Most Democrats agree (I know I do) that the effort to make adequate and affordable health care accessible to all Americans was morally correct; they believe that the health reform bill enacted last spring was a major legislative accomplishment attained against huge obstacles; and they hope that the health care bill enacted last spring eventually will make coverage all but universal while reducing costs below what would otherwise have been their trendline. There is debate, however, about the near-term political impact of the health-reform effort—and two surveys released this week have brought the consequences into greater focus.
The bipartisan Democracy Corps/Resurgent Republic survey found, as have others, a large drop-off in support for Democratic candidates among Independents—13 points since 2008, and a startling 19 points since the previous midterm election in 2006. The survey also found some clues as to why this happened. By a margin of 60 to 34, Independents endorsed the proposition that “government is doing too many things better left to businesses and individuals,” and rejected the claim that “government should do more to solve problems and help meet the needs of people.” When asked whether they favored or opposed the president’s health care plan, 51 percent of Independents registered their opposition while 39 percent indicated support. The difference in intensity between these two groups of Independents was startling: 43 percent were strongly opposed to the plan, versus only 18 percent who strongly favored it. (In the electorate as a whole, strong opponents constituted 44 percent of the total, strong proponents only 24 percent.) Looking forward, 53 percent of Independents favor repealing and replacing the law (and 43 percent strongly).
I turn now to the November edition of the Kaiser Health Tracking Poll, widely regarded as the gold standard on this issue. Let me begin with some basics. When respondents were asked right after the election whether they and their families would be better off, worse off, or unaffected by the new health-reform law, only 25 percent said better off, the lowest level recorded since tracking began early in 2009. When asked whether they thought the country as a whole would be better off, only 38 percent answered in the affirmative, also a new low. And consistent with the DC/RR survey, Kaiser found that 56 percent of voters favor repealing part or all of the law, compared to only 36 percent who want either to leave it alone or to expand it. Among the Independents in the Kaiser survey, 44 percent had an unfavorable view of the health reform law (32 percent very unfavorable) versus 37 percent favorable (only 13 percent strongly so). As with the DC/RR survey, Independent opponents enjoyed a considerable edge in intensity over supporters.
When asked an open-ended question about the factors that had the biggest influence on their votes, 17 percent of respondents named health care. Of those voters, 58 percent had an unfavorable view of the health-reform law, 58 percent thought it would make the country worse off, and 56 percent thought it would leave them and their families worse off. Not surprisingly, health care voters went for Republican over Democratic candidates by a margin of 59 percant to 35 percent. (Non health-care voters were divided 44 percent to 44 percent.)
But why do these respondents oppose the health care bill? There's been debate about whether they're unhappy about the content of the bill or, rather, because of its symbolic linkage to the general direction of affairs in Washington, D.C. The Kaiser survey probed this question in depth. Among voters opposing the health reform law, 45 percent said their disapproval was rooted more in the specifics of the bill versus 33 percent who emphasized its connection with the ills of national politics, and 14 percent who cited both equally.
Putting all these data together, it is hard to avoid the conclusion that the health-reform bill had an independent impact on Democrats in the midterm election, reducing their support below the level to which the economy alone would have depressed it. A back-of-the envelope calculation suggests that health care voters contributed about 10 percent points to the Republicans’ share of the vote and only 6 percent to Democrats—a gap of 4 percentage points. No doubt a more sophisticated statistical analysis (which I hope someone will perform) would refine this estimate. But it is unlikely that this analysis would come close to eliminating the independent effect of health care on the outcome of the election.
Does this mean that undertaking health care reform in the midst of a major economic crisis was a mistake? Not necessarily. But proponents of that choice should acknowledge that it entailed significant political costs—and that it may take a painfully long time to reverse them.