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Heidi Heitkamp: Improve the Affordable Care Act, don't ditch it

Heidi Heitkamp

As the Democratic presidential primary begins to take shape, I'm thrilled by the growing field of talented, capable contenders—any of whom would be a welcome breath of fresh air for the nation after President Donald Trump's divisive leadership.

At times, though, I am also concerned that, in their rush to earn the support of the party's highly energized primary electorate, some of the best prospective Democratic standard-bearers are embracing positions that would present serious risks when it comes to challenging and defeating Trump in the general election.

An area of particular alarm is health care. With Republicans in disarray—unable to legislate or even agree among themselves on a reasonable path forward—this issue is one of the Democratic Party's greatest strengths. Under President Barack Obama's leadership, Democrats in Congress did the right thing in 2010 by passing the Affordable Care Act. And though they paid a high price for their triumph in ensuing midterm election cycles, the American people have largely come around, now that the ACA's many benefits have become clear and Republicans' inflammatory rhetoric has been debunked by reality.

Just look at the results of last fall's elections, with Democrats netting 40 House seats, sweeping into the majority and now providing a crucial check and balance against Trump and his Senate allies. This House majority was won not on the platform of national single-payer health care, but on a commitment to improve the ACA. Candidates promised to build on its successes and take common-sense steps to further extend coverage, promote affordability and strengthen patient protections.

Now consider that the path to the White House—and to a Democratic Senate that could achieve real results on progressive priorities—will run through swing states and rural America, where midterm voters responded to that message about the ACA. When I see some potential Democratic nominees expressing their support for Medicare-for-all, which would cast aside the ACA and start all over again with a single, government-run health-care program into which every American would be enrolled, I worry that the candidates are playing directly into the hands of Trump and Senate Majority Leader Mitch McConnell, R-Ky.

Campaigning on Medicare-for-all, Democrats would give Trump a costly, drastic proposal to attack. Better to put Trump on defense about health care, forcing him to answer for his relentless attacks on the ACA, challenging its constitutionality in the courts and endangering coverage for about20 million Americans who have benefited from the law.

According to Census Bureau data, roughly 90 percent of Americans now have health-care coverage. Of those, 217 million are covered by private health plans, 181 million of them with employer-provided insurance. Polling indicates that most Americans are satisfied with the health care they receive and do not want their coverage options taken away and replaced with a one-size-fits-all government program.

Meanwhile, as The Washington Post reported in an article headlined "Medicare-for-all plans get a reality check," the nonpartisan analysts of the Congressional Budget Office released a study on May 1 calling the proposals "complicated, challenging and potentially disruptive." Responsibility for trillions of dollars in health-care costs would be shifted to the government, and as the New York Times reported in April, the "violent upheaval" entailed by Medicare-for-all would compel some hospitals, "especially struggling rural centers," to close almost overnight, while others would respond by "laying off hundreds of thousands of workers."

Championing a health-care policy that threatens to close rural hospitals and limit patients' access to vital services is not a winning message. Democrats need to attract voters in rural areas who supported Trump in 2016 if they are going to take back the White House and Senate.

Don't misunderstand me; I appreciate the passionate commitment to progressive principles shown by Democratic presidential hopefuls. I share many of those values. But winning in 2020 will require a smart, strategic approach, especially on an issue as important as health care.

I urge my fellow Democrats not to back Medicare-for-all policies that would drastically change health care for every American, and to instead rally behind constructive proposals that would move the nation toward universal coverage, while bringing down costs for families and protecting patients. That would be in line with the desires of a majority of Americans on an issue that is a top priority. Don't take that enormous advantage off the table in 2020 by ditching the Affordable Care Act for Medicare-for-all.

Heidi Heitkamp, a former Democratic senator from North Dakota (2013-2019), is the founder of the One Country Project.

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