush to get accelerated visas for foreign medical residents": “A program that allows employers to fast-track H-1B visa applications for their employees has been suspended as of Monday. US immigration officials announced the change just a month ago — and Match Day, when new residents learn where they will be placed was March 17 — leaving some hospitals rushing to figure out who needed this kind of visa and to apply before “premium processing” would no longer be an option.” —Eric Boodman, Stat News
- "Trump takes up health care with Rand Paul, on golf course": “The outing to Trump National Golf Club came hours after Trump tweeted that talks on replacing the law have been going on and ‘will continue until such time as a deal is hopefully struck.’ He added that anyone who thinks the effort is dead ‘does not know the love and strength in R Party!’ Trump golfed and discussed policy with Paul and budget director Mick Mulvaney, said White House spokeswoman Stephanie Grisham.” —Catherine Lucey, Washington Post