Washington, DC – The Patient Protection and Affordable Care Act – the ACA, or, to its detractors, “Obamacare” – is nearly two years old, but the controversy surrounding it continues. On March 26, the Supreme Court will begin oral arguments about the constitutionality of several of its key provisions, including the individual mandate, which requires that all Americans have healthcare insurance. House Republicans are seeking to capitalise on renewed attention to the ACA by pushing to eliminate its fabled “death panel”, formally known as the Independent Payment Advisory Board.
Republicans have reason to believe their efforts will pay dividends with voters: A February USA Today/Gallup poll found that 53 per cent of respondents in battleground states believed the healthcare law was a “bad thing”. Although Democrats quickly dismissed the poll, it raises the question: Will Obamacare actually hurt his re-election bid?
The 2010 election certainly provides Democrats cause for concern. Although Democratic incumbents in Congress were already vulnerable because of the weak economy and their party’s relatively unpopular president, those who supported healthcare proved especially vulnerable. In research I conducted with several other political scientists, we found that support for health care cost Democratic incumbents about 6 points at the ballot box. This effect occurred largely because independent and Republican voters came to perceive Democratic supporters of the ACA as more liberal – and in this case, too liberal.
What about in 2012? Here, there is less reason to suspect that healthcare reform will be consequential. Support for the ACA is already polarised along partisan lines. In a Kaiser Family Foundation poll conducted in January, 62 per cent of Democrats supported the law compared to 12 per cent of Republicans.
Republican opposition appears more intense than Democratic support, but few Republicans are going to vote for Obama anyway. As political scientist Jonathan Bernstein put it, “There’s never been any real question about whether Republicans would be unified against Obama this fall – no matter what he did or does.” And even Democrats with reservations about healthcare reform are likely to end up supporting Obama. Partisan loyalty in presidential elections is very high and has been increasing.
What about among independent voters? Although few Americans, and even fewer actual voters, are truly independent, in a close election their choices could be decisive. But whether healthcare will affect their votes depends on several things.
For an issue to influence votes, people first need to have a real and relatively stable attitude about that issue. This allows voters to ask, “Is this candidate’s position similar to or different from mine?” Without a real attitude, voters sometimes end up simply adopting the position of the candidate they favour. When that happens, positions on the issue will appear to guide voting decisions, but in reality voting decisions are driving issue position.
Given the stability in polling on healthcare reform, this first condition would seem to be met. But it’s debatable how solid opinions really are, especially among swing voters. Polling has repeatedly found that many Americans do not know about the ACA’s key provisions; in fact, their knowledge may be declining.
When presented with pro and con arguments about the details of the ACA, many people change their minds. For example, in a December 2011 Kaiser Family Foundation poll, opinions toward the individual mandate became anywhere from 28 points more supportive to 16 points more opposed, depending on which argument respondents heard. The presidential candidates may thus be able to shape opinions on healthcare, instead of opinions on healthcare shaping views of the candidates.
But presuming that attitudes toward healthcare reform are fairly stable, there is another important step: Voters must perceive some difference between the candidates’ positions. Otherwise, the issue doesn’t help voters choose between them. Consider Obama and Mitt Romney. At the moment, only 44 per cent of voters (and 42 per cent of independents) say that Obama’s and Romney’s “views on healthcare policy” are very or somewhat different. The rest believe their views are similar (see Obamneycare?) or simply do not know enough to answer.
“When the votes are counted, we may find that ‘Obamacare’ was more a sideshow.”
The campaign could easily change this by clarifying the candidates’ differences. But if Romney is the nominee, that task is complicated by his support as Massachusetts governor for a similar health care reform plan. Although the Massachusetts healthcare reform is fairly popular in Massachusetts, most other Americans – somewhere between 60-70 per cent – say they know little about it. Obama would have ample opportunity to persuade swing voters that there is little difference between Romney and himself.
Finally, even if voters have an opinion and perceive differences between the candidates, healthcare may not affect their votes if other issues are more important. Although some voters report that the ACA will influence their vote, these responses are not necessarily meaningful. Research in psychology and political science has shown that we are not very good at reporting the reasons for our choices.
More diagnostic is what voters say when asked whether different issues are important problems. Here, concerns about the economy and unemployment dominate the agenda. In a recent New York Times/CBS News poll, 47 per cent named the economy or jobs as the issue they most wanted the presidential candidates to talk about; only 9 per cent named any topic related to healthcare. Even though the economy is arguably improving, it may remain so salient that issues like healthcare never emerge from the background.
Between now and Election Day, there will be many confident claims about how health care will matter to voters. No doubt Democratic and Republican leaders will each argue that the issue helps their party. But when the votes are counted, we may find that “Obamacare” was more a sideshow.
John Sides is Associate Professor of Political Science at George Washington University, and a contributor to The Monkey Cage, a blog about politics and political science.