President Biden is leaning into lowering health care costs as the White House shifts into campaign mode, but the issue is barely mentioned by the gaggle of GOP candidates barnstorming the country.

The Hill reached out to 10 leading Republican candidates about how they would reduce health costs and improve affordability; only former Rep. Will Hurd (R-Texas) responded.

The relative GOP silence has left the White House with plenty of room to tout Democratic efforts, such as letting Medicare negotiate drug prices, capping insulin costs, cracking down on surprise medical bills and “junk” insurance plans.

While more Democrats say they care about health costs than Republicans, the issue ranks high across the political spectrum. 

According to a Pew Research poll released in June, 64 percent of Americans think the affordability of health care is a “very big problem,” second only to inflation as the top-rated issue.

An overwhelming 73 percent of Democrats said health costs were a major concern, compared with 54 percent of Republicans. While still a majority, they ranked health costs behind issues like inflation, violent crime, drug addiction, and illegal immigration. 

GOP pollsters said the relative silence from candidates is not surprising because Republican primary voters have a different set of concerns than general election voters. 

“If it’s not immigration or you know, owning the libs or identity politics, it’s a very narrow view of what issues appeal to Republican voters and Republican primary voters,” said Chuck Coughlin, president and CEO of HighGround, an Arizona-based public affairs firm. 

“If you’re a Republican, what are you going to talk about on health care? You’ve done very little unless you’ve been a vote on one of the Biden [legislative] packages. I just think it’s a huge hole, not surprisingly, in the very narrow repertoire of issues that they focus on,” Coughlin said. 

Even if health costs specifically don’t rise to the top of the list for GOP primary voters, there could still be an opportunity for candidates to seize on the issue, said Jim Merrill, a veteran Republican consultant in New Hampshire.

If a candidate comes up with the right mix of populist economic messaging, they could carve out a unique space in a crowded field, he argued. 

“Could someone distinguish themselves, come up with some messaging around health care reforms and do something that might distinguish them a bit? I think the answer is yes,” Merrill said. “I think given the amount of time we have left and some months ahead here, there’s an opportunity to do that. But I think for now, what you’re seeing is a reflection of where the base electorate is.”

As the Biden campaign for 2024 revs up, inflation and affordability remain dominant concerns among voters. The administration is focusing on pocketbook issues aimed at helping families keep expenses in check and tying health policies to Biden’s economic successes.

At an event in July when he announced the new policies on “junk” plans and surprise billing, Biden rattled off a list of accomplishments he credited to “Bidenomics.”

“The rate of Americans without health insurance is at an all-time low. Premiums for coverage under the Affordable Care Act are $800 less per person than before I took office. And that’s Bidenomics,” he said.

In remarks at a manufacturing plant in Maine late last month, Biden again brought up the need to save Americans money.

“My dad used to say, ‘At the end of the month, the question is: Do you just have a little — after you pay all your bills, do you have just a little breathing room — a little breathing room, a little left over?’” Biden said. “Folks, that’s Bidenomics.”

Republicans in Congress have pushed back on many of the White House economic and health policies, arguing those plans have directly led to higher prices. 

But there is bipartisan recognition among lawmakers about the need to lower health costs, whether it’s by capping the cost of insulin, changing how certain hospital visits get billed or reforming the pharmacy benefit manager industry.

Hurd told The Hill he wanted to promote price transparency across different industry sectors, something Biden and former President Trump have tried to do. 

“We bring down health care costs by using the same principle that brought down the cost of big-screen high-definition televisions — competition. And to have real competition, we need price transparency,” Hurd said.

“Price transparency forces medical providers to compete on cost while empowering Americans to secure the best care for their unique needs at the lowest prices without the fear of surprise medical bills,” he added. 

Still, health care has not been a winning issue for Republicans since the party failed at repealing and replacing the Affordable Care Act, and Democrats used that failure to win control of the House in 2018. 

“I think they’re [Republicans] not going to focus on health in this cycle. They have to some degree given up on health as their issue. They’re kind of now treating it as a loser issue for them,” said Drew Altman, president and CEO of the health policy research group KFF.

The other factor that complicates the Republican response to health affordability is that their voters may not like the solution.

“The concern about health care costs absolutely transcends politics. The willingness to address the issue, the support for measures to address the problem, those tend to be embraced more by Democrats,” Altman said. 

“You either have to unleash market forces, and we’re kind of past that point because the health care industry is so consolidated, or regulate the health care industry. And there isn’t much appetite for either of those things right now,” Altman said. 

The outcomes of presidential elections rarely turn on individual issues, but administration allies believe the White House has a winning strategy tying health care and the economy together.

“Oftentimes, health care has kind of rode its own sidecar. Now, it’s also a key part of the overall economic message for Democrats,” said Leslie Dach, founder and chairman of the liberal advocacy group Protect Our Care. 

But to take advantage while Republican candidates cater to the base, the administration’s message needs to break through.

A KFF poll released Friday showed few adults in the U.S. are aware that the Inflation Reduction Act, a signature achievement for Democrats, is meant to bring down the cost of prescription drugs for people on Medicare — despite Biden signing the law almost a year ago.

“Not enough people know about benefits [of the law]. I think that that’s true,” Dach said. “But it’s all upside for the American people as these things come into play. And for Democrats.”