Although the politics of Obamacare have cooled down this year — and even with declining interest in this year's midterms — the upcoming election will have a bigger influence on the direction of health care than you may think.
That's the major takeaway from a new Harvard University analysis of 27 public opinion polls from 14 organizations on President Obama's signature law. The analysis, published in the New England Journal of Medicine, offers a pretty comprehensive view of how the Affordable Care Act — less than a year into its major coverage expansion — will shape the agenda for the next Congress and potentially the 2016 presidential race.
Even Republican Senators are now talking down the possibility of full repeal. Instead, GOP leaders are talking about more targeted efforts to scale back the law, like weakening its coverage mandates and reducing subsidies for private insurance sold on the ACA's marketplaces. Democrats, meanwhile, are promoting "fixes" to the law, like cheaper insurance offerings and efforts to close coverage gaps. And if they maintain control of the Senate, they might try to pour more resources into supporting the law.
The Harvard researchers set out to answer several major questions about the public's attitude toward the law and what that means going forward:
How important is ACA/health care as a voting issue?
Health care ranks third among likely voters' most important issues in this election, according to polling from ABC News-Washington Post and CBS News-New York Times. But both polls found likely voters were three times as likely to cite the economy as their top issue. "Even though health care care is only one of a number of top issues in the 2014 election, the majority party in Congress will claim it has a mandate for its priorities on what is still a controversial national health care issue," write Harvard School of Public Health's Robert Blendon and John Benson, from the John F. Kennedy School of Government.
Are voters more or less likely to vote for a congressional candidate supporting the ACA?
Most voters say they’re less likely to vote for a congressional candidate supporting the health-care law (40 percent), compared to those who are more likely to (31 percent), according to a September HSPH–Social Science Research Solutions poll. There was naturally a partisan split here, but Republicans said they were less likely to vote for a candidate supporting the ACA (69 percent) than Democrats said they were more likely to vote for a candidate supporting the ACA (60 percent). About one in four voters said the ACA won't factor into their vote at all.
Do voters think it's the government's responsibility to make sure citizens are insured?
This has been a pretty big shift in just the last seven years, the Harvard researchers write. Support of this view, according to Gallup polling, slipped from 64 percent in 2007 to 47 percent to earlier this year, as the coverage expansion took effect. Gallup also finds the public has generally soured on the government's ability to fix domestic problems, like health care. The public trust has slipped from 51 percent to 40 percent over just the past two years.
How does ACA support vary according to voters' partisan affiliation?
Most Republican voters still favor the unrealistic option of full repeal (56 percent), and another 27 percent want to see the law scaled back, HSPH-SSRS polling found last month. Meanwhile, 44 percent of Democrats want the ACA's scope expanded and 30 percent say the law should be implemented as is. This guides just how different the health policy discussion will look depending on which party controls the Senate.
What does this mean for the next Congress?
A Republican Senate, the researchers write, would scale back the law's mandates and taxes, mostly through the budgetary process. They may put up some Obamacare replacement plans, but likely wouldn't pass any. They say if Democrats keep the Senate, they would try to provide more resources for the law, and the political environment would encourage more of the 23 Medicaid expansion hold-out states to opt into the program. And it would give Democrats' 2016 presidential candidates more confidence to push for expanded coverage.