Ramae Hamrin was a high school math teacher in rural northern Minnesota, in a small town with a Paul Bunyan statue and snow on the ground by October.
Hamrin, 50, instructed low-income students in calculus. It was not an easy job, but it provided health insurance for her and her three children. When it came to voting, like many Americans, she was put off by the two-party system. She voted third-party and often libertarian.
Then, Hamrin slipped, fell and broke her hip. She went to hospital, doctors discovered a 9-centimetre (3.5-inch) lesion on her femur, and within weeks was diagnosed with cancer: multiple myeloma. Within two years, she was unable to work, permanently disabled by the ravages of cancer treatment.
“Before I got diagnosed, I would have never thought about healthcare or drug prices,” as a voting issue, said Hamrin. “Now, really that’s my only issue.”
This year, she said, she is voting one way: “strictly Democratic”.
With the US election just over a week away, Hamrin is one of millions of Americans who’s been heading to the polls this fall with healthcare and drug prices as their top voting issue.
The United States’ massive, largely private and very expensive health industry has ranked as a top voter concern for years, and helped drive Democrats to victory in the midterm elections of 2018, when the party took control of the House of Representatives.
But over the last six months of the coronavirus pandemic, which has killed more than 220,000 Americans, Covid-19 eclipsed healthcare as the top issue of the election, though health voters like Hamrin argue the two are inseparable. Her daughter, an accomplished cross-country runner in college, was diagnosed with Covid-19 and now needs an inhaler.
“I do trust the Democrats more than I trust the Republicans to get anything done on this issue,” said Hamrin. Although, she added: “It’s hard to know who to trust these days.”
Although healthcare reform elicits concern across parties, it’s one in which Democrats hold a huge advantage. Biden has a 20-point lead over Trump on issues ranging from how to lower Americans’ health costs and to how to protect people from loathed insurance industry practices.
“Covid has made us all healthcare voters,” said David Mitchell, founder of Patients for Affordable Drugs, one of a handful of advocacy groups which does not take money from pharmaceutical companies.
Mitchell is also a cancer patient. Without insurance, the drugs he depends on would cost $900,000 per year. Because Mitchell buys private insurance, he pays $15,000 per year.
“We track prescription drug pricing in campaigns, and whether it’s the Senate race in New Mexico or the Senate race in Iowa or the Senate race in North Carolina, Georgia, Maine and Michigan – drug prices are figuring in all those races,” Mitchell said. “They’re spending millions and millions and millions of dollars in ads.”
It’s not hard to find stories about why the issue resonates with voters.
“My wife is a diabetic with high blood pressure. We don’t know how to pay for her meds next month!” wrote Brett, a Florida resident who provided their story to Patients for Affordable Drugs.
A story submitted to the organization by a Wisconsin woman named Kelsey, said her insurance requires $650 in monthly cost-sharing to cover post-traumatic stress disorder, diabetes and allergies among others. The cost “leaves us virtually broke every month”.
“People are terrified, folks have lost their jobs, the economy isn’t doing well for folks who are having to make some stark decisions, so healthcare is something people need in this moment,” said Rosemary Enobakhare, the campaign director for Healthcare Voter.
The campaign helped galvanize voters in 2018, and win Democratic control of the US House, on the back of support for the 2009 Affordable Care Act, more commonly known as Obamacare – the largest overhaul of the US healthcare system in decades that extended health insurance coverage to millions of Americans who could not afford it.
The politics of healthcare has changed dramatically in four years of the Trump administration. Republicans have repeatedly failed to fulfill their vow to repeal and “replace” Obamacare.
“We thought we had done all the work we needed to do to protect the ACA, but we have Republicans still working very hard to take away people’s healthcare,” said Enobakhare.
A repeal bill sank after Trump antagonist and Republican former US Senator John McCain cast a thumbs-down-no vote. But Republicans have also since found that protections brought in under Obamacare have become more popular.
“When you are dealing with people who are sick on the verge of death they will do whatever it takes to get better and to stay alive,” said Daniel Dawes, director of the Satcher Health Leadership Institute at Morehouse School of Medicine.
“You now have folks who have reached the breaking point,” said Dawes. “They recognize there is something unfair about this system.”
Democrats and insurgent progressives then rode the wave of GOP failure to office in 2018. Senator Bernie Sanders has meanwhile raised the prominence of the Medicare for All healthcare plan, an NHS-style single-payer system favored by progressives that would eliminate private health insurance.
This election year, Democrats are again making healthcare and insurance a top issue, though Democratic presidential candidate Joe Biden’s health policy does not support Medicare for All. Instead, Biden advocates for the expansion of Obamacare, a policy likely to appeal to more centrist voters who are not yet convinced by the promise of a full healthcare revolution.
Trump has repeatedly claimed a new Republican health plan is in the wings, though he has failed to unveil one, and touted executive orders he claims will bring down drug prices, though they lack detail and are unlikely to do so.
The Trump administration is also now backing a legal challenge that could leave 20 million people without health insurance in the middle of a pandemic. One week after election day on 3 November, the supreme court is scheduled to hear oral arguments on whether the ACA is constitutional, which could send shockwaves through the health system as the United States grapples with the Covid-19 pandemic.
A Trump supreme court nominee, Amy Coney Barrett, expected to be confirmed this week, could be the deciding vote.
For Hamrin, this is not an ideological debate. On 1 January, she loses her private insurance, and the cost of the medication keeping her alive skyrockets to $15,000 per year, all but wiping out her disability checks.
“The whole system is broken,” said Hamrin. “I think government needs to interfere on this one,” she said, adding that she is voting Democrat because she believes government interference “follows their philosophy”.
Without government regulation, she said: “I’m just not sure we’re ever going to see a workable solution, and one in time to save the lives of people that need it.”