The health care stalemate
One full year after President Obama signed the Affordable Care Act (aka the health care bill) into law, public opinion on it has been remarkably unaffected by the massive amounts of spin put out by both sides over the last 365 days.
A Kaiser Family Foundation survey taken this month found the numbers on health care basically unchanged. Gallup finds the public almost evenly divided; again, barely different from their 2010 numbers. Polls generally show a slight tilt against the law, with Republicans more enthusiastic in their opposition than Democrats in their support.
“I think everything that could have been tried has been tried,” said William Galston, a former policy adviser to Bill Clinton. “The debate next year will not be so much an effort to get people to change their minds as to mobilize people whose minds are already made up one way or another to vote.”
So, how did we get to this political stalemate on health care?
After privately conceding that they had lost the message war during much of the process-dominated fight surrounding the health care law, White House officials predicted that health-care legislation would become more popular once it was passed, arguing that the ugly congressional battle had colored peoples’ views. The law did get a post-passage bump in polls, with slightly more people in favor than opposed.
But the administration’s longter-term education effort around the bill hasn’t done much to build momentum for the law. About half of people are still confused by it, with 52 percent of respondents telling Kaiser that they don’t still don’t have enough information about how the legislation will impact them personally. Lack of understanding is higher among the uninsured and low-income populations, groups that the White House repeatedly argued would benefit most from the law. Meanwhile, a new Gallup poll finds that 58 percent of Americans are still greatly concerned about the availability and affordability of health care.
Not all Democrats think the PR battle is over. “It’s still a difficult sell, and there’s work to do and we’re doing it,” said David DiMartino, a Democratic strategist. “With an effort, over time I think support will go up.” He argued that when pollsters explain individual provisions of the bill, support goes up — suggesting there’s room for overall public opinion to improve with education. `
One heartening thing for the White House is that while public opinion is static on health care, there seems to be little appetite for a repeal effort that some Republicans are championing. In the Kaiser poll, only 39 percent would like to either repeal the law or repeal and replace it with a Republican alternative.
“One of the challenges for Republicans is pretty straightforward — to come up with the replace part,” said Republican pollster David Winston. “People are sort of waiting to see what it is they offer.”
For many Republicans, keeping opinion of the law divided might be victory enough. Even if they can’t repeal the law, they have kept Democrats from getting any political benefit from its passage. And opponents argue that disapproval is trending upwards. Republican pollster Whit Ayres pointed to the Pollster.com graph of poll averages from the past two years:
Some independent pollsters, on the other hand, argue that the gap in reliable surveys is so small that the shifts are insignificant. Health care also churns many Republican base voters into a furor. The party was able to capitalize on that energy boost in races across the country in 2010, a blueprint GOP strategists hope to follow again in 2012.
“One could argue that the economy was predetermined when he came into office,” said Republican pollster Frank Luntz. “Health care reform was all Obama and congressional Democrats. I think health care is going to be the illustration of whether you like or dislike the change that Obama brought.”
What’s clear from the mounds of data that have come out to mark the one year anniversay of the bill’s passage is that opinions on health care aren’t likely to shift much by the 2012 election — particularly since many of the larger pieces of the legislation don’t go into effect until 2014.
When that happens, opinion might actually evolve as voters will be able to assess the full impact of the law (or at least close to it). Until then, however, the political debate over President Obama’s health care law is largely settled. And that’s a good thing for Republicans.