Democrats ran and won on health care. Now what?

In 2018, 41% of voters said that health care was the most important issue facing the country. Health care wasn't asked in 2016, but in 2014 only 25% said it was the most important issue and it was lower, 18%, in 2012.

Health care is an extremely Democratic issue; three-quarters of those who said it was the top issue also said they supported the Democratic candidate in their vote for Congress. Next up were immigration (23%) and the economy (22%). A majority of those who chose immigration and the economy as the most important issue voted for the Republican candidate in this midterm election.

Democrats made sure to push the issue hard as they ran this year; half of ads run by and for Democrats in the election cycle through October this year featured health care, according to data from CMAG / Kantar Media.

But now what? Democrats have successfully run promising to protect the US health care system they and President Barack Obama helped reshape over the past decade. How can they deliver to voters?

Don't expect that too much will change immediately.

"Democrats capitalized on the public's concerns about health costs effectively in the midterm election and will continue to focus on health in the House and the presidential campaign, but don't expect any major health care legislation to be enacted by a sharply divided Congress in the middle of oversight hearings, investigations, and a presidential election campaign," Kaiser Family Foundation President and CEO Drew Altman said.

The importance of health care to Democrats shows that their priorities are rooted in reform, lowering costs and safeguarding protections put in place by the Affordable Care Act that Republicans and President Donald Trump tried to hard to repeal.

Trump and many Republicans pledged during the campaign to keep many of the ACA protections like guaranteed coverage for people with pre-existing conditions despite their desire to chip away at the law.

California Rep. Nancy Pelosi, likely future speaker of the House, has said that the Democrats' priority with a new House majority is to build on the progress of the ACA, perhaps by allowing Medicare to negotiate drug prices, and requiring transparency from drug manufacturers.

Drug prices in particular might be a place for bipartisan accord. Both Trump and Pelosi mentioned it the day after the midterm elections last week.

But despite those bipartisan opportunities, Democrats view health care as something to fight for.

"Today is more than about Democrats and Republicans, it's about restoring the Constitution's checks and balances to the Trump administration," Pelosi said on Election Night. "It's about stopping the GOP and Mitch McConnell's assault on Medicare, Medicaid, the Affordable Care Act, and the health care of 130 million Americans living with pre-existing medical conditions."

But not all the disagreement will be between Democrats and Republicans.

On the campaign trail, many Democratic candidates were pushing for a "Medicare for All" system -- a single payer system -- that would radically reform the US away from the controlled markets used today.

Many of the newly elected Democrats will be pushing to deliver on that promise, but it's a non-starter with a Republican Senate and President in place for the next two years at least. Currently, Democrats have proposed the Better Deal, which, for at least health care, would accomplish some of their goals.

It's unclear even whether any ACA improvements would have to get past a split Congress, and even more questionable is what Trump would sign. He has boasted about his efforts to hurt the law, like utilizing the 2017 tax cut law to zero out the penalty for people who do not obtain health insurance.

On what exactly should be done, the public is relatively split. Around half of Democrats, Republicans and independents all agree that the health care system has some good things but does need fundamental changes to it, according to a CBS poll from mid-October. Fewer think it needs only minor changes or it needs an entire demolition and rebuilding.

Among those who said that health care was the most important issue for candidates to talk about in a late August Kaiser Family Foundation poll, most agreed the cost of health care was what they were specifically referring to, a constant across all parties, but especially Democrats and independents.

A majority of Americans have viewed the ACA, also known as Obamacare, favorably for a while now (it passed into net positive territory around the same time Obama left office), and that support continued in Kaiser's poll. Around three-quarters of Democrats have a positive opinion of the law, while Republicans have about the same percentage who see it negatively. Meanwhile, about half of independents like the ACA.

Majorities in the CBS poll (65%) want a government administered health insurance plan (like Medicare) that would compete with private insurance companies, including 39% of Republicans, 84% of Democrats and 67% of independents.

By the end of the election cycle even Republicans who want to repeal the ACA turned toward campaigning on a platform of keeping protections for those with pre-existing conditions. Now, the two parties will have to figure out how to collaborate on that.

Continuing protections for people with pre-existing conditions was very important in Kaiser's poll -- more than three quarters of Democrats, independents and Republicans said it's very important that health care insurers be banned from denying coverage based on a person's medical history or charge sick people more.

If nothing else, this election brought strong bipartisan support and some stability to that portion of the current law.

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