The NYT is wrong — the health care wars aren’t over

We will still be fighting over the ACA until we’re all old enough for Medicare

Senate Minority Leader Chuck Schumer, accompanied by Sen. Jeanne Shaheen, spoke at a news conference to call on Republicans to stop premium hikes. (Photo by Andrew Harnik/Getty Images)

In American politics, the fight over health care is a little bit like the Star Wars franchise: It’s decades old, very repetitive, but viscerally important to millions. Even if the series goes quiet for a bit, you should probably never, ever underestimate its ability to come roaring back and swallow the discourse like a Sarlacc.

Yet earlier this month, The New York Times polling guru Nate Cohn argued that “in some fundamental sense” health care “is not what American politics is about anymore.” Yes, Medicaid cuts dominated much of the debate over President Trump’s tax and spending bill earlier this year. And yes, Democrats have refused to fund the government unless Republicans extend expiring Obamacare subsidies. But, according to Cohn, “health care hasn’t been front and center” of voters’ minds for years.

As proof, Cohn noted that just 1% of Democrats called health care the most important issue facing the country in the last Times-Siena poll, and in their last poll of the 2024 election cycle, less than 1% of voters said it was the most important issue to their vote.

The Argument’s numbers, however, tell a different story.

In our latest poll, we asked participants to name the two policy issues “most important to you.” The cost of living came in at number one, with 62% checking it off (no real shock there). But health care followed at number two with 42%. Nothing else broke 25%.

Across all ages, races, education levels, and income groups, health care was number two. Even among Trump voters, a solid 25% listed it among their top two issues.

Other polling outfits have reached similar results lately. Voters also told Echelon Insights that the cost of living and health care were the number one and two issues lawmakers should be focused on, respectively. The AP and NORC last week found that 81% of voters feel health care is either “extremely” or “very” important to them, second only to the economy on their list of issues. About six in 10 said they were worried about health care costs going up next year.

So what’s going on? Why are voters so much less concerned about health care in the Times’ survey?

First, our two polls are built a little differently. The Times asked participants to name the most pressing issue from a list of 22, including facing the country, which allowed respondents to offer more abstract topics like “polarization” and “the state of democracy” that tend to concern liberals. The Argument’s survey only included nine specified topics, focusing on more traditional policy areas like education, the debt, and crime. And, of course, we let people pick two options instead of one.

Subtle wording choices may matter too. If you ask people about the most important issue facing the country, that may trigger a different response than asking about the most important issue to them personally. I’m a health care policy nut who thinks it’s a crime that this country still doesn’t have universal coverage. But if you asked me to name the single most pressing thing facing the United States right now, I’d probably say it was something about our democratic backsliding.

But political context matters as well. Health care really was demoted to a secondary issue during the presidential campaign. Trump’s admission that he only had “concepts of a plan” for how to replace the ACA was arguably the defining health care moment of the race. Democrats skewered him over the line. But in retrospect, it was probably an effective signal that he didn’t have firm intentions of tearing up Obamacare, either.

As he told the moderator: “If we can come up with a plan that’s going to cost our people, our population less money and be better health care than Obamacare, then I will absolutely do it. But until then I’d run it as good as it can be run.”

Now the campaign is over and voters’ immediate pocketbook concerns are paramount. About 24 million Americans use Obamacare’s exchanges, and their premium payments are expected to more than double, on average, if the enhanced subsidies passed under the Biden administration actually expire.

According to KFF’s tracking poll, 69% of voters have heard at least a little about the subsidies’ looming expiration, and once the issue is explained to them, 78% say Congress should extend the subsidies. Health care is salient again. It’s doing numbers at the box office, so to speak.

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Cohn’s argument is about more than week-to-week polling, however. It’s a far more sweeping case that American politics have moved into a new, post-material era, where conservative populists have abandoned (or “deliberately sought to neutralize”) old fights about issues like health care and Social Security in order to focus relentlessly on more “potent” topics like immigration and fighting “woke” overreach.

“[H]ealth care is part of a broader pattern in American politics during the Trump era,” he wrote. “On issue after issue, the defining fights of the 20th-century Democratic Party have mostly been resolved, and usually resolved in favor of the Democrats.”

Cohn noted that Republicans have “no obvious appetite” for a full rollback of Obamacare after their failed, politically disastrous 2017 attempt, and that they “seem unusually willing to compromise on Democratic demands” to extend the law’s expiring subsidies, something that once would have been considered completely beyond the pale in conservative circles.

As for the Democrats? He wrote that they are “not pushing another major expansion of government-provided health care,” and that there is not much room to improve the uninsured rate anyway (it’s currently around 8%, near an all-time low). There isn’t enough political juice left in the issue to justify a big squeeze, in Cohn’s view.

There is at least some truth in all this. Donald Trump changed American politics by promising to keep his hands off of Social Security and Medicare. The 2017 repeal push taught Republican leaders that any attempt to weaken Obamacare’s protections for patients with preexisting conditions would prove politically toxic, which has made them hesitant to try another round of reforms. The Trump administration really has said it is open to negotiating over the law’s expiring subsidies, as long as Democrats agree to open the government first.

But still, Cohn is wrong. There are basic structural facts about the American health care system that will exert a gravitational pull on the electorate.

First, the battle over Obamacare has not been put to bed. With open enrollment starting Nov. 1, it is still unclear whether Congress will reach a deal to extend its enhanced subsidies, which were put in place under the Biden administration. If it fails to, millions of Americans will have to pay much more for their insurance.

Lots of those people vote, and they have the power to swing elections. KFF found that in the 10 most competitive congressional districts last election, the number of marketplace enrollees was more than four-times higher than the winner’s margin of victory.

It’s also unclear whether Republicans are open to extending the subsidies for more than a year. If not, Washington could be fighting about this all over again next October, as open enrollment and the midterms loom.

Nor is it true that all conservative populists have broadly made their peace with the ACA’s existence. Rep. Marjorie Taylor Greene, R-Ga., has been agitating for her party to put together an “off-ramp” from the law that would deregulate the health insurance markets. Trump himself has been musing about the possibility of trying to once again replace the health law, though it’s not obvious whether he has moved beyond “concepts of a plan.”

There is also another major health care fight that is effectively scheduled into federal law: The new Medicaid work requirements Republicans included in the One Big Beautiful Bill aren’t set to start kicking in until 2027, and Democrats are almost certain to try and fight them.

The rules, which require Medicaid enrollees to spend 80 hours a month at a job or in another qualifying activity, are actually very popular for now. But droves of enrollees could begin to lose their insurance simply because they get caught in red tape — which is what happened in the one state that actually tried to implement work requirements in Trump’s first term. At that point, it’s easy to see a swarm of negative public attention refocusing our politics on this issue.

(The CBO estimates that the GOP’s entire One Big Beautiful Bill, including the Medicaid work requirements and other provisions, would raise the number of uninsured by 10 million in the next nine years.)

If the Biden subsidies expire and work requirements are implemented, the health insurance system will be left in dire shape. It would look like a worse version of the ACA circa 2015, with higher premiums and a less generous Medicaid program. I don’t think anybody will consider health care “resolved” if that’s the case.

Democrats will almost certainly try to undo any damage to the ACA done by Trump. But, contra Cohn, they are also likely to try at least some sort of major health care expansion, too. The push for universal health care has been one of the party’s defining goals since World War II, and there’s no particular reason for them to stop trying to make progress toward it in order to focus elsewhere.

Cohn’s argument that politics is now largely postmaterial is in direct conflict with his own outlet’s polling. Recall that the top issue of the 2024 election was not immigration or the fight over “woke.” In the final New York Times/Siena survey of the race, it was the economy.

Meanwhile, inflation and the cost of living remain top of mind for voters according to our polling at The Argument, as well as the recent surveys by the AP and Echelon Insights. Bringing down the cost of health insurance and care for consumers fits neatly into that broader issue. And it could become an even more pressing topic if the cost of employer-provided insurance continues its recent takeoff, or if frustrations over high deductibles and coverage denials boil over.

Sure, Cohn is right that Democrats don’t have a consensus plan on health care. But it’s early. This summer, after the One Big Beautiful Bill had passed, I asked Sen. Brian Schatz where he saw the party’s health care agenda going next. The Hawaii senator, who is now set to become the chamber’s second-ranked Democrat, said his party needed to work in two phases. (This was well before talk of a shutdown over the ACA had begun.)

“In the midterms, the party that is out of power is wise not to develop 12-point plans and long policy papers. It is wise to say, ‘Have you had enough of these jackasses taking away your health care?’ And that’s where we should be until and through the midterms,” he told me. After 2026, Schatz continued, Democrats could start to work on their own plans in more detail and think about how to build beyond what existed before.

“I think it’s very important for us to realize people were not satisfied with the status quo in health care and that restoring the status quo is not exactly going to set the political world on fire,” he said.

Exactly where Democrats want to go on health care will be litigated during the 2028 primary, which will help raise the salience of the issue again. The broader point is that the issue isn’t really at all settled. Nor have entered some sort of postpocketbook political period where every major issue is fundamentally a battle over what it means to be an American.

Rather, we’re in a period where swing voters are so focused on their personal finances and the cost of living that they were willing to set aside concerns about headier issues like the future of democracy to punish the party that let inflation get out of control. Those voters are now ticked that the current president hasn’t done enough to curb grocery prices. The cost of health insurance is very much the sort of thing American politics is still about.

Correction: An earlier version of this article incorrectly described Brian Schatz as the number two Senate Democrat. He has secured the votes to replace Dick Durbin, the current whip, when he retires at the end of this term.

Correction: An earlier version of this article did not accurately note the open-ended nature of The New York Times’ poll question