On the number one issue on Floridians’ minds Ron DeSantis still is mostly mute

There are big differences between Andrew Gillum's and Ron DeSantis' proposals to improve Floridians' access to health coverage and control health costs, and it is extends well beyond DeSantis opposing and Gillum supporting Medicaid expansion in the Sunshine State.

For starters, Democratic gubernatorial nominee Gillum has a healthcare plan.

Republican gubernatorial nominee DeSantis does not. At least none he is ready to talk much about three weeks before Election Day with tens of thousands of votes already cast.

This is striking for several reasons.

One, DeSantis and his running mate Jeanette Nunez have been saying for more than a month they were just about to release their health care plan.

Two, Gillum is making healthcare a central part of his agenda, even if his expanding Medicaid and "Medicare for all" proposals have a snowball's chance in Boca of getting through Florida's Republican-dominated legislature. Democrats are attacking DeSantis as a threat to voters' access to healthcare, and the Republican nominee is barely pushing back.

Three, health care is about the most important policy issue on the minds of Floridians. Look at Google's analysis of the most searched political topics in Florida over the past week. In more than 60 of 67 counties, health care was number one:

Similarly, an NBC News/Marist Florida poll in late September found health care to be the top issue among both registered Florida voters and likely Florida voters, just ahead of jobs and the economy.

Democrats see a clear advantage over Republicans on healthcare, after years of being pummeled over the Affordable Care Act. In state after state, Democratic candidates for governor and U.S. Senate are airing TV ads accusing Republican opponents of wanting to roll back popular provisions of Obamacare, especially the requirement that insurance companies cover people with pre-existing conditions such as cancer or diabetes.

Rarely, if ever, do the Democrats mention the words "Affordable Care Act" or "Obamacare" in their commercials. Expanding Medicaid polls much better than the Affordable Care Act that made it possible for most states to do it.

"I believe that healthcare should be a right, not a privilege," Gillum says in one of multiple campaign ads that mention health care. "In the state of Florida everyday working people, middle-class people, should not be one illness away from bankruptcy."

Another recent TV ad from the Florida Democratic Party: "They're called pre-existing conditions and everybody knows somebody who has one. But in Congress, Ron DeSantis demanded that any new health law eliminate protections for people with pre-existing conditions. He'd let insurance companies deny them coverage. And when he was asked what cancer patients should do without health insurance, DeSantis said, 'show up to the emergency room.'"

That emergency room comment came in a 2017 CNN interview, where DeSantis said, "If people really need it, if they show up at the emergency room, they do get care."

DeSantis, whose campaign did not respond when asked by email about the status of his health care plan, is in a trickier position than most Republicans when it comes to popular elements of the Affordable Care Act.

He was among the most hard line opponents, a member of the House Freedom Caucus who in 2017 opposed the health care plan backed by President Trump and Speaker Paul Ryan until it included provisions enabling states to obtain waivers to allow insurers to increase prices for people with pre-existing conditions.

On the campaign trail this year, DeSantis has said he would like to see people with pre-existing conditions, but not through the Affordable Care Act that he blames for making costs increase.

"I would certainly support protecting pre-existing conditions but would do it in a way to allow vast majority of Floridians to have access to a competitive private market," he told the the Tampa Bay Times a month ago.

How he would accomplish that and also keep policy costs affordable for people who are't covered through their employer or Medicare remains to be seen, just as paying for Gillum's ambitious health care proposals is unclear.

"Somebody's got to pay for it," said Jay Wolfson, Distinguished Service Professor of Public Health and Medicine at USF. "If I'm going to see you a policy that has no (coverage cap) and guarantees you that pre-existing conditions are going to be covered I'm going to have to have one hell of a large population that includes people who are not as sick as you. Because if they're all very sick people it's going to be a very expensive policy."