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Crossing the Political Chasm


Our divisive election season has at times made it seem that our vast political differences boil down to demography—that our divisions based on gender, race, ethnicity, education, and religion are almost unbridgeable.

But with the election behind us and change on the horizon, it’s worth reflecting on the national concerns and undertakings that bind us together.

Improving health care is one such shared endeavor. Breakthrough drugs, better care coordination, and timely, patient-centered treatment have the potential to benefit all Americans, regardless of their political views, racial and ethnic heritage, or house of worship.

Similarly, insurance expansions under the Affordable Care Act (ACA) have touched a diverse swath of the American public. In particular, millions of the white, working-class individuals whose voices seemed to swell so loudly in the recent presidential campaign have likely been among those to benefit from the ACA (Exhibit 1). One reason: most of the "swing states" that decided the election—Ohio, Pennsylvania, Michigan, Iowa, Arizona, and New Hampshire—have expanded Medicaid eligibility under the law.

Yet health care remains unaffordable for many Americans. These include low- to moderate-income individuals who earn just a little too much to qualify for the law’s subsidies and cost-sharing assistance through the marketplaces, but not enough to afford a health plan on their own. And some of those who qualify for help paying premiums have plans with steep copays and deductibles. Many working Americans with job-based coverage have seen their health care costs increase because employers have raised deductibles and copays faster than wages.

As a new chapter in the saga of U.S. health care reform is written in the coming year, it’s worth remembering that, behind the layers of jargon and obscure political maneuvers, the consequences of success—and of failure—will be shared by individuals and groups across our society…regardless of ideology, demography, or geography.

Publication Details



D. Squires and D. Blumenthal, "Crossing the Political Chasm," To the Point, The Commonwealth Fund, Dec. 6, 2016.