Downs and pre-existing conditions

Recent Washington Post and New York Times articles profiled the trend of Republican lawmakers and candidates in difficult elections to come out in support of coverage for pre-existing conditions. These include Josh Hawley, running for Senate in Missouri, who brought a lawsuit against the ACA and Dana Rohrabacher, running for re-election in CA-48 who voted for the AHCA (which would have effectively repealed the ACA and its mandate to cover pre-existing conditions). This dichotomy between past actions and current policies of these Republican politicians may point to political maneuvering with the aim of winning votes by (1) discouraging rational voting or (2) by changing policy positions.

In Downs’ The Statics and Dynamics of Party Ideologies, the author describes how in a two party system, parties have an incentive to be ambiguous about their platforms, in order to discourage rational voting. This is because when voters perceive both parties as having similar platforms, voters have a more difficult time determining actual policy differentiation, and thus often make decisions based on other factors. Further, liberal voters may interpret a candidate’s stance in favor of coverage for pre-existing conditions as closer to their own policy preference (more regulation of healthcare) while conservatives may take a candidate’s past actions into account when considering the candidate (support for pre-existing conditions but not increased regulation on the whole), thus widening the candidate’s net of appeal along the spectrum. When Republicans attempt to make their positions on healthcare more similar to the position of Democrats by coming out in support of pre-existing conditions, it makes voters choose their candidates based on different issues or personal qualities, or candidate preferences.

Similarly, Downs notes the tendency of parties to change their policy platforms in order to appeal to more voters. In a two party system with a central mode (a third of Americans identify as moderate), this may lead to parties shifting some policies towards the center. Indeed, three quarters of Americans believe insurance companies should not have a right to deny coverage based on pre-existing conditions. This number includes 75% of independents and 58% of Republicans. Because of this, there is less danger of alienation of extreme voters if republicans were to move left (more government regulation) on healthcare.