I’ve been researching to try to find out exactly how many Democrats vote from abroad. In 2018, the Federal Voting Assistance Program (FVAP) released its biennial Overseas Citizen Population Analysis (OCPA) estimating there were 3 million U.S. citizens of voting age living abroad in 2016 who cast approximately 208,000 ballots. The overseas voter turnout of approximately 7 percent compares to a domestic turnout of 72 percent.
That doesn’t sound as though the overseas voters have much clout. However, in the Democratic primaries, the voters have the choice of voting in their home state or else as a member of Democrats Abroad voting in the DA primary. Democrats Abroad are treated as a “state” for the purpose of the presidential primary. DA gets 12 at large delegates, 1 pledged party leader and elected official (PLEO) delegate, and 4 superdelegates. By way of comparison, Guam, the Northern Marianas, and American Samoa each get 6 pledged delegates and 5 superdelegates. Hawaii gets 22 pledged delegates and 9 superdelegates.
In 2016, with the same number of pledged delegates at stake, Bernie got 69% of the vote and 9 pledged delegates while Hillary got 31% of the vote and 4 pledged delegates. A candidate gets only get a share of the delegates with a minimum of 15% of the vote.
The DA 2016 vote shows that, at least among Democrats, the progressives have a substantial 2/3 of the vote. There are no similar statistics for Republicans since they do not have a separate “state” for expats. But if the Democratic nominee were to espouse Medicare for All, No Matter Where expat Republicans might vote Democratic.
Let’s suppose that Bernie was to support Medicare for Ex-Pats. “Most Americans who receive Medicare do not realize that they cannot get those benefits if they live outside the United States. Basically, Medicare is geographically limited. The program is only good (for the most part) within the borders of the United States. If you live outside the United States more or less permanently, you aren’t covered unless you have some way of getting back inside relatively easily.
“What’s the point of this exclusionary rule? While it is not expressed specifically, the reason for the rule is plain: the government wants retired persons with their disposable income to remain within the American economy. And, of course, the American medical establishment wants older patients to remain within their economic grasp.
“The negative part of this plan is that the cost of medical care within the United States is generally much more than medical care outside the United States. If retired people were able to receive coverage outside the United States, their care would cost the Medicare system less than if the same care were achieved within the United States. Moreover, those living outside the United States would avoid the substantial cost of traveling back to the United States in order to get their healthcare paid by Medicare.”
So if Bernie promised to re-write the law, he would doubtless get at least 69% of the vote in the DA. But don’t forget that expats also vote in state primaries. Even in general elections, expats have had a low vote. But the Medicare issue hits them all in the same place: the pocketbook. If 7% of the potential voters are 208,000 (see above), it’s not hard to believe that they would go up to 50%, which is 1.456 million. Republicans would doubtless vote more Democratic, too.
There’s really no downside politically. At the moment, there are a considerable number of expats who take an expensive trip to the U.S. in order to use their Medicare. If they could use Medicare abroad, more of them would use Medicare, but the cost of foreign doctors is about half of what American doctors charge – so things would doubtless balance. Yes, the knee-jerk reaction of health insurers would be to oppose the idea, but once they looked at the figures, they would probably back off.
At the end of the day, Medicare for All, Everywhere, could be adopted with real benefit to expats but little impact on anyone else. Politically, though, it could only help those who supported the idea.
Try it, Bernie. You’ll like it. (P.S. I’ve sent a copy of this article to him, to AOC, and Rep. Jayapal. If I get no response, that’s really terrible).