National Journal Column: ‘Don’t forget health care’

Monday, December 18th, 2023

“It’s the economy, stupid.” James Carville’s famous phrase that drove the 1992 Bill Clinton campaign is so ingrained into our politics that we have repeated it and parodied it endlessly over the last 30 years. It’s driving the discourse of 2024 now, as we see poll after poll telling us how unhappy Americans are with the economy. A widespread view that everything is going badly is generally bad news for the party holding the presidency, so obviously unhappiness is interpreted as being bad news for President Biden.

It only takes a quick Google search to see poll-based headlines that say, “Voters’ grim economic outlook helps boost Trump,” “Biden’s economy is great everywhere except in the polls,” and, “Even most Biden voters don’t see a thriving economy.” Those headlines are indeed reflective of what the polls show—tons of proverbial ink has been spilled trying to figure out why voters are so down on the economy when most indicators show it’s doing well, including in this column. But these articles aren’t showing the full story.

What we seem to have forgotten is that Carville’s economy reminder was just one of three talking points that he used to drive the 1992 Bill Clinton campaign. It was never 100 percent about the economy. The current conventional wisdom assumes that voters’ economic views spell doom for Biden—but that’s because the discourse is focusing on the economy. Carville’s other messages were “Change vs. more of the same,” which doesn’t work for Democrats in 2024, and “Don’t forget health care,” which does work for 2024, thanks to former President Trump and Florida Gov. Ron DeSantis stirring up the issue again.

To some degree, it makes sense to bring up the Affordable Care Act yet again—after all, it drove Republicans to a true red wave in the 2010 midterms. And health care issues remain near the top of Americans’ concerns—when polls ask about it. In a single question asking people to point to the most important issue, the economy tends to overtake all other issues. But when you give people the opportunity to rate multiple issues, health care is still right up there near the top.

The most recent KFF Health Tracking Poll shows that while voters are most likely to say it is very important to hear from 2024 candidates on inflation and household expenses (86 percent), nearly as many (80 percent) say it is very important to hear about the affordability of health care. Three in four say it’s very important to hear about the future of Medicare and Medicaid, and 70 percent say the same about access to mental health care.

Ultimately, though, Republicans might want to rethink how much they focus on health care. Republican voters are most likely to say they want to hear candidates talk about inflation and immigration. The poll asked which party voters trust most to handle each of the issues, and not surprisingly Republicans have the upper hand on inflation, 54 percent to 45 percent. Democrats are more likely to want candidates to talk about the affordability of health care—it’s their top issue, along with gun violence. And Democrats have the upper hand on health care: 59 percent of voters trust Democrats more, compared to 39 percent who trust Republicans.

In the last 18 months, the pushback to Republican strength has been that Democrats are getting a boost from voters who are opposed to strict abortion restrictions in the wake of the Dobbs decision that overturned Roe v. Wade. Abortion often gets lumped in as a culture-war issue, but it’s fundamentally a health care issue. The KFF poll shows, as most polls have since June of 2022, that abortion is a stronger issue for Democrats than Republicans—a reversal from the pre-Dobbs era. Voters trust Democrats more than Republicans on the issue, 58 percent to 41 percent.

Plus, Biden administration health care policies are popular among voters who know about them. An AP-NORC poll in September showed that most Americans aren’t aware of moves like allowing Medicare to negotiate drug prices, but that the policies are quite popular among voters when they learn about the steps taken. Contrast that with a CNN-SSRS poll from September that shows most Americans think the Biden administration’s economic policies have made things worse.

Trump and DeSantis are giving Biden a gift if they continue down a pathway of criticizing the Affordable Care Act—not because the ACA itself is perfect or highly regarded by Americans, but because it puts health care out as a main topic. Voters want it to be a main topic, just like inflation. But health care is an issue that favors Democrats and gives Biden a chance to tout popular legislation—probably not what Republicans want to see.

Weekly column written by Vice President Natalie Jackson for National Journal.

This column was originally published on December 5, 2023, on and is owned by and licensed from National Journal Group LLC.