Health Care in the 2010 Congressional Election | Health Policy and Reform
Health Care in the 2010 Congressional Election
NEJM | October 27, 2010 | Topics: Data Watch, Reform Implementation
Robert J. Blendon, Sc.D., and John M. Benson, M.A.
Eight months after the enactment of historic health care reform legislation (the Patient Protection and Affordable Care Act), the country faces a midterm congressional election with all seats in the House of Representatives and one third of Senate seats up for election. The election has significance for health care because most of the provisions of the national reform law do not take effect for years, and some of them could be altered by the next Congress. Such alteration might involve expanding the government’s role in the plan — for example, by adding a public insurance option to compete with those of private insurers — or in the other policy direction, repealing and replacing much of the current legislation before it is implemented. The former possibility has been raised by some leading congressional Democrats, and the latter by leading Republicans.1,2 This partisan divide over the legislation’s future makes the 2010 election highly significant for Americans involved in medicine and health care.
We examined the role of health care in the coming congressional election from the perspective of potential voters, drawing on results from 17 independent polls.
Most of these polls, which have sample sizes of 721 to 2054, report the views of the public as a whole, though others report the views of registered voters or people likely to vote in the election (see Opinion Polls on Health Care and the 2010 Election). Our analysis focuses on six questions: the mood of the country at the time of the election, the potential role of health care as a voting issue, the public’s approval or disapproval of the current national health care reform legislation, what registered voters want the next Congress to do about the legislation, differences in views of the health care law between those who report that they intend to vote for a Democratic congressional candidate and those who say they’ll vote for a Republican candidate, and the implications for health care reform of electing a new Congress controlled by Republicans.
First, regarding the question of the country’s mood, it seems clear that Americans today have very negative views about the general direction of the country, and they express an anti-incumbent attitude toward Congress. As the 2010 congressional election approaches, more than 6 in 10 likely voters (64%) believe that the country has gotten off on the wrong track, while about one third (31%) think the country is headed in the right direction (Bloomberg). In addition, the results of current polling portray the electoral environment as similar to that of 1994 and 2006, when the incumbent party lost control of both houses of Congress. Registered voters’ anti-incumbent mood can be seen in their inclination not to vote to reelect their current congressional representative, but rather to look around for someone else: 55% of registered voters say they are inclined to look around (WP–ABC, September–October), and only 31% say they are inclined to vote to reelect their current representative, a lower proportion than just before the 1994 and 2006 congressional elections (37% each).3 An important sign for the future of the new health care law is that 53% of likely voters believe that if the Republicans become the majority party in both houses of Congress, they could successfully repeal laws that have been passed during the past 2 years (Battleground–GWU–Politico).
Second, polls suggest that health care is an important but secondary voting issue in this election. Asked how important each of several issues would be in their voting decision for Congress this year, more than 4 in 10 Americans (41 to 49%) said that health care or health care reform would be extremely important. The economy or jobs was the issue designated as extremely important by the largest proportion (55 to 62%), and 37 to 51% said that the budget deficit or federal spending would be extremely important in their voting decision (USA Today–Gallup; KFF, October). In addition, 37% pointed to dissatisfaction with government, and 36% to taxes, as issues that would be extremely important in their vote (KFF, October).
More than 7 in 10 respondents (71%) say that a candidate’s position on the health care law will play a role in their congressional vote — and there’s a large partisan division on this question: 67% of Democrats say they are more likely to vote for a congressional candidate who supported the new health care law, and 72% of Republicans say they are less likely to vote for such a candidate. Among independents, a larger proportion say they would be less likely (37%) than say they’d be more likely (29%) to vote for a candidate who supported the new health care law (Pew–NJ, September–October).
Third, more than 7 months after the health care reform law was enacted, a majority of Americans neither favor nor oppose it. Various independent polling organizations have taken varied approaches to this question and have reported a range of results
(WP–ABC, September–October; AP–GfK Roper, September; CBS–NY Times; KFF, October; Pew–NJ, September 9–12). Since the law’s enactment, there has been a huge continuing debate about its potential positive and negative implications. Although support for the legislation may have varied during this period, public support is not substantively different at the time of the election from what it was at the time of enactment (WP–ABC, February; AP–GfK Roper, March; CBS, March; KFF, March; Pew, March) (see Table 1).
Americans clearly have conflicting views about various aspects of the health care legislation and their impact. On the one hand, many elements of the law are highly popular, including the provision of tax breaks for small businesses to make coverage for their workers more affordable (favored by 90% of the public), expansion of the Medicare prescription-drug benefit to fill the “doughnut hole” (favored by 79%), and the requirement that insurers cover all applicants, even if they have preexisting conditions (favored by 58 to 80%).