Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Journal Article


A Way Forward for Bipartisan Health Reform? Democrat and Republican State Legislator Priorities for the Goals of Health Policy

health care cost


Health reform has become a politically divisive issue in the United States. But survey responses from Democratic and Republican state legislators show that both parties agree on one thing: the importance of reducing health care costs. While the parties have other competing priorities — like increasing access to health care and reducing the role of government — tackling costs could provide a basis for future bipartisan health reform.

The Issue

IMPORTED: www_commonwealthfund_org____media_images_newsletters_transforming_care_2017_june_tc_quote.png
This survey demonstrates that common ground between Republicans and Democrats can be found on the sufficiently challenging task of tackling health care costs.

The passage of the Affordable Care Act and the many attempts to repeal and replace the law reflect the highly polarized nature of health care reform in the United States. Many observers have argued that only health reform carried out in a bipartisan manner is sustainable over the long run. But making such reform possible requires both Democratic and Republican policymakers to converge around specific, articulated health policy goals. A research term led by Christina Pagel, a 2016–2017 Commonwealth Fund Harkness Fellow in Health Care Policy and Practice, surveyed state legislators about their health policy goals to gain insight into the opportunities and challenges for future bipartisan reform.

Key Findings

  • Republican and Democratic state legislators differ in their priorities for health care but agree on the importance of reducing costs for individuals and families, as well as for payers, like government and employers. Republicans prioritize reducing costs and limiting the size of government. Democrats place improving health and equity outcomes and reducing costs at the top of their agenda.
  • Republicans are split on the relative importance of improving health versus limiting government involvement. About 30 percent of Republicans surveyed gave high priority to improving overall health and lower priority to reducing government involvement in health care; 40 percent said the opposite.
  • Republicans and Democrats disagree about the level of involvement the government should have in health care. Overall, Republicans ranked reducing the role of government as their second-most important priority, while Democrats ranked it lowest out of 13 possible goals.

The Big Picture

Based on the survey’s findings, Democratic-only health reform would prioritize expanding access for individuals and government-driven efforts to improve health outcomes. Republican-only reform, on the other hand, would prioritize limiting the role of government and decreasing government spending. Both sides agree on the importance of reducing costs, making it the most obvious area for bipartisan collaboration — provided that cost-control policies do not adversely affect the parties’ other goals. The authors suggest that advocates for health policies should emphasize their impact differently. For Democratic lawmakers, they should highlight the policy’s impact on reducing health disparities. For Republican lawmakers, they should focus on the potential for decreased government spending.

About the Study

The researchers surveyed a group of state legislators for their views on a list of 13 health policy goals developed with input from a bipartisan group of policymakers. The surveyed lawmakers all serve on health or budget committees in state legislative bodies. The research team received responses from 377 legislators: 192 Democrats, 182 Republicans, and three others.

The Bottom Line

Republican and Democratic state legislators agree on one health policy goal: reducing health care costs. While the parties have other competing goals, building on this common ground could lead to successful bipartisan health reform.

Publication Details



Mary Mahon, Former Vice President, Public Information, The Commonwealth Fund

[email protected]


C. Pagel, D. W. Bates, D. A. Goldmann et al., “A Way Forward for Bipartisan Health Reform? Democrat and Republican State Legislator Priorities for the Goals of Health Policy,” American Journal of Public Health, published online Aug. 17, 2017.