ANALYSIS: Political Landscape Changing on Healthcare Issues
Ahead of the 2026 election, Democrats and their progressive allies are dusting off the healthcare fear-mongering playbook to counter Trump’s agenda. However, in North Carolina at least, the political landscape on the particular issues at hand this election cycle favors Republicans. Americans broadly support Republican changes to Medicaid that favor Americans over illegal aliens. The pharmaceutical industry supports over a quarter of a million jobs in the Tar Heel state. Senator Tillis continues to lead on solutions to extend the premium tax credit, which assists nearly a million North Carolinians.
Across the country, including North Carolina, Democrats continue to hyperbolically claim that Medicaid is under attack while ignoring the substantive policy changes made to the program. The problem for Democrats is that Americans broadly support the key policy changes Republicans passed through the House. A polling memo from the American Action Network showed that 72% of Americans support adding work requirements for able-bodied working-age adults, and 68% support strengthening Medicaid eligibility integrity efforts to better screen enrollees and end coverage for those who are ineligible. This is not the level of support Democrats need to effectively oppose this legislation.
Progressive organizations have already begun to signal their plan to reuse misleading attacks against Sen. Tillis and his connection to the pharmaceutical industry. While those attacks may be effective in other states, North Carolina has a substantial pharmaceutical industry. There are over 7,000 pharmaceutical companies that call North Carolina home, supporting over 200,000 jobs across the state. Additionally, North Carolina, particularly Raleigh, will substantially benefit as companies relocate manufacturing operations from overseas back to the United States.
Finally, the latest attack from Democrats on healthcare issues relates to tax credits that assist close to 24 million Americans buy health insurance through the marketplace. But Senator Tillis is leading the charge to find a bipartisan solution to preserve these tax credits. As Axios reported, Sen. Tillis is working with his Republican colleagues to protect this tax credit for people who buy insurance on the marketplace. Tillis’s leadership on this issue may prove crucial if Congress manages to pass something ahead of the scheduled expiration of the credits at the end of 2025, as he's one of a few Republicans who has been vocal for in his support.
While Democrats will likely try to make healthcare a key campaign issue, it’s far from clear whether any of these attacks will land, given the disconnect from reality. Americans support the Republicans' reforms to the Medicaid program, and Senator Tillis is fighting for policies that benefit his state and protect North Carolinians. The political landscape around healthcare may follow the changes seen in recent years regarding education. For years, Democrats were viewed better on education issues, and they continued to push policies that favored systems over students. But then COVID happened, and parents saw what was happening in their kids’ classrooms through Zoom. Then, the political reality shifted, and a range of education policy reforms became viable.
In a similar way, Democrats passed the so-called “Affordable Care Act” over a decade ago, and healthcare costs have continued to skyrocket. This election cycle, Republicans can focus on the debate on policy issues that highlight Democrats' extreme agenda and out-of-touch priorities, like opposition to work requirements. Instead of healthcare serving as a liability, Republicans can go on offense to show how they are providing practical solutions, while the Democrats oppose improvements.
