Issue Spotlight: Healthcare
Healthcare was one of the most frequently mentioned issues in tweets about the Democratic Party nomination. This is not surprising. In a YouGov poll conducted in early 2019 for the Voter Study Group, 82 percent of Democrats said that healthcare was a very important issue to them. Going into 2020, we expected to see healthcare emerge as a top issue.
There could be many reasons driving the importance. For one, the Affordable Care Act (ACA) still faces legal challenges. A lawsuit brought by more than a dozen Republican state attorneys general, and supported by the Trump Administration, once again asks the courts to strike down the entire Affordable Care Act as unconstitutional. Just last month, the U.S. Supreme Court agreed to hear the case after Democrats appealed a ruling by the U.S. Court of Appeals for the 5th Circuit that struck down the individual mandate as unconstitutional on the grounds that Congress had eliminated the associated financial penalty in the 2017 Tax Cuts and Jobs Act (TCJA). Although the Supreme Court is unlikely to issue a ruling before the election, Democrats will no doubt try to exploit the legal threats to the ACA in their campaign strategy, looking to attack the Republican Party on healthcare just as they did in the 2018 midterm elections when they won back control of the House of Representatives.
At the same time, candidates vying for the Democratic presidential nomination spent the last ten months debating about how best to expand healthcare coverage for more Americans. Healthcare quickly emerged as one of the key points of contention dividing the field of candidates, with Sanders and Warren supporting a national, single-payer system that would eliminate private health insurance for basic coverage (Medicare for All) and others, including Biden, favoring a plan that would keep private insurance but allow Americans to choose a government-run program (public option).
The coronavirus outbreak in the United States brought yet another healthcare issue to the fore: paid sick leave. As noted by the Washington Post, “[a]bout a quarter of U.S. workers get no paid sick leave at all.” Only twelve states and Washington D.C. require private-sector employers to provide sick leave to their employees. However, in response to the pandemic, Congress passed emergency legislation in mid-March to give a subset of American workers access to paid sick leave if they are ill or impacted by quarantine orders and paid family leave to those who have to take time off work to care for children who are out of school because of the pandemic. But this measure is temporary, covering coronavirus-related leave taken over the next year; small businesses with fewer than 50 workers are also able to receive an exemption from having to pay these benefits.
Below we look at how tweets mentioning healthcare evolved over the course of the Democratic nomination. To do so, we classified healthcare-related tweets into six categories: Obamacare/ACA, Medicare for All, public option, Medicare, Medicaid, and paid sick leave.
One of our key research questions is whether the issues dominating social media are important to the typical American voter. Twitter users are not a representative cross-section of the American electorate in many ways. A recent Pew Research Study, for example, finds that they are younger, wealthier, and more highly educated. They are also more liberal, particularly on issues having to do with race, immigration, and gender. Pew did not compare attitudes about healthcare between Twitter users and the general electorate, but our examination of healthcare-related tweets about the Democratic nomination suggests some clear differences.
While Democrats overwhelmingly agree that the federal government has a responsibility to see to it that everyone has access to healthcare coverage, they are more divided on how best to expand healthcare coverage. A survey by the Kaiser Family Foundation (KFF), for example, found that a majority of Democrats prefer a candidate who would build on the existing ACA (55%) rather than replace it with Medicare for All (40%).
Yet on Twitter, Medicare for All dominates – by a lot. The issue received even more attention on Twitter the week that Biden and Sanders went head-to-head in the 11th presidential debate. Biden’s remarks that Italy’s national healthcare system did not prevent a coronavirus outbreak drew particular ire on Twitter.
In contrast, tweets about the ACA (Obamacare) were smaller in volume and more stable over the course of the nomination. Even fewer tweeted about adding a “public option” to expand healthcare insurance coverage, and the issue did not gain more traction on Twitter as Biden overtook Sanders in the delegate count. March saw a dramatic increase in tweets about paid sick leave as the pandemic took hold in the United States. Whether paid sick leave becomes a bigger issue this election cycle remains to be seen, though there is good reason to suspect that it might.
Our time series of data here concludes when Sanders ended his bid for the Democratic nomination on April 8th. However, we will continue to track all of these healthcare issues in our new issue tracker for the general election, which we will launch later next week.