Health care and COVID-19 top voter concerns as 2020 election begins

Will Congress eliminate surprise medical bills? Who will be the first to receive the COVID-19 vaccine? USC experts examine pressing health issues amid the 2020 election.

October 21, 2020 Jenesse Miller

With or without the COVID-19 pandemic, health care was destined to be a top voter issue for the 2020 presidential election.

Earlier in the 2020 primary elections, much of the focus was on whether the U.S. should transition to a “Medicare for All” program that would guarantee coverage for everyone. Now, with coronavirus cases on the rise, President Donald Trump and former Vice President Joe Biden are continuing to debate health care access and affordability ahead of the general election, with the coronavirus crisis often used to illustrate the failings and successes of U.S. health care.

Some of the most pressing topics for voters include pandemic-related loss of health insurance, how quickly there will be viable COVID-19 vaccines and how they will be distributed, and the potential for the Supreme Court to invalidate the Affordable Care Act — also known as Obamacare.

Who are the biggest losers if the Affordable Care Act is overturned?

“The Affordable Care Act, or ACA, has provided many with increased access to health care and financial protection against needing expensive care,” said Paul Ginsburg, director of the USC-Brookings Schaeffer Initiative for Health Policy and director of public policy at the USC Schaeffer Center for Health Policy & Economics.

“But the Texas-led challenge, now pending before the Supreme Court, risks dismantling all of the ACA, even portions unrelated to coverage expansion that had bipartisan support. The legal challenge would be extremely disruptive to the health care system, as a decade of health legislation and regulation that builds on the ACA would no longer be in effect.”

If the ACA was overturned, Ginsburg says the “biggest losers” would be people who are no longer eligible for Medicaid coverage and those not able to purchase individual insurance coverage because they cannot afford it without subsidies. He explained that others would lose coverage, including those with preexisting conditions — who would be excluded from coverage as uninsurable — and those with employer-based insurance who happen to lose their jobs or just want to change to one where they have to obtain their own insurance coverage. Even Medicare beneficiaries would be impacted, as an important ACA improvement in their drug coverage would end.

Polls show health care is a top election issue

“Health care is on the short list of top issues for all voters in this election and is not a partisan concern. Independents, low-income voters and voters of color are all more likely than others to say they are basing their vote on the issue of health care,” said Jill Darling, survey director for the USC Dornsife Daybreak Poll, which is conducted by the Center for Economic and Social Research (CESR) at the USC Dornsife College of Letters, Arts and Sciences.

What we have here is a perfect political storm that feeds the potential for a blue wave in November.

Bob Shrum

Darling said many in these groups have taken the hardest economic hit from the pandemic. In a COVID-19 tracking survey conducted by the CESR, low-income and non-white participants reported losing jobs at a higher rate than whites. Those with lower household incomes are three times as likely as people who are more affluent to say they don’t have any type of health insurance at this time.

Bob Shrum, the director of USC Dornsife’s Center for the Political Future and a former political strategist and consultant, said COVID-19 is a dominant concern for Americans “and becoming more so every day as cases rise.”

“What we have here is a perfect political storm that feeds the potential for a blue wave in November,” he said. “This includes the handling of the virus itself; fears about the loss both of protections for preexisting conditions and health coverage in general — which powered Democratic victory in the midterms; and the adroit way in which the Democrats have positioned a Supreme Court nomination that the GOP thought might help the party rebound as a clear and present danger to the Affordable Care Act, which the court will rule on this term.”

Darling added that, according to the Daybreak Poll, voters who say health care is their top priority favor Biden over Trump by 16 percentage points as the candidate who they trust to handle the issue.

Who should get the first COVID-19 vaccines?

“Once safe and effective COVID-19 vaccines are available, tough choices will need to be made about who gets the first shots,” said Dana Goldman, interim dean at the USC Price School of Public Policy and the Leonard D. Schaeffer Director’s Chair at the USC Schaeffer Center. “After taking care of essential workers, vaccinations should be given to the biggest transmitters of the virus — mostly the young — and only then to the most vulnerable.”

Goldman said an important lesson from prior pandemics is that prioritizing vaccinating people who are most likely to be asymptomatic spreaders can prevent large numbers of infections.

“Very few of the COVID-19 ‘superspreaders’ are elderly,” he explained. “It is the younger people who have a much greater propensity to resume social lives at schools and in other venues. Optimally, older people will drive down deaths by staying home in large numbers, and younger people will drive down infections by getting vaccinated in even larger numbers. It all works if the vaccine is effective and enough people take it.”

That’s the key, agrees John Romley, an associate professor at USC Price and a senior fellow at the USC Schaeffer Center who recently co-authored a piece about the growing public health challenge of vaccine “hesitancy,” particularly among African Americans.

Our survey suggests that African Americans would be particularly hesitant to use a COVID-19 vaccine.

John Romley

“It is widely recognized, and concerning, that political orientation is driving so much of the discussion about how to address the COVID-19 pandemic. It’s less recognized, and perhaps even more important, that the pandemic has collided with other long-standing problems to form an almost perfect storm,” he said.

“First, we have very, very substantial racial and ethnic disparities in health in this country,” he added. “Second, among Americans as a whole, there is growing skepticism about vaccines of all kinds. Our survey suggests that African Americans would be particularly hesitant to use a COVID-19 vaccine. Such hesitancy could be explained at least in part by the mistrust that this community has developed toward the American medical system, with ample reason.”

Solving surprise medical bills must be a post-election priority

“Before the COVID-19 pandemic hit, solving surprise medical bills was one of the key health care issues on Congress’ agenda,” said Erin Trish, associate director of the USC Schaeffer Center and an assistant professor of pharmaceutical and health economics at the USC School of Pharmacy who has researched surprise bills.

Trish explained that patients can receive these bills when they are unexpectedly or inadvertently treated by an out-of-network physician or another provider they didn’t choose. This happens about 1 in every 5 times a commercially insured patient goes to the emergency room, and about 1 in every 10 times they have an elective procedure.

Recent investigative reports have revealed that these bills have plagued many coronavirus patients.

“Surprise medicals bills represent a breakdown in the functioning of health care markets,” she said. “They are unfair and can be very costly to patients who receive them. But they also allow certain types of health care providers to charge higher prices, which raises costs for everyone. While recent actions have attempted to protect COVID-19 patients from receiving surprise bills, broader action is needed to solve this problem once and for all.”