I have no idea what the outcome of this very close election will be. I do, however, have a fix on several of the ways health care played a role in the election and in campaign strategy. It won’t change much by election day.

With no big health reform debate to command the attention of the nation and no big health proposal from either candidate, this is not a “health care election,” except, of course, for the impact abortion will have on voting and turnout, whatever the outcome on November 5.

But health care has played a role in the campaign and the election in the following significant ways.

First and foremost, voter concerns about their medical bills are an integral part of their worries about the economy and their costs, mixed in with general inflation and other pocketbook issues such as food, gas prices, and the rent or the mortgage. Most national polls continue to miss this, treating health care as a separate issue. When you treat health care as a stand-alone issue, it ranks as a fairly low priority. However, out-of-pocket health care costs and worries about unexpected medical bills are a big part of the public’s economic worries. Exit polls have made the same mistake. Determining the role health plays on voters’ decisions requires an extra question, which takes time that short polls often do not have. The question that needs to be asked is a variation on this follow-up: “You said the economy was your number one concern. What about the economy most worries you?” The question can be open ended, or respondents can be given a list to choose from. There are arguments for either approach.

The advantage Vice President Harris and the Democrats have on health has also had an impact on former President Trump and his campaign strategy. He has generally backed off plans to repeal the Affordable Care Act (ACA), saying various things, including recently that he has “concepts of a plan,” but mostly protesting that he now wants to “make the ACA better” with no specifics. He’s also pledged that he will not cut Medicare (no such pledge on Medicaid). And he backtracked on his earlier, more bullish positions on drug costs, going silent on his plan to tie drug costs in the U.S. to what other countries pay, apparently wanting to stay away from even popular health proposals. Overall, he has ceded health care to Harris, likely wary that she will get traction with criticisms that he would take health coverage away from millions and weaken protections for pre-existing conditions.

Harris has taken the opposite approach on the issue that Trump has about an equivalent advantage on—immigration—by taking the offensive to try to close the gap. And she has tried to do the same on the economy with some success, according to several recent polls. (Of course, positions taken in campaigns do not necessarily presage positions a candidate will take if elected.)

The sweeping proposals made by several conservative think tanks to fundamentally change Medicare, Medicaid, and the ACA have been swept under the rug by the Trump campaign, even as Democrats have had some success making Project 2025 a symbol of right-wing extremism. That doesn’t mean the candidate and his administration will not embrace some elements of these plans if elected or appoint some of their architects to high positions. It is, however, a notable element of the campaign, and an acknowledgment that these ideas are a target for Democrats and that Trump and his campaign know that many of them would be controversial and unpopular.

Senator JD Vance’s brief and somewhat vague foray into segmenting healthy and sick people into separate risk pools as an alternative to ACA protections for people with pre-existing conditions was treated by Trump almost the same way he treated the think tank plans: he ignored it. It was as if health had become radioactive for Trump, who campaigned on other issues, including immigration, which he saw as more favorable to him.

Health might have been more of an important issue in the campaign if differences between the candidates and the parties on converting Medicare to a voucher-like, premium support plan, or Medicaid to a block grant to the states, were clarified for voters by the candidates themselves, the debate moderators, or the media generally. Debate moderators focused more on the ACA, likely because of the drama associated with Trump’s earlier attempts to repeal it. Had Trump been forced to choose between embracing or rejecting either of these big and controversial policy proposals, it would have elevated health in the campaign and might have been a flashpoint.

The Democratic left’s concern that Trump might be elected has led them to hold fire on pushing for the more expansive health reform proposals they favor, instead supporting President Biden’s more moderate, incremental policies, and subsequently, the proposals made by Vice President Harris. Should Harris prevail, expect the left to feel less constrained and to hear again about Medicare for All, the public option, Medicare Buy-In, and other policies favored by the left. Passage of legislation on these ideas, or others, is an entirely different matter, especially if Congress is divided.

Harris’s new proposal to add a home care benefit to Medicare may find favor with some elderly and near elderly voters, especially senior women or their family members. That’s one thing to watch as the voters go to the polls. The idea should be popular unless voters come to doubt that Harris can deliver. So far Harris has proposed popular benefits such as extending the $2,000 cap on out-of-pocket drug costs and the $35 monthly cap on Insulin to the private sector, and she has endorsed continuing the enhanced ACA subsidies. She has avoided proposals that would inflame the powerful health care industry, such as extending drug price negotiation to employer coverage.

These are some of the ways in which health care and health care costs have played a role in the presidential campaign. It’s certainly true that health care has not been decisive in this election, but it has played a role, and always will.

View all of Drew’s Beyond the Data Columns

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Presidential debates are prime-time audience grabbers and the brunt of late-night talk show host jokes. The two candidates are a complex contrast in tone and leadership.  The nation’s significant issues are many – immigration, economy, health costs, rampant racism, women’s reproductive rights, global security, and more. Still, another debate topic must squeeze in among the moderator’s debate questions: climate and environmental sustainability. 

Climate is the back-burner priority we routinely kick down the road for a future Congress or administration to address eventually.  But under the Biden Administration, Congress enacted bipartisan legislation, and legislators red and blue engaged.

Climate is often the catalyst for migration and demographic shifts, impacting where people live and work. Extreme weather events disrupt agriculture, manufacturing supply chains, real estate value, tourism, and health. But what makes Congressional candidates act is clear – it’s the economy. Climate change destroys more than the earth’s landscape. It ruins people’s livelihoods and lives.

Climate – A Call to Action Among Gen Z Voters

Now 75 years old, Former Vice President Al Gore has long embraced climate as a platform issue. Still, climate advocacy has since been left mainly in the domain of youth-led movements such as Fridays for Future, School Strike for Climate, and the successful class-action suit led by 16 young Montanans.

The presidential candidates and those seeking election to Federal and state offices should be pressed on climate – they should prioritize sustainable communities, continents, and commerce. Climate is not a topic that should dominate the Gen Z agenda alone. It must become a presidential candidate call-to-action as they cross the nation, campaigning, debating, and outlining sustainability platforms to voters.

In a highly partisan Congress, the Biden Administration has, against the political odds, advanced one of the nation’s most comprehensive investment programs to stimulate jobs, innovation, and sustainable communities. The Environmental and Climate Justice Program (ECJ Program), part of the Inflation Reduction Act (IRA), provides financial and technical assistance for environmental innovation and climate justice activities.

The IRA breathes new life into toxic pollution policies by reinstating the Superfund tax, raising more than $11 billion in guaranteed funding for years to come, and reducing the community pollution disproportionately felt by low-income and disadvantaged communities.

Young Voters Care About Climate – Their Grandparents Should Too

The most inflammatory consumer-pressing topics will likely dominate the campaign conversation during the months ahead – seeking to either show one candidate is out-of-touch with voter urgencies or ill-equipped to lead – climate (albeit urgent) will likely be a secondary issue on the electioneering circuit. If Gen Z and younger are rightfully anxious, their parents and grandparents, who are voters, should take note. As the Greatest Generation fought to keep the world safe, in going to the ballot box, they should keep the planet safe for future generations.

Here are 10 hot-button topics that are part of the climate and environment conversation that we should consider as the nation heads into November. These are pocketbook, job creation, and equity transformation possibilities.  When Congressional representatives speak out for their constituents, it’s expected.  Looking at their longer-term needs – and the nation’s – requires collaboration and policy action. 

Top 10 Environmental Priorities for Voters and Candidates

1. Climate Change: We need continued support for policies to reduce greenhouse gas emissions and meet ambitious targets, such as transitioning to renewable energy sources and increasing energy efficiency. The IRA is a tremendous step forward, and the return of the Superfund Tax returns teeth (and tax dollars) to enforcement.

• Renewable Energy: Promoting the expansion of clean and renewable energy sources like wind power, solar energy, ground source and hydropower will decrease reliance on fossil fuels and enhance energy security.  Buying “alternative energy” from supplies is an added cost.  Finding ways to subsidize this expense for homeowners increases jobs and reduces carbon emissions. Even better, look for communities integrating renewable energy into their building plans. 

• Carbon Pricing: Advocate for a carbon pricing mechanism, such as a carbon tax or cap-and-trade system, to incentivize emissions reductions and drive investments in low-carbon technologies. Airlines like United and Turkish Airlines are among the many that have stepped to the fore and put a public face on this issue. Consumers are asked to join in contributing toward carbon credits. Some will question this co-funding approach. In reality, we’re in this together.

• Environmental Disparities: Address environmental disparities and ensure that vulnerable communities, often disproportionately affected by pollution and climate change, receive equitable access to resources, clean air, and clean water.  Post Hurricane Sandy, millions of people were displaced from the New Jersey coastline.  Innovators such as Ecocrete are pioneering ways to create “reefs” that double as protective guards against flooding and protect sea life in the face of continued environmental risks. Advocacy organizations like Rivers are Life are uniting companies that must now repair damages created in years past.

• Conservation and Biodiversity: Support policies that preserve and restore natural ecosystems, protect endangered species, and promote sustainable land and water management practices. According to one innovator – Beewise –75 percent of our produce is pollinated by bees, while 40 percent of bee colonies collapse yearly. That points to a looming global challenge and innovator opportunity.

• Sustainable Food: Promote sustainable farming practices, reduce harmful pesticides and fertilizers, and incentivize regenerative agriculture to protect soil health and decrease emissions. All over the world, companies are stepping up to address the dual challenge of sustenance and sustainability.  One shining example is Tetra Pak, which takes an integrated approach to sustainability, focusing on package recycling to move the world’s food systems forward.

• Clean Transportation: Invest in public transportation infrastructure, incentivize electric vehicles, and develop sustainable urban planning to reduce emissions from the transportation sector. The Inflation Reduction Act of 2022 has set a goal for all new light-duty vehicles to be electric by 2027 and make all Federal vehicle acquisitions electric by 2035. Billions of incentives will be available to stimulate production and purchase.

• Community Response: Develop strategies and funding mechanisms to help communities at risk – close to rising coastal flood and heat zones – adapt to the changing climate, protect critical infrastructure, and plan for sea-level rise and extreme weather events. Babson Ranch is one community that stands among the Time Magazine featured examples other builders should follow.

• Waste and Supply Chain Management: Promote policies that reduce waste, encourage recycling and reuse, and decrease the environmental impact of manufacturing and consumer goods. There are incredible examples of success – companies that are well on their way to showing how our landfills can be transformed into raw materials and recycled into furniture, consumer goods, and more.  If you need an inspiring “it’s possible” example, follow UBQ Materials.

1. International Collaboration: Advocate for global climate agreements and partnerships and engage in diplomatic efforts to address climate change internationally. COP28 was contentious – a fossil fuel nation hosting the international community.  But in reality, all the developed countries are a large part of the problem and must be leaders investing in solutions.

The UN Climate Change Conference COP29 meets on the heels of the US presidential elections. Organizers must set an agenda that draws in the American public and candidates, including benchmarking successes and urgency.  Whoever sits in the Oval Office will have an incredible influence on the US voice in the global forum. The US and global political agenda must align.  We share one planet – a planet that doesn’t need people.  But people need the planet.

“Don’t Live Your Life on the Sidelines”

Will climate and environment be little more than a side mention during the presidential campaign trail? People tend to look at urgent bread-and-butter issues rather than addressing concerns that unfold over time. We “live for today and (supposedly) plan for tomorrow.” 

That being said, for the young people of Montana who successfully sued to protect the environment (and the other 49 states that care), demonstrated climate will be among the ballot box priorities that bring out younger voters to polling places. It’s often suggested that age corresponds with wisdom. That adage is out of step with today’s pressing realities.

The late tech genius and Apple Computer Founder Steve Jobs offered a different perspective: “The people who are crazy enough to think that they can change the world are the ones who do.”

We need courageous government leaders who are ready to prioritize climate change and redirect our imaginations and economic and time investments to preserve our future.  Old and young alike must recognize that delay is not an option.  A theoretical asteroid is heading toward our planet through rising temperatures, melting ice caps, and polluted water and air.

Which presidential candidate can take these challenges on sensibly? Regardless of age, “Think Different” voters look to and vote for the one who can do it!

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