Is cost of health care top election issue?

What's the number one issue concerning people right now? Yes, folks are concerned with pocketbook issues like the price of groceries, housing and utilities and some are concerned with immigration, but KFF (the Kaiser Family Foundation) has just released a nation-wide poll reporting that people say the issue that will most affect their votes come November is the increased costs of health care.

When Congress finally passed a stopgap measure to end the 43-day federal government budget shutdown last November, the bill did not include provisions to extend or continue the tax credits reducing the cost of health insurance through the Affordable Care Act (ACA) marketplaces. It was the biggest issue, along with Medicaid funding, at the heart of the shutdown, but was disregarded.

As a result, premiums for some 24 million Americans (7.2%) with ACA marketplace insurance have more than doubled beginning in January, from $888 annually in 2025 to $1,904. Interestingly, 77% of people facing these increases live in red states like North Carolina.

Two in five people are covered by government insurance — Medicare (19%) or Medicaid (17.6%). Another 54% are covered by employer sponsored insurance plans. Larger firms, those typically with 100 or more employees, pick up about 75% of the cost of their employees' insurance premiums; the employee contributes 25%.

Over the past five years the premiums for family health coverage have increased by a whopping 26%, now amounting to some $27,000 annually and rising. To control cost increases, many insurance plans have raised employee out-of-pocket deductibles and co-pays.

A December Gallup poll further makes the case. Seventy percent of those polled say the U.S. health care system is in a state of crisis. Eighty-one percent of Democrats agree with that statement, while only 66% of Republicans and 64% of Independents concur the system is in crisis or has major problems.

It is obvious that health care and health care costs are on voters' minds and promise to be a election issue in the November midterms.

I don't pretend to be an election campaign strategist, but if I was working for a candidate, here is some advice I would off er, especially to Democrats.

Stop constantly railing about what a terrible person Donald Trump is and what horrible things he is doing. It's not working. About 40% of the electorate continues to support him — I can't explain why, but they do. Like Trump said in 2016, he could kill somebody on Times Square in New York and get away with it.

Running against Trump is a losing hand.

Instead, my advice would be to find issues that concern large numbers of people, keep those issues constantly present on the minds of voters and off er solutions to them. Health care looks like a winner.

My health care election strategy would begin with this question: Is health care a privilege or a right in this country? Is it something only rich people can afford or should all people be afforded basic health care?

Despite some rhetoric to the contrary, our country obviously thinks everyone is entitled to some basic health care. Consider the EMTALA act, a federal law passed in 1986. EMTALA, the Emergency Medical Treatment and Labor Act, states that any hospital accepting Medicare must treat anyone coming to their emergency department requesting evaluation or treatment. If they have an emergency condition, the hospital must provide treatment, regardless of the patient's ability to pay.

Now, part of the imperative in passing the Affordable Care Act was that increasingly large numbers of patients without insurance were showing up to emergency rooms, overwhelming the ERs and slowing down health care delivery for other patients needing urgent care.

ACA and Medicaid expansion allowed large numbers to obtain health insurance, thereby establishing relationships with a care provider. When our state finally decided to expand Medicaid, some 600,000 citizens obtained health insurance, taking pressure off our overcrowded emergency rooms.

That care has now been eliminated or restricted by three things. First, the inaction of Congress to restore the tax credits of the ACA marketplace. Additionally, while the full impact of the $1 billion in cuts to Medicaid in the Big Beautiful Bill are still unknown, there's no question those cuts are going to have huge impacts on health care in our state.

And third, since our legislature has failed to pass a budget for this current year that started July 1, we face large deficits in the amount the state needs to pay its share of Medicaid costs, forcing our department of Health and Human Services to cut the reimbursement amounts they pay to care providers by 3%. This cut in revenue will undoubtedly reduce the number of care providers available and the quality of care being provided.

If you were a candidate, do you think you could make health care, especially health care costs, a significant campaign issue? Seems like a winner to me!

Tom Campbell is a Hall of Fame North Carolina broadcaster and columnist who has covered North Carolina public policy issues since 1965. Contact him at tomcamp@