Photo by Martha Dominguez de Gouveia on Unsplash

Health care is a sleeper issue that just might bite the Republican Party in the butt in 2020, just like it did at the midterm elections of 2018.

Imagine if the GOP had come up with some kind of inviting national proposal to provide affordable health care that was an alternative to Obamacare, instead of standing in the way and saying no, just like it has done for years. Just having a plan — something long promised and undelivered upon by President Trump — would have shown engagement on the issue that remains high on Americans’ minds, particularly with a pandemic killing more than 200,000 people since the beginning of the year.


These thoughts came to mind during conversations this week with two longtime Republican friends in Florida, both of whom have cancer. One, who said he would hold his nose and vote for Trump because of his economic policies, thought the president wouldn’t be behind in national polls had the GOP not ceded leadership on health care to Democrats, particularly with so many Americans attuned to the nation’s health during the pandemic. 

The other, a lawyer, said he no longer would vote for Trump because of leadership and character issues. But he agreed the president has made it much easier for the Democratic message to be heard — particularly by older Americans who fear the destructiveness of coronavirus. 

Had there been better leadership and engagement on the virus and on health care in general, the political landscape might be vastly different with less than three weeks before the election.

A South Carolina Republican operative, who asked not to be identified, recognized the pickle the party was in: “The administration has missed chance after chance to effectively talk about policy issues, such as health care, or tell stories about what they believe are accomplishments because they have been distracted by the off-message personalities involved in decision-making. There is without a doubt a cost associated with these missteps, and the size of it we will see on election day.”

Another GOP insider observed the party missed a huge opportunity, especially after the 2018 election in which health care was a major driver. Engaging on health care would have shown leadership, he said.

“Everything is framed around health care with COVID-19 being the overwhelming shadow. Just opposing it, trying to overturn it both legislatively and in the courts without offering a legitimate, working solution, does seem to be short-sighted.”

For years, the Republican plan on health care has been little more than being against whatever the Democrats wanted or passed. When the GOP held the majority in the U.S. House, members voted endlessly to try to dump the Affordable Care Act. The alternative? Nada.

Meanwhile, South Carolina was one of 14 states in which legislators refused, year after year, to accept billions in federal money to expand the federal Medicaid program to provide coverage for some 200,000 mostly poor residents. The result: A 2019 study showed nearly one in 10 older and poor S.C. residents who died in five years starting in 2014 likely would be alive today had they had access to care. 

Dr. Robert Saul, a Greenville pediatrician, sees inaction on expanding health care as dangerous, particularly for children.

“Too many of our vulnerable children have less than adequate insurance or have too many obstacles to that care,” he said. “Now, add on top of this, uncertainty about the continuation of a less-than-perfect health insurance system that is under attack and threatened with possible termination. Then add to that, no tangible replacement in sight! The party that follows the latter path is certainly not helping their fellow citizens.”

In the 2020 election, health care might just be the sleeper issue of the campaign. Republicans often talk about how Trump will win because of the “silent majority” of Trump voters who don’t want to tip their hands to the media, pollsters or anybody else. But if there are silent Trump voters, wouldn’t you think there probably are a similar bunch of quiet voters who will pull levers for Biden because they don’t want neighbors to know they’re voting for a Democrat, particularly one who cares about health care?

Andy Brack is publisher of Charleston City Paper. Have a comment? Send to:

Stay cool. Support City Paper.

City Paper has been bringing the best news, food, arts, music and event coverage to the Holy City since 1997. Support our continued efforts to highlight the best of Charleston with a one-time donation or become a member of the City Paper Club.