In poll after poll of American voters, health care consistently ranks among the top issues of concern.

High costs, a tangle of insurance plans, and the devastating price of prescription drugs have all come to frustrate both Democrats and Republicans.

Ultimately, it all comes down to cost.

People can’t afford their medications. Families go bankrupt when faced with massive hospital bills. Decent insurance is so valuable that people refuse to consider changing jobs for fear of losing coverage.

A recent Gallup survey found that an “overwhelming majority of Americans believe the government is not doing enough to ensure that prescription drug prices and healthcare costs, in general, remain affordable.”

The numbers clocked in at 77 per cent and 74 per cent respectively. That’s three-quarters of Americans who say the high cost of health care is the government’s fault.

Which brings us to the 2020 election, and a very worried U.S. President Donald Trump.

You see, 2018’s midterm elections were all about health care. Exit polls found that 41 per cent of voters said health care was the top issue driving how they voted.

Those are the same midterm elections in which Democrats made huge gains across the board, and won control of the House of Representatives.

So Trump needs to do something, or at least be seen to be doing something, lest he let his eventual Democratic opponent own the issue, all over again.

The Washington Post reports that Trump’s strategy now is to have the administration roll out a new health care proposal every two or three weeks until the election.

In fact, Trump may be willing to move to the left of Democrats, specifically on the issue of sky-high prescription drug prices.

Trump’s Secretary of Health and Human Services, Alex Azar, announced the administration will allow states to import cheaper prescription drugs from Canada — well, sort of.

Azar went on to tell MSNBC that what he was really announcing was a “new historic open-mindedness” to the idea of allowing drugs to be imported from Canada.

What Azar was really saying is that the administration plans to solicit proposals from individual states, pharmacies and wholesalers to see if it can be done.

What he didn’t mention is that the whole plan is based on the assumption that Canada would allow prescription drugs to be sent across the border, and that the massive American pharmaceutical lobby wouldn’t tie the whole proposal up in court.

In other words, it’s not happening anytime soon, if it ever happens at all.

“Trying to make prescription drug prices lower is a great campaign talking point for anyone who can achieve it,” says Capri Cafaro, who teaches comparative analysis of Canadian and American Health Policy at American University, adding, “I think that shouldn’t be lost on this conversation.”

Even if the idea is purely aspirational — all talk, no action — Trump will be left with something to campaign on, giving him a chance to own, or at least talk about an issue that voters care about.

Trump also knows he cannot claim exclusivity in this fight. Democrats are all over this file too. Presidential candidate Bernie Sanders recently joined a group of diabetic Americans on a road trip to Windsor, Ont., in search of cheaper insulin.

“Insulin, is sold here in Canada for one-tenth the price that it is sold in the United States,” said Sanders to a cheering crowd outside a Canadian pharmacy. “It’s collusion, it is corruption and it is greed,” he argued.

Democrats have it easy. Their base wants this fix. There are no votes to lose, especially over the idea of lowering prescription drug prices.

But Trump, in his desire to find a winning issue with the electorate, is about to run up against his own party.

Drug price reform is the first stop on the long road to reforming America’s health care system.

There’s a good chance Republican lawmakers, facing pressure from the pharmaceutical lobby, may try to block any measure to import prescription drugs.

The odds are equally good that some Republicans will reject the idea of interfering in a free market on principle alone.

That would effectively put Trump at odds with his own party heading right into an election.

But what other choice does he have?

His approval rating is stagnant. He won the 2016 election by the slimmest of margins in just three states.

He needs something to drive people to vote for him again. By taking up the health care fight, he might have found a winning issue.

Jackson Proskow is Washington Bureau Chief for Global National.

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