Not Red. Not Blue. Healthcare Is a Populist Issue, Says Costa | AMCP Nexus 2025

Healthcare has become a battleground for both political parties. Robert Costa, national correspondent for "CBS News Sunday Morning" and chief Washington analyst for CBS News, said today at the inaugural pharmacy policy summit of the Academy of Managed Care Pharmacy (AMCP)

Costa told the AMCP audience that populist movements on both the left and right are fundamentally reshaping healthcare debates in ways that defy traditional partisan frameworks.

“You can’t look at policy as red versus blue anymore," Costa said. “It’s about how populism is informing the parties and the party leaders, and it’s about grievance with the global economy and grievance about cost.”

The policy summit is being held the day before AMCP’s traditional fall meeting, called AMCP Nexus, which starts tomorrow. Although AMCP Nexus and the academy’s spring meeting have had sessions devoted to policy and politics, this is the first year that the academy has devoted a whole day to them. The policy summit and the AMCP Nexus are being held at the Gaylord National Resort and Convention Center in National Harbor, Maryland, outside of Washington.

Costa said populist ideas and sentiments are evident in the way both Democrats and Republicans in Congress talk about healthcare. And populist concerns are why Rep. Marjorie Taylor Greene, a Republican from Georgia and prominent voice for the Make America Great Again movement, has become so concerned about the expiration of enhanced subsidies for coverage under the Affordable Care Act (ACA), said Costa.

The current federal government shutdown — which started on Oct. 1 and is the longest ever — centers on extending ACA subsidies that were increased during the COVID-19 pandemic. Democrats have made extending the subsidies a condition for votes that would end the shutdown. Republicans have staked out a position that any negotiations about extending the enhanced subsidies should wait till after the federal government reopens.

Both parties are facing pressure from constituents who will experience significant sticker shock when subsidies expire. ACA, which was enacted during the Obama administration, is a signature achievement of the Democrats but support of its provisions is no longer a simple dividing line between the parties. A KFF analysis showed that 57% of people enrolled in ACA marketplace plans live in congressional districts represented by Democrats.

A different KFF analysis has projected that premiums in 2026 will more than double if ACA tax credits expire. Additionally, 78% of the public say they want Congress to extend the enhanced tax credits, including 59% of Republicans, according to a recent poll by KFF. In that survey, 42% of those enrolled in ACA plans say they would go without healthcare insurance if costs were to double.

“There is now an orientation when it comes to policy toward the concerns of working people,” Costa said. “It’s people versus business interests, party interests, and ideology. President Trump and Senator Bernie Sanders are really the forefathers of this new progressive moment on the left and the populist conservative moment on the right.”

Costa said today’s healthcare debates can be traced to Trump’s 2017 comment that he wanted “insurance for everybody,” which was at odds with the traditional Republican ideology but aligned with Trump’s populist instincts.

It’s also why Trump selected Robert F. Kennedy, Jr., as HHS secretary. Costas said Kennedy appealed to many people who previously had not voted but who were center left. The Make America Healthy Again movement that Kennedy has elevated is crucial to winning nontraditional voters.

“What you saw in 2024 was that traditional nonvoters, the mother or father who has a family and is skeptical of vaccine mandates, living in a blue state or purple state and doesn’t really ever pay attention to politics, started to read about Robert F. Kennedy Jr. and wellness on social media and drifted toward the Trump campaign,” Costa said.

There is lingering skepticism related to the COVID-19 pandemic, which he said created “deep resentment, if not skepticism, of how healthcare leaders handled the pandemic.” This distrust particularly affects younger voters who blame the “healthcare establishment” rather than political leaders for pandemic-era disruptions.

Costa said an important takeaway for healthcare leaders is that American citizens don’t trust institutional knowledge or established thinking. “They don’t trust the FDA. They don’t trust the CDC [Centers for Disease Control and Prevention]. That lack of trust creates a new impulse for people to do things on their own. You may try to guide the audience and teach them new information. But you can’t come in with a perception that the audience is going to be on the same level as you when it comes to facts and norms and conception of an issue,” he said. “So establish your place where you are a trust center, whatever sector you’re in.”