DEAR DEMOCRATS: PA18 makes it clear: Whether ACA2, MEFA or M4A, it's time to go on offense on healthcare.

From Public Policy Polling this morning:

Exit Poll of PA-18 Shows Lamb Won Big On Health Care
Date: March 14, 2018

Public Policy Polling conducted a telephone exit poll election survey of voters who cast ballots in Pennsylvania’s 18th Congressional District special election yesterday. Voters who voted in the contest were asked about the role of health care in their decision.

The exit poll shows that health care was a top priority issue to voters in this district and that voters believed Democrat Conor Lamb’s views were more in step with theirs.

In 2016, voters in this district backed Donald Trump by 20 points, but last night they backed a Democrat for Congress in a referendum on the health care plans of the Republican Congress:

• Health care was a top issue to voters. Health care was ranked as a top issue for 52% of voters (15% saying it was the most important issue and another 37% saying it was very important). Only 19% said it was not that important or not important at all.

• Conor Lamb won big especially among voters for whom health care was a top priority. Among voters who said health care was the most important issue for them, Lamb beat Rick Saccone 64-36 and among the broader group of voters who said it was either the most important or a very important issue Lamb beat Saccone 62-38.

• On health care, voters said Lamb better reflected their views by 7 points (45% to 38%) over Saccone. With independents, that gap widened to 16 points with 50% saying Lamb’s health care views were more in line with theirs to only 34% for Saccone.

• Voters were less likely to support Saccone because of the Republican health care agenda. Saccone’s support of the Republican health care agenda made 41% of voters less likely to vote for him and only 28% more likely to support him.

• Voters in this heavily Republican district disapproved of the Republican efforts to repeal the Affordable Care Act by 14 points (53% to 39%).

• 48% of voters believed Republicans are now trying to undermine and sabotage it since they failed to repeal it. Among independent voters, the disparity is even wider with only 33% supporting the GOP’s health care repeal efforts to 63% opposing them.

• In this deeply red district, 44% of voters support the Affordable Care Act while 42% oppose it.

• Only 38% of voters think the best path forward on health care is to repeal the Affordable Care Act, to 59% who think it should be kept in place with fixes made to it as necessary.

PPP surveyed 567 PA-18 voters on March 13th. The margin of error is +/- 4.1%. This survey was a joint project of Protect Our Care and SEIU.

Anyone who reads my site, listens to my presentations or watches my videos should already know this, but the path for 2018 and 2020 on healthcare for Democrats is clear:

• 2019: Pass the Undo Sabotage & Expand Affordability of Health Insurance Act IMMEDIATELY upon taking office in January 2019 (this assumes a big blue wave, of course).

Since #USEAHIA is an absurdly stupid acronym/hashtag, I'm terming this bill ACA 2.0 instead.

Before anyone says it: Yes, I realize this would probably be vetoed by Donald Trump; unless some miracle happens and we're blessed with President Pelosi, the odds are 99.9% that we're gonna be dealing with a President Trump or President Pence through January 20, 2021.

However, unlike a total overhaul bill, there's a small chance that Trump might sign such a bill if it's bundled as part of a "must-pass" omnibus/budget bill, the way he signed the 6-year (later 10-year) CHIP extension recently. Stranger things have happened.

If it becomes law, it will stabilize and strengthen the ACA for several years, tiding things over until...

• 2021: Assuming a Democratic sweep in 2020, pass some variant of CAP's Medicare Extra for All (MEFA). It may look somewhat different than MEFA as presented last month, but it will likely look similar.

Obviously this is where the real battle lines will be drawn on the left side of the aisle: Folks like myself will push for a CAP/MEFA-style system, while Bernie supporters will push hard for a full-blown, near-immediate M4A/SP bill. If there's a full Democratic sweep, the final version may end up somewhere in between the two.

Alternately, if for some reason 2021 brings a Democratic House/Senate but with a Republican President (which I can only envision if someone like John Kasich manages to "reform" the GOP after Trump is removed from office/etc), then the final bill that's passed will probably be somewhere in between ACA 2.0 and MEFA, I'd imagine...either of which would still be a quantum leap ahead of where things stand today.

UPDATE: Here’s roughly how I envision the path of the Dems healthcare strategy under Obama, Trump and in the future:

• 2010 — 2013: ACA 1.0 (as passed)
• 2014 — 2016: ACA 0.9 (weakened via tech screw-ups/other mistakes & pre-Trump sabotage)
• 2017: ACA 0.8 (weakened further via 2017 Trump-era sabotage, such as CSR cut-off, half-length enrollment period, 90% marketing cuts, etc.)
• 2018: ACA 0.7 (weakened further due to Trump’s 2018 sabotage, mainly Mandate Repeal, #ShortAssPlans & Medicaid Work Requirements)
• 2019 — 2021: ACA 2.0 (assuming it can actually get signed)
• 2022/beyond (assuming full Dem sweep): Some MEFA/M4A hybrid
• 2022/beyond (assuming partial Dem wave): Some MEFA/ACA2.0 hybrid