Missing from this year's election: Sweeping health care plans

The big picture: The Affordable Care Act — and efforts to tear it down or build on it — has been at the center of presidential elections since 2008, but there's declining appetite for politically challenging health care reforms.

• Inflation and rising health care costs have voters looking for immediate pocketbook relief rather than a time-consuming reordering of the health care system, experts said.
• "The country is unusually pessimistic when you ask them about state of the country and the future. They're also very short-term," said Harvard professor emeritus Robert Blendon, an expert on public opinion and health care.

State of play: Following this month's State of the Union address that served as an unofficial kickoff to the general election, President Biden signaled a campaign health care message that will focus heavily on supporting abortion rights — a major motivator for Democratic voters — and reducing costs.

• Kamala Harris last week made the first-ever visit to an abortion clinic by a sitting vice president or president, part of the effort to highlight the impact of post-Roe abortion bans.
• Biden and allies are also focused on building on key health care accomplishments they say will save consumers money, including the first-ever Medicare drug price negotiations, caps on Medicare drug costs and expanded financial help in the ACA health insurance marketplaces.
• Polls regularly find support for those ideas, but Biden has gotten relatively little credit from voters so far.

Although Trump has signaled his interest in pursuing ACA repeal, he hasn't offered a formal plan. Republican lawmakers are wary of taking another crack at a law — though they haven't ruled it out.

• Trump abandoned his call for Medicare drug negotiations while in office, but he remains critical of the pharmaceutical industry. He's said he plans to pursue other drug pricing measures, such as an effort to tie Medicare reimbursement to overseas costs, in a second term.

• While Trump takes credit for the Supreme Court overturning Roe, he hasn't indicated if he would pursue federal limits — though he recently said he could decide on that soon.

The bottom line: A sharply divided Washington doesn't allow much space for sweeping health reforms, which are heavily partisan, cost huge political capital and often come at the expense of other priorities.

• Even relatively lower cost health care measures that draw significant bipartisan support have struggled to advance this Congress, such as reducing Medicare payments to outpatient hospital departments to make them on par with what the program pays doctors' offices.
• "There's fatigue amongst policymakers," said Anand Parekh, chief medical adviser at the Bipartisan Policy Center. "There are many other competing challenges. They're not sure if they want to take on some big health care package."