With Republicans poised to capture control of the House, the future of the historic health care reform legislation passed earlier this year grows increasingly uncertain. A new Harvard poll of registered voters documents just how highly partisan the debate over health care reform has become among those who expect to vote in the midterm congressional elections next week. Eight out of 10 of those who intend to vote Republican oppose the health care bill passed earlier this year, and seven out of 10 of them want it repealed or substantially dismantled. And yes, the flip side is also true--more than seven out of 10 voters likely to vote Democratic favor the reforms powered through by the Democrat-controlled Congress and signed into law by President Obama on March 23.
"If Republicans regain the House, it will be seen as a mandate from those who voted for them to roll back or replace the health reform bill," said Bob Blendon, a Harvard School of Public Health professor and colleague who I caught up with by telephone yesterday. His latest public opinion poll, released late Wednesday as part of a larger analysis in the online New England Journal of Medicine, surveyed a national representative sample of 938 registered voters between October 1 and 12. Blendon and Harvard research scientist John Benson also did a comprehensive analysis of 17 independent polls conducted this year, most in the past two months.
"We're caught in the polarization of this issue," with the most partisan voters and candidates moving ever further apart, said Blendon, a polling guru who has been tracking public opinion on health care since the Clinton Administration. News accounts, such as the New York Times story Wednesday about the congressional race in Charlottesville, VA, show the Republican "playbook" for the 2010 campaign making health care a prominent issue in many House and Senate races by "largely keeping Democrats on the defensive about the Obama presidency's signature domestic achievement." A recent Pew Research Center-National Journal poll found that more than seven out of 10 responded that a congressional candidate's position on the health care law will play a role in how they vote, with the expected partisan divide among the two major parties and independents far more split.
Ironically, despite the partisan political fur flying among Democratic and Republican candidates, Blendon said the polling shows that overall "slightly more people are in favor of implementing the bill than not ... In terms of the bottom line, the country is about evenly divided." As was the case when the bill passed, many polls show that a majority of Americans neither favor nor oppose the federal health care reform law. The October Harvard poll found that 41 percent of registered voters say they are for repealing or dismantling it, while 49 percent of them support implementing or even expanding the law.
Expanding it? Huh? Apparently ignoring the current political reality--and the pundits--nearly one-third of registered voters still think Congress should do more by passing changes to increase the government's role in the health care system, perhaps with a public insurance option or more cost controls. And among those who expect to vote Democratic, nearly half support a bigger program (which may well be a good idea, but it surely ain't gonna happen with so much anti-government sentiment gathering steam!).
The economy and jobs are obviously at the top of voter concerns in this election, but the Harvard study noted that "polls suggest that health is an important but secondary voting issue in this election." While about six out of 10 Americans polled say that the economy or jobs would be extremely important to their voting decision, more than four in 10 said the same about health care or health care reform (on the same order as concern about taxes). Concern about the deficit and federal spending fell in between. But voters have a way of linking these things together, particularly those voters who don't like the health reform bill. The Harvard poll found that three-fourths of those expecting to vote Republican think that the economy will be worse off because of the new law, compared to only about 10 percent of Democrat-leaning voters. About 40 percent think the opposite, that the economy will be better off because of the health law, while half of those voting Democratic think it won't make much difference one way or the other to the economy.
And of course, some provisions are wildly popular, including tax breaks for small businesses, expansion of the Medicare prescription drug benefit, and requiring coverage for all insurance applicants, regardless of preexisting conditions. Despite the widespread "repeal" rhetoric, Blendon and others point out that even if Republicans should gain control of one or both houses of Congress, outright repeal of the bill's major provisions won't happen, given President Obama's veto power.
But the complex provisions of the legislation, which will be phased in over several years, provide multiple opportunities for the next Congress to take another whack at the vulnerable bill. Major provisions could effectively be cut back or gutted if Republicans were to succeed in substantially cutting back annual federal appropriations needed to implement key provisions of the bill, perhaps as part of an effort to reduce the deficit.
"Implementation could be substantially reduced," said Blendon, making it harder to reach the universal mandate requiring individuals to have health insurance if subsidies are cut back that are needed to make that happen. "This could reduce the scale of coverage and the time schedule for implementing the law," he warned.