2020 Voters Call for Health Care Fix – Not Repeal or Replace

Marilyn Serafini – B ipartisan Policy Center

[ M us ic ]

Marianne O ’ Hare : Welcome to Conversations on Health Care with Mark Masselli
and Margaret Flinter, a show where we speak to the top
thought leaders in health innovation, health policy, care
delivery, and the great minds who are shaping the hea lth ca re
of the future. This week , Mark and Margaret speak with
Marilyn Serafini , Director of the Health Policy Project, the
Bipartisan Policy Center. They've just released an in - depth look
at voter attitudes around health policy, focusing on voters and
early polling sta tes in the 2020 presidential election. The poll
showed a majority of voters from both parties favor fixing the
current health care system rather than a dramatic overhaul
like Medicare for All.

Lori Robertson also checks in , Managing Editor of
FactCheck.org looks at m i sstatements spoken about health
policy in the public domain, separating the fa ke from the facts .
We end with a bright idea that's improving health and
wellbeing in everyday lives. If you have comments, please
email us at [email protected] or find us on Facebook,
Twitter, or wherever you listen to podcast. You can also hear
us by asking Alexa to play the program Conversations on
Health Care . Now stay tuned for our interview with the
Bipartisan Policy Cent er’s Marilyn Serafini here on
Conversations on Health Care .

[Music]

Mark Masselli: We're speaking today with Marilyn Serafini . She's the Director
of the Health Policy Project at the Bipartisan Policy Center
whose mission is to develop policies to improve t he nation's
health outcomes and reduce preventable health care cost. An
award winning journalist Ms. Serafini was Senior
Correspondent for Kaiser Health News and Senior Reporter for
Congress Daily. Marilyn, welcome to Conversations on Health
Care.

Marilyn Serafini : Thanks very much. Thank you. It's pleasure to be here.

Mark Masselli: Yeah. We 've just had the opportunity , we were just saying a
minute ago how much we love this time of year. All the polls
are coming out , i t's election season, and we love the w ork that
you do at the Bipartisan Policy Center. You've released this
report in advance of the 2020 p residential e lection and your
survey was done in conjunction with Morning Cons ult, a group
we follow as well, which sought to identify w here voters in
earl y polling states stand on health policy and other issues. I'm
wondering if you could just share with us what important

Marilyn Serafini – B ipartisan Policy Center

trends do you see emerging in the 2020 p residential cycle.

Marilyn Serafini : Absolutely. Well, the most important trend is that health ca re
is at the top of everybody's list. Normally in elections, we see
the economy right up there at the top and health care is
usually a top three issue. But our poll show ed that health care
is the number one issue. Now do we know for sure that
everyone is g oing to now go to the polls and place their votes
based only on health care ? That's not really realistic. But we
do know that this is a top of voters ’ minds. We know that
they're super concerned about health care costs. In particular,
they ment ioned prescr iption drug costs, soaring prescription
drug costs, and they're concerned. W e do expect to see this
play out in the elections. We certainly know that it will
highlight th ese issues during the campaign.

One of the most interesting findings was that people w ant to
improve the current health care system. The top pick when we
asked voters, do you prefer a Medicare for All style single
payer approach such as Bernie Sanders and Elizabeth Warren
are promoting? Do you want to repeal and replace the
Affordable Care Act such as President Trump has been talking
about and other Republicans ? Or would you like to improve
the current health care system? Twice as many voters said
they wanted to improve the health care system th a n said they
either wanted to repeal and replac e the Affordable Care Act or
to go with a transformed to a Medicare for All style system.

It's a little bit different when you look at the breakout by
parties . F or example, Democrats and Independents ,
a bsolutely , t hey were all for improving the current hea lth care
system, even ahead of Medicare for All . Republicans while
they favored repealing and replacing the Affordable Care Act ,
still a third of them said that their top choice was to improve
the current health c are system.

Margaret Flinter: Well, it does n't surprise me really that it was at the top of their
list because it's one thing everybody has an experience of,
right ? They have an experience of getting health care and they
have an experience of paying for it. But I'm really curious
about this majorit y would rather see efforts to fix the current
health system. I always wonder what are people talking about
when they say, fix the system such as let's not have Medicare
for All , let's just improve t he system . A re they really thinking
about improving health care , or a re they thinking about
improving how we pay for health care? I'm curious whether
you were able to tease out any of that in your polls, because
they really are kin d of two very different things .

Marilyn Serafini – B ipartisan Policy Center

Marilyn Serafini : Indeed . Well , we didn't ask them that question specifically. But
in everything that we're doing it feels absolutely like voters are
talking about both of these things. We know that they're
concerned about health care cost. We also know that they are
concerned about what they're seeing in their communities.
We did ask voters , what health problems are you seeing in
your communities ? T he number one issue that they named
was opioids, illicit drugs. They also were very concerned about
mental and behavioral health care. We were actually a little bit
surprised that they came up as high as it did in the poll , but
this is a big concern. It's the number two concern for these
voters. T hen it was followed by smoking and vaping, which of
course is big news , and then by obesity.

Mark Masselli: Well, I th ink those are the conversations that we're hearing
our friends, families and neighbors talk about at the kitchen
table. I think they're really talking about the experiences that
people are seeing in their own community , in their own
families , certainly the opioid crisis. We've had somebody on
talking about these deaths of despair, right? Suicide , opioids,
and the like that are really challenging , families and
challenging the health system. You broke it out nicely in terms
of there were sort of equal numbers of folks who were either
for repealing the Affordable Care Act or for moving to a
Medicare for All . A ny sense of the intensity of commitment to
those because sometimes those 23 % and 24% can drive the
whole conversation, even though they were against modif ying
the system whether or not those folks were really intent on
voting, how muc h were they motivated by those?

Marilyn Serafini : Lo ok, it's a really good question, and we've been traveling
around the country for different projects that we're doing on
rura l health and mental health . As we're talking to people, we
hear the people who are adamant about Medicare for All , they
are truly adamant. I just had this conversation with my niece
yesterday , s he's 29 years old . S he believes so strongly about
this. This i s the one thing that proponents of a Medicare for All
style system do. They do energize the far - left liberal base .

This is not a new approach. This is not a new policy proposal.
We have been seeing this for decades. But right now we've got
two major candid ates who are talking about this as the
solution , and people are so frustrated with the current health
care system that I truly believe that that people those who
support it are truly support ing it . That said, we know that the
R epublicans did very well in t he last election, last couple of
elections on their vows to repeal and replace the Affordable
Care Act .

Marilyn Serafini – B ipartisan Policy Center

B ut here's something else we know, those people who are,
who have insurance, they're happy with it, especially those
who have employer coverage . It i s a little more affordable for
them. It's very different than the people who have individual
coverage and they're buying it on their own in the
marketplaces that were created by the Affordable Care Act.
Also, many people are very happy with the insurance rule s
that the Affordable Care Act created, for example -- [Crosstalk]

Margaret Flinter: They don’t give a lot of credit for it to the Affordable Care Act,
but they're very happy with it.

Marilyn Serafini : Well, that's exactly right. They don't want to be face d with
preexisting conditions , a gain, they don't want that to either
raise their prices to astronomical levels , o r they don't want to
be excluded all together from getting insurance or having
their, say , breast cancer , or cancer carved out of their
insuran ce coverage. They don't want to have these unlimited
maximums for what they pay. T here are many parts of the
Affordable Care Act they're really happy with. They're just very
concerned about the price of health care , and this is what has
been driving effort s for health reform for as long as I've been
doing this.

Mark Masselli : Yeah.

Margaret Flinter: Yeah. Marilyn, I found it interesting that your poll focused on
some of the early caucus states , right , like Iowa and New
Hampshire and also South Carolina, whi ch are largely rural .
T he rural areas really have a particular set of challenges.
They've been hit very hard e conomically, they've been hit very
hard by the opioid crisis , but they also face particular issues
around access just by geography where health pr ofessional s
tend to practice . I think it [crosstalk] of some of the smaller
community hospitals that traditionally were both economic
forces in their community, but they also were a source of
health care. What did your polls reveal about the rural voting
p opulation? Was there a difference between their more urban
counterpart s, o r did you pick up nuances there about people
whose experience of health care may be very different?

Marilyn Serafini : Right, when we decided to do this poll, the poll is a national
p oll , but we over sampled in three early primary states
because we wanted an early look into what early primary
voters , what was important to them . W e were interested to
see whether that would set a tone for the rest of the country.
Then we were picking out early primary states and we see that
all three of them New Hampshire, Iowa and South Carolina,
are very rural states. When we asked about the difficulties

Marilyn Serafini – B ipartisan Policy Center

with health care, we expected to hear things like I have to
travel too far to see a doctor. There ar e not enough medical
providers in my area . My hospital is closing or is closed , but
actually these were relatively low down on the list , and it
surprised us . B ut I think what that tells us is that health care
costs and coverage are still just really drivin g this for
everybody. It's not that they a re not important in rural areas ,
but this is what's driving any effort to do anything about
health care right now.

The only differences that we found in between rural areas and
urban and suburban , w ere that in New Hampshire we saw an
enormous response to opioids when we asked them what are
the problems you’re seeing i n the communities ? T heir
response was so much greater than we saw for either the
national finding or in Iowa or South Carolina. Iowa, on the
other hand , had a very large finding for mental and behavioral
health care for what they're -- it was the top issue for what
they're seeing in their community.

Mark Masselli : We're speaking today with Mar ilyn S e rafin i , Director of the
Health Policy Project at the Bi partisan Policy Center . I t was
very clear that there is bipartisan support on one major issue,
that the cost of health care is really digging into people's
wallets , and so that cost of drugs, the cost of insurance, these
out - of - pocket expenses really are a lso animating lots of the
conversations that we hear , and then I know your survey
picked up. Tell us though, how is this translating into what
voters want from their candidates , from their policymakers o n
how to address the health care cost? They all seem to have
sort of a little different spin on it. What do you think the
candidates are missing here in the conversation ?

Marilyn Serafini : Well, I think that the candidates , I mean the candidates have
been focusing quite a bit on what is the name of the
appro ach? Is it Medicare for A ll? Is it repealing the Affordable
Care Act? Is it a public option so that there is some sense of
Medicare for A ll but it's a portion of the approach ? B ut we're
not focusing as much on the issues that really matter to
voters. We ar e hearing as part of those discussions. The
candidates talk about costs. We are hearing them talk more
about prescription drug costs , but we saw in this poll, for
example, that the voters have a very strong interest and
concern for mental and behavioral he alth care and what's
happening there.

There is an enormous problem with our workforce, our health
care workforce, and in particular, in having access to services

Marilyn Serafini – B ipartisan Policy Center

for behavioral and mental health and some of this is opioids ,
and some of this is depression a nd schizophrenia and anxiety,
whatever it is. We're not hearing candidates talking about
that. We are hearing them talking about rural health care. In
fact, each candidate does have a plan for rural health care , but
that happened early on , and we're not he aring as much
discussion of that right now. We've got small hospitals closing
in rural areas . Some hospitals that have one day of cash left,
and some of these people are at risk at great risk for losing
their hospital . I t's not so much that these people ne ed a rural
hospital, but they need some health care in their community.

Margaret Flinter: Well, this is so fascinating because we know that mental
health and behavioral health services and substance abuse
treatment services are affecting just about every f amily in
America . B ut we're also hearing a lot of other issues of
concern on people's minds , and I know you’re looking
specifically at health care . W e are certainly hearing about the
economy, particularly for those people who are college
graduates. Climate change , w e hear about this whether it ’ s
staff or community members, that is galvanizing people . G un
control, big issue depending on where you live in the country,
maybe with different feelings, but also women's health , and
certainly that is caught up in s ome of the changes that people
are looking to say. We're really curious did this emerge in
these conversations , b ecause they do seem to us to be
something part of the mix.

Marilyn Serafini : Yeah, absolutely , and again, one thing to remember is that
very fe w voters are single issue voters . S pecifically we asked
them, what are your top three concerns? Because we know
that voters aren't just concerned about how -- look, the
economy is pretty strong right now. When the economy is not
strong , that’s when we see the economy at the top of the list
for all voters . B ut let me get into the breakdown just a little bit
because health care absolutely was the top issue for the
D emocratic and the independent respondents .

F or the R epublicans health care was the third issue. The first
issue for R epublicans was the economy. I t was followed closely
by immigration. T hese are the top two issues for the
Republican respondents, yet, they still had a fairly strong
showing for health care. Now, we also saw that there was
definitely c oncern for environmental policies, gun control,
taxes, but none of them came as close to health care n umber
one, the economy number tw o and immigration number
three.

Marilyn Serafini – B ipartisan Policy Center

Mark Masselli: Well, we've been following the work the Bipartisan Policy
Center for a long time now, and really excited about how you
think about translating information like this , a nd sort of what's
your next step as you think about how you're going to
continue to cultivate bipartisan support as we go forward in
the 2020 election cycle . W hat's next on your agenda as you
translate t his information?

Marilyn Serafini : Well, as you well know, bipartisanship is a tough order. P eople
ask us this question all the time, how do you achieve
bipartisanship? How do you do this? T his is one of the reasons
w hy we conducted the poll. But we have a big report that
we're going to be releasing, but this project we've been
working on is the future of health care. W e pu lled together a
bipartisan group of 10 of the nation's leading health care
experts, five D emocrat s and five Republicans, and the effort is
led by former Senate Majority Leader Tom Daschle and former
Senate Majority Leader Bill Frist, a Democrat and a R epublican ,
also Gail Wonlaski [PH] and Andy Slavitt , who are both former
Centers for Medicare and Med icaid Services, administrators ,
s o these are really top level people.

T he recommendations in this report will not be Medicare for
A ll or and they will not be repealing and replacing, but we will
be coming right down the center a nd it wi ll be a very
pragmat ic report for improving the current health care system,
the system that we have right now. A lot of the focus will be
on reducing costs for people and the government and ensuring
competition in markets. The bottom line here is that if we can
pull together five D emocrats and five Republicans who
normally would agree on pretty much nothing. If we can do
this, get them to sit down and talk to each other and to agree
on a set of recommendations for moving forward then we
think policy make rs can do that too.

Mar k Masselli: Yeah.

Margaret Flinter : Great. Well, we look forward to that report. W e've been
speaking today with Marilyn Serafini s he's the Director of the
Health Policy Project at the Bipartisan Policy Center. Y ou can
learn more about her work and access t his poll by going to
bipartisan policy.org. You can also follow them on Twitter
@BPC_Bipartisan or @ Marilyn Serafini. Marilyn we want to
thank you for this very insightful analysis for the work that you
continue to do to foster bipartisanship in American po litics.
T hank you so much for joining us on C on versations on H ealth
C are To day.

Marilyn Serafini : It's my pleasure. Thank you.

Marilyn Serafini – B ipartisan Policy Center

[Music]

Mark Masselli: At Conversations on Health Care we want our audience to be
truly in the know when it comes to the facts ab out health care
reform and policy. Lori Robertson is an award winning
journalist and Managing Editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim
to reduce the level of deception in US p olitics. Lori, what have
you got f or us this week?

Lori Robertson: Through a TV ad and Twitter, Democratic presidential
candidate Mike Bloomberg and President Donald Trump are
arguing about Trump's actions on preexisting medical
conditions. Bloomberg charged in an ad that Trump had
broken a pr omise to protect those with pre existing conditions.
Trum p fired back on Twitter, “ I was the person who saved
preexisting conditions ” . In fact, Trump backed R epublican
plans that would have weakened the protections in the
Affordable Care Act . U nder the ACA insurers can ’t deny
coverage or charge more based on health status. Those
provisions of the law have primarily affected the individual
market where those without insurance through an employer
or a government programs such as Medicaid b u y their own
poli cies .

B efore the ACA, premiums on the individual market were
often set based on health status and coverage could be denied
entirely. The Republican repeal r eplace bills debated in 2017
did include some of the ACA protections, but not all of them.
In partic ular, the GOP plans could have caused some with
medical conditions to pay higher premiums. The Trump
A dministration also has backed a court case arguing the ACA is
unconstitutional . I n a 2018 letter, then Attorney General Jeff
Sessions said if the case wer e successful ACA provisions
regarding preexisting condition protections would need to be
eliminated. T hat's my fact check for this week. I'm Lori
Robertson, Managing Editor of F act C heck.org.

[Music]

Margaret Flinter: FactCheck.org is committed to factual a ccuracy from the
country's major political players and is a project of the
Annenberg Public Policy Center at the University of
Pennsylvania. If you have a fact that you'd like checked, email
us at chcradio.com, we'll have FactCheck.org's Lori Robertson
che ck it out for you here on Conversations on Health Care.

[Music]

Marilyn Serafini – B ipartisan Policy Center

Mark Masselli: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives .
Over the past few decades, kids have been getting less and
less physical activity throughout the school day. Phys E d has
become less prevalent in many schools . T he University of
Michigan researchers wanted to find a creative and effective
solution that would increase kids movement wit hout
disrupting the school day.

Dr. Rebecca Hasson: We looked at the scientific literature in terms of prolong
sitting, if you just t wo minutes of activity, a small burst , get up
do some movements . A ctivity in that small of a dose can have
dramatic improvements on health , on cognit ion , on learning.
W e decided to develop an intervention , a program that would
allow children to get these small burst of activity throughout
the day.

Mark Masselli: Dr. Rebecca Hasson is Principal Investigator for InPACT ,
I nterruption of P rolonged S itting wi th A ctivity.

Dr. Rebecca Hasson: We typically see in PE or recess lower participation in girls
compared to boys. But in classroom activity breaks you
actually see similar rates of participation, if not higher rates of
participation in girls. We also saw that for children who are
carrying a few extra pounds , those children also were
exercising at a high intens ity , e ven children with asthma.

Mark Masselli: They wanted to design the intervention that would be easy for
teachers to adopt and manage. T hey creat ed videos desig ned
to get kids moving quickly.

Dr. Rebecca Hasson: We created a compendium of 200 activity breaks that are just
three minutes long. T he teachers had a variety of different
types of activities, whether it was jumping jacks , leapfrogs,
someth ing that will get their hear t rate in a target heart zones.

Mark Masselli: Kids burned on average about 150 more calories per day, and
at the end of the week , had accrued a significant amount of
physical activit y.

Dr. Rebecca Hasson: We had these little ac celerometers , t hey measure movement
at the hip and so it tells us how many calories were the kids
burning away from the laboratory and how much phys ical
activity were they getting.

Mark Masselli: A low cost easily adoptable fitness intervention for kids,
a llowing short burst of physical activity throughout the school
day , e nhancing fitness , positively impacting the learning
experience. Now that's a bright idea.

Marilyn Serafini – B ipartisan Policy Center
[Music]
Mark Masselli: You've been listening to Conversations on Health Care. I'm
Mark Masselli.
Margaret Flinter: And I'm Margaret Flinter.
Mark Masselli: Peace and Health.
Marianne O ’ Hare : Conversations on Health Care is recorded at WESU at
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[Music]