Engaging confidently on health care reform

Republicans will run on health care reform in 2014 and 2016, so get used to it. But do not believe that it will give them a better chance of securing their seats or the best shot at putting competitive Democratic seats in danger.  Democrats in the most rural and the strongest Romney seats will have to be inventive as usual, but Democrats have a lot to say on health care: fix it, don’t repeal it, don’t put the insurance companies back in charge and take your hands off Medicare.

Health care is just not a wedge issue that threatens to change these races very much – as we saw in the 2012 elections where Republicans played out this strategy.  This is basically a 50-50 issue in the battleground districts and the country, and it remains a 50-50 issue after voters have heard all of their toughest attacks, including one on the role of the IRS in the new system.  These attacks have power, and it is important to engage on the issue.  But there is no reason to think the debate changes the dynamic in these competitive House seats: we actually show Democrat members gaining on handling health care reform in their own seats. 

Why is it that the popularity of the Republican Congress keeps going down as the Republicans vote now 40 times to repeal the Affordable Care Act, despite that the law is not popular with the public?  We suspect because the House Republicans are associated with gridlock, extreme partisanship, and intense anti-Obama sentiment; because voters have other serious priorities and their steadfast focus on health care alone says Republicans are not focused on them and their issues; because Democrats are more trusted than Republicans on health care; and most important because voters do not want to repeal the law.  The more voters hear “repeal,” the less they are interested in voting Republican. 

We know Republican base voters feel intensely about health care reform, but voters rank “government takeover of the health care system” pretty low as a concern about Democrats in Congress. 

These results suggest Democrats should engage the issue with some confidence — they can undermine the Republican attacks and indeed gain an advantage by educating the public on the reforms.  

Democracy Corps released the first memo on the Congressional Battleground several weeks ago. We felt the health care issue merited a deeper look with this off-year electorate, 86 percent of which is white and one-quarter seniors.[1]

Key findings:

  • Don’t repeal it, fix it – and don’t put insurance companies back in charge.  Republicans are out of touch on repealing health care reform, apparently their top priority in Washington. That is true in the Republican battleground seats and more so in the Democratic.  Virtually all polls say majority of voters are against repeal – and Democrats should hit the Republicans on this.  The main reason?  They don’t want to put the insurance companies back in control of your health care.
  • Voters do not want the insurance companies calling the shots on women’s health: they do not want to hand the reins back to insurance companies who can discriminate against women and those with pre-existing conditions.  The new law makes health care more affordable for the middle class and can be improved to help small business – and voters respond.
  • Seniors now split on whom to trust on health care reform: take your hands off of Medicare.  Seniors broke for Republicans in 2010 – 38 to 59 percent according to exit polls – when Republicans tried to make health care front and center.  Now, seniors are divided between Republicans and Democrats on healthcare.  That could be a fundamental break going into this election, which is very likely related to proposed Medicare cuts and the Ryan budget.
  • Republicans have strong attacks.  To be sure, given voters’ uncertainty and confusion about the law, Republican attacks against Democrats in the health care debate are strong and get a serious hearing. In this survey, the idea of the IRS collecting penalties and fines associated with the law raise serious doubts for nearly two-thirds of voters.  Worries about new taxes and higher deficits also raise significant doubts.
  • But Democratic attacks are equally strong.  Democrats have strong complementary attacks on Republicans for putting insurance companies back in charge, enabling them to refuse coverage on pre-existing conditions and discriminate against women.
  • Tough health care attacks from both sides leave trust on health care reform where it started.  In short, health care is no game-changer and Democrats do best when they engage on confident ground.  After the attacks in this survey, Democrats come out with a slight edge (44 to 40 percent) in the most competitive Republican seats.  And in the Democratic seats, voters cement their preference for the Democrats’ approach to health care reform, 46 to 39 percent. 

Voters not interested in repeal

Voters would rather see the law implemented and improved than watch Republicans take another vote on repeal.  In the most competitive Republican districts, by an 8-point margin (50 to 42 percent), voters say the law should be implemented and improved rather than repealed.  Even in the second tier of less competitive districts, as many voters want to see the law implemented and reformed as want to see it repealed.  

Voters have many bigger worries about prospect of total government control of health care

In the most competitive 24 Republican seats, a government takeover of the health care system ranks fifth on a list of concerns about a Democratic Congress, well behind concerns about spending, entitlements, and gun control.

Strongest Democratic attacks: start with put insurance companies back in charge

As shown in the graph below, the strongest attacks on Republicans focus on their putting the insurance companies back in charge and giving them the power to refuse coverage to people based on pre-existing conditions or drop their coverage if they get sick.  The attack is particularly strong when focused on discrimination against women.

These attacks were very strong among unmarried women, seniors and voters in suburban districts.  Suburban voters reject handing the reins back to insurance companies; this attack raises serious doubts for more than two-thirds (68 percent) of suburban voters (35 percent very serious doubts).  This also raises serious doubts for near 80 percent of unmarried women and over two-thirds of seniors.  This attack, as well as the one focused on discriminating against women, even raises serious doubts for nearly two-thirds of white non-college voters.

Democrats have strong complementary positive case to make for health care reform

There is a great deal of legitimate uncertainty about how the implementation of the ACA will fare; yet, there is an important role for Democrats in both defending the law based on its benefits, particularly to women, and the fact that we do not want to return to the days of insurance companies determining eligibility for coverage or charging differential rates to men and women.

This argument is among several strong cases Democrats can make on the benefits of health care reform in their districts.  Two-thirds of voters in these seats respond favorably to arguments on the benefits of the health care reform law for women, as well as focusing on improving the law and working to lower costs for the middle class.  But the women-focused message really has the most intensity, although all are strong.

Emphasizing the law’s benefits for women is the strongest message for many key groups—including voters in suburban and rural districts, unmarried women, seniors, and white non-college-educated voters.  Half (51 percent) of women – including white women — feel much more favorable toward the health care reform law after hearing that argument (71 percent total more favorable).

Unmarried women respond very strongly to the moral argument for the law, which states, “Passing health care reform was the right thing to do because it will provide affordable coverage for millions who didn’t have it before.”  Two-thirds of unmarried women (65 percent) feel more favorable toward the law based on this argument (46 percent much more favorable) and, surprisingly, 64 percent of white seniors feel more favorable toward the law based on this argument (44 percent much more favorable). 

An argument focused on the law’s benefits for small businesses lacked the same intensity as the others mentioned, but is strong among seniors and white non-college voters.

Republican attacks are serious but do not impact when Democrats engage health care

Reflecting the contested nature of this debate, Republicans also have powerful arguments rooted in the alleged tax increases and increases in the deficit.  

Despite the strength of the GOP attacks, after the debate, Democrats maintain an advantage on health care in the 24 most competitive Republican seats. Democrats actually gain ground in their own seats, going from a 3-point lead (42 to 39 percent) to a 7-point lead (46 to 39 percent) on this issue.

Maybe more importantly, Democrats maintain their standing with seniors and white seniors in the 49 Republican seats.  Before the health care debate, seniors are split on health care at 37 percent.  After the back-and-forth, seniors favor the Democratic approach to health care reform by 2 points, 40 to 38 percent.  White seniors, who begin the debate marginally favoring Republicans, 37 to 38 percent, end the debate favoring Democrats, 40 to 39 percent. 

Impact of implementation

In short, we do not know how implementation plays out, though most of the news on costs has been positive.

We may also learn from history.  Our polls from before and after the implementation of Medicare Part D, the prescription drug benefit for seniors passed under George W. Bush, indicates opinion will likely evolve once implementation begins in earnest.  While there was a lot of advertising on behalf of the new plans, opposition collapsed, particularly among seniors, within three months of the new law taking effect. There could be a similar drop in opposition as the law is implemented, which would change the dynamics of the issue. 

[1] This memo is based on a unique survey of 1,250 likely 2014 voters in the 80 most competitive Congressional districts in the country (750 interviews in 49 Republican-held battleground districts and 500 interviews in 31 Democratic-held battleground districts), conducted by Greenberg Quinlan Rosner Research for Democracy Corps from June 6-12, 2013.  Some questions were asked only in Democratic-held or Republican-held seats.  For questions asked of all respondents, the margin of error = +/- 2.77% at 95% confidence. For questions asked just in Republican districts, the margin of error = +/- 3.58% at 95% confidence.  For questions asked in just Democratic districts, the margin of error = +/- 4.38% at 95% confidence.

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