Industry conferences have generated a lot more political punditry than normal in the past year or so — and with good reason. A presidential race unlike any other in history is dominating headlines (and social media), and the outcome could have widespread repercussions for the health care industry.
At last month’s AHIP Institute & Expo in Las Vegas, several notable political experts added their thoughts to the fray. During a session titled “Healthcare 2016 and What It Means for the Future of Health Care,” political strategist and media commentator Stephanie Cutter, who served as a senior advisor to President Obama, joined Nicolle Wallace, bestselling author and former White House director of communications during the George W. Bush presidency, to discuss this year’s crazy political environment.
Where do we stand?
When asked to discuss the current state of the race, Cutter noted that Donald Trump has “wasted the last five weeks” and is currently struggling to unify his party. Meanwhile, things finally seem to be coming together on the Democratic side, as Bernie Sanders slowly fades away and Hillary Clinton begins to gain momentum.
Cutter started the discussion by highlighting five things to watch over the next five months:
- The approval rating of the sitting president – The more popular the current president, the better chance his party has at the presidency. Currently, President Obama’s approval rating is higher than 50 percent in most polls, meaning he could be an “incredible asset” for Clinton.
- The economy – Often considered the biggest indicator of whether people will want change, economic statistics currently show the economy is doing well: an unemployment rate below 5 percent; lowest number of unemployment claims since 1973; and the longest record of month-by-month job growth in 50 years. “But we’ve learned that economic statistics don’t determine how people feel about the economy,” Cutter noted. “It’s their own personal experience, which varies significantly depending on where you live.”
- Money – Another key factor, Cutter said, is how much money candidates have. The fact that Trump is allotting travel time to red states instead of battleground states is a sign that the campaign is likely “being driven by fundraising rather than persuasion and driving votes.”(Recent news about the state of Trump campaign’s finances seems to bolster this theory.)
- Party support/strength of campaigns – President’s Obama’s reelection campaign began with an 11 percent probability of success, Cutter said, but was fueled by a well-run campaign “road map” and 30,000 volunteers. Clinton is following the Obama model and has even hired many who worked on his campaign, while Trump has relied on the RNC for his general election campaign and has said “he doesn’t believe in using data and would rather rely on large rallies.” “As someone who has run several presidential campaigns,” Cutter said, “I can tell you that is a waste of money and you’re not going to reach the voters you need to persuade. If I had to call it right now, I’d say Trump is not going to have a campaign that will bring him over the finish line.
- National security – The recent Orlando shooting gave Americans a good idea of how each candidate would handle a national crisis as president, Cutter said. “My instincts tell me that Clinton came out of handling that crisis pretty well. She was strong in her response and showed great empathy. What I don’t know is how Donald Trump comes out of that … he showed no empathy and played into a nationalist view. I have no idea how that will play in the national election, but my instinct is that it will rally his base but not bring in new voters.”
But although Trump has alienated “basically every voting block in this country, something is keeping him alive” she said. “So as much as I’d like to say this election is over, it’s not. Buckle up, it will be an interesting five months.”
Meanwhile, Wallace admitted that these days, she tends to yield time to the Democrats when it comes to Donald Trump because “they usually say everything I was going to say.” But she then asked for a show of hands: “How many of you know someone, live near someone, or are related to someone who is a Trump supporter?” When nearly everyone in the packed room raised a hand, she dryly said, “It’s not over.”
“We Republicans are all in a 10-step program rounding the corner toward acceptance that this is our new reality,” she quipped. She then noted that although many are waiting for the public to declare the race over because it seems so obvious to people who live in New York and Washington, “there’s nothing obvious about this cycle.”
Wallace was often scathing in her comments about her party’s nominee, describing his candidacy as “cloaked in demagoguery with overt racial themes like the banning of an entire class of people, which is unconstitutional, unAmerican and unsound,” yet she noted that he still holds a relatively high approval rating among the party’s base.
“That’s something that everyone should stop and go figure out,” she said. “[Republicans] want to make sure this doesn’t happen again. They need to get out of Washington and go talk to people and understand why are they so scared that they support someone who says things that you would forbid your child to ever say out loud at school because they’d get suspended.”
So why is Trump still only 10 points behind? “I think there’s a lot of things going on in this country that might not be politically correct, that may not be the types of positions or beliefs that people are proud of,” she said.
“I call him ‘political chemo.’ He might be the medicine that’s so strong it wipes out every healthy blood cell in the political bloodstream. A lot of voters think he might be the one thing that can cure the cancer of a corrupt Washington, of a political establishment more interested in perpetuating jobs and lobbyists and the status quo. This thing isn’t over.”
What about the ACA?
Both Cutter and Wallace agreed that if elected, Clinton would likely adopt a “mend it, don’t end it” approach toward the Affordable Care Act (ACA). Meanwhile, Cutter described Trump’s position on the law as “retreads” of Republican positions that aren’t part of a larger, connected plan.
Health care reform will likely come under discussion frequently during the presidential debates, both analysts said. But will Trump present some “real answers” or continue to describe his plans with vague terms such as “huge” and “tremendous”?
Actually, it may not matter, according to Cutter. “It probably doesn’t do him any good to put out more details, because that’s not what his candidacy is about … he’s happier pointing out what’s wrong with this country, not what’s right. If that’s the case, there’s really no pressure on you to put out there the details of how you’re going to make it right.”
But Wallace noted that with a candidate like Trump who hasn’t previously been involved in politics, it’s important to observe his instincts. “When I look at health care and guns and Planned Parenthood, Donald Trump reveals himself as a lifelong Democrat, which he is. Many politicians don’t know what they’d do about health care if they were president; Donald Trump doesn’t know exactly what he’d do. Until he learned that ‘mandates’ were bad words for Republicans, he was for them. His instincts are actually very un-Republican.”
What if Trump wins?
In order for Trump to win the White House, Cutter said, something big will have to happen. Even so, she noted that in that scenario, “it’s unlikely the Democrats would take back the Senate, but they won’t lose seats, which means the margins will remain very tight, which means nothing is going to get passed if we follow the traditional policy proposals on health care.”
The big question then becomes whether Trump will “go the traditional Republican route and try to repeal the ACA or put policy fixes on the table.” At that point, it’s a matter of what Republicans would go along with, Cutter said.
What if Clinton wins?
If Clinton were to win, Cutter believes “she is serious about putting some fixes on the table. There is broad support in the Democratic party for some of these fixes, but there’s been a fear that once you start opening it up with a Republican Senate and House, that you can’t stop the unwinding of it.”
Both Cutter and Wallace were understandably reluctant to offer too many concrete predictions about the coming months. However, Wallace noted that if Trump can somehow transform how he’s seen by a demographic group such as mothers that historically decides late in the process, “it’s very much in reach.”
She noted that the wild card may be that “Trump could decide he doesn’t want to lose this thing, that he doesn’t want to be humiliated … I don’t think he’s trying that hard right now. If he decides to try hard and do some of these things, it’s possible that he does something to alter the demographics. That’s why I wake up every morning and grope for my glasses and my iPhone. Because every day is a new mystery.”