A strategic pivot to healthcare reform could save the midterms for Democrats

Democrats are increasingly at risk of losing control of Congress in the 2022 midterms. Facing a stalled legislative agenda and record-low approval numbers, President Biden and the Democratic Party need to show voters that they can deliver for the American people — and they should begin by delivering on healthcare.

As things stand, President Biden has the lowest approval rating of any recent president at their one-year mark aside from Donald Trump. Just 40 percent of Americans approve of Biden’s job performance, while 56 percent disapprove, according to a recent Gallup poll. 

Furthermore, U.S. political party preferences shifted 14-points in the G.O.P.’s favor in the last year, going from a 9-point Democratic advantage at the beginning of 2021 to a 5-point G.O.P. edge at the end of the year, per tracking by Gallup.  

In light of Democrats’ declining ratings and their two back-to-back legislative failures — the stalled Build Back Better Agenda and their unsuccessful effort to weaken the filibuster to advance voting rights legislation — the party desperately needs to come together around a new domestic agenda.  

Such an agenda should focus on alleviating one or two major problems that everyday Americans struggle with, and reforms should be crafted and communicated in a simple, straightforward way that voters can understand, engage with, and ultimately, can give Democrats credit for.   

Healthcare reform clearly fits the bill. Americans across the country are facing higher insurance premiums and prescription drugs costs, medical conditions that were left untreated during the pandemic, and potential long-hauler medical issues from COVID-19.   

The party is tentatively gearing up to pass their Build Back Better agenda in chunks, rather than as one mammoth bill, which is something I have advocated for many times. Some Democrats have indicated a desire to start with the climate provisions in Build Back Better; however, from a practical and political perspective, Democrats would be wise to pursue the health care components first.  

Practically speaking, Democrats have the best chance of coalescing their entire party around healthcare reform — rather than around robust climate and green energy provisions, which West Virginia Sen. Joe Manchin is more likely to oppose, which would once again derail the party’s agenda.  

Furthermore, healthcare has proven to be a winning political issue for Democrats in past elections. Democrats won back the House of Representatives in 2018 — flipping 40 seats — in large part due to their compelling message on healthcare. Exit polls from the 2018 midterms reveal that 41 percent of voters believed healthcare was the most important issue facing the country, followed by immigration at 23 percent, and the economy at 22 percent. 

Healthcare was once again a pivotal issue in the 2020 election as the country grappled with COVID-19. Throughout the 2020 campaign, Democrats found success by advocating for making healthcare more affordable and accessible, while also casting Trump and Republicans as the party that would take away Americans’ healthcare when they need it most.  

Looking ahead to 2022, Democrats have an opportunity to dig in on significant healthcare-related issues like lowering prescription drug prices and advancing legislation that will deliver them a much-needed legislative win.  

In the private sector, billionaire investor Mark Cuban launched an online pharmacy this week that offers more than 100 generic drugs at affordable prices. In order to achieve Cuban’s stated goal of being “radically transparent” about price negotiations with drug companies, his new business endeavor essentially cuts out the middlemen in drug pricing — known as pharmacy benefit managers — to make drugs more affordable. 

Under the current system, pharmacy benefit managers operate as middlemen in the supply chain for prescription drugs. When they negotiate with drug companies to distribute their products, they often receive partial refunds, known as rebates. However, in recent years, pharmacy benefit managers have been keeping the rebates and not passing them on to consumers.  

In terms of how future legislation can fix this in a way that benefits consumers, Democrats should essentially follow the model of Cuban’s new business venture and pass legislation stating that rebates must be passed on to consumers. 

Not only would this secure a major win for Democrats, but it would also force Republicans to either vote against lowering drug prices for a second time, or come on board in a bipartisan fashion. If Republicans buck bipartisanship, Democrats would then be able to open a new line of attack on Republicans in the midterms, arguing that Democrats are the party of lowering drug prices for all Americans and delivering real change.  

And despite ideological divisions within the Democratic Party, drug pricing rebate reforms can serve as an issue that Democrats can indeed coalesce around based on what lowering prescription drugs prices offers to the American people in terms of alleviating a significant financial burden.  

Ultimately, in order to cut their losses in the 2022 midterms, it’s clear that Democrats need to put healthcare — specifically, lowering drug prices — at the center of their strategic pivot.  

Douglas E. Schoen is a political consultant who served as an adviser to former President Clinton and to the 2020 presidential campaign of Michael Bloomberg. He is the author of “The End of Democracy? Russia and China on the Rise and America in Retreat.”