A Pivotal Political Moment on Health Care

Republicans are running heatedly on health care – repealing “ObamaCare” – and it is a cornerstone of their strategy.  Winning on health care is critical to their motivation and to what they believe is the edge they need to ultimately prevail over Obama and congressional Democrats in November.  This poll suggests that they are right that health care will be a significant factor in the vote, but very wrong on the consequences.  If Democrats take up the debate with confidence—educate voters on the benefits and, above all, denounce the battle to repeal and refight health care—they will win the issue.  Support for health care reform has risen steadily over this year; if proponents engage the issue, it is more likely to help than hurt in November.[1]  

Unmarried women – one of the main beneficiaries of health care reform – and one of the groups most affected by the economic crash—are also politically disengaged.  Their support for Obama now falls short of their 2008 vote by 10 points.  Importantly, they are also the voters who learn the most in this argument.  If Democrats take up health care in a serious way that is both educative and compelling—they are likely to make their biggest gains among these voters.

For unmarried women, the most important reforms in the Affordable Care Act are that health care plans cannot limit or deny benefits for a child younger than 19, that children can remain on their parents’ plans up to age 26, and that preventive care for women must be covered by all new insurance plans.  And the strongest arguments emphasize that repealing the law will mean that insurance companies can go back to charging women higher rates than men and the impact repeal will have on the most vulnerable.  However, while specific benefits to women and vulnerable women are very important to their support, framing health reform as particularly beneficial to women does not make it stronger, even with women and unmarried women.

Pivotal political moment: health care

This poll shows Obama with a 4-point lead, which we believe.  This week the Wall Street Journal showed a 6-point lead and our poll the previous week with Resurgent Republic showed a 2-point lead.  This poll shows Obama at 50 percent – and averaging 49 percent over the last six months.  Obama’s approval has hit the critical 50 percent mark while Romney is stuck at 46 percent.   

This shift in Democratic fortunes since 2010 has been produced by a growing and deepening contempt for everything Republican.  The Democrats’ standing with the public is relatively stable, but the pattern has left a pretty astonishing gap between the parties that is shaping the race, despite the economic slowdown.  It matters that Obama is more favorably viewed then Romney by 11 points (49 to 38 percent); that the Democratic Party is more favorable than the Republican Party by 7 points (40 to 33 percent), and that the Democrats in Congress are more favorably viewed than the Republican Congress by 5 points (36 to 31 percent).   Nearly 50 percent view the Republicans in Congress unfavorably—a net negative 18-point image gap that leaves them particularly exposed.

When we do our regression modeling, not surprisingly the biggest factors are Barack Obama’s job approval and personal thermometer.  The former is stronger, but the personal does matter in predicting the presidential vote.  But nearly as important as both Obama measures in predicting the vote are feelings toward Romney, measured by the thermometer (38 percent warm and 46 percent cool).  Feelings about Romney are more important than party identification as a predictor right now. 

But the problem for Republicans is that support for health care reform has grown steadily – to the point where the law produces equal warm and cool reactions, though intensity is against it.  In this survey, the public splits evenly on favoring or opposing the new law.  So, health care is a voting issue, but we do not yet know how it finishes.

Unmarried women: the unfinished story

There remains an enthusiasm gap among the Rising American Electorate—the unmarried women, youth, and minority voters who were key to Democratic victories in 2006 and 2008.  Among all likely voters, 41 percent say they are following the election very closely; by contrast, just 29 percent of unmarried women and young voters are closely following the presidential election—a 12-point engagement gap.

Correspondingly, the likelihood that these voters will turn out in November lags behind the average.  Among all likely voters, 82 percent are classified as most likely to vote.  Among seniors, that number climbs to 89 percent.  By comparison, less than three quarters (73 percent) of all voters in the Rising American Electorate are most likely voters, and that number drops to 71 percent among unmarried women.  This is striking compared to even just four years ago.  Unmarried women accounted for almost half—48 percent—of the increase in ballots cast between 2004 and 2008, even though they represented a quarter of the voting age population. 

In 2008, 70 percent of unmarried women voted for Barack Obama, giving him a 40-point margin among this group. While unmarried women still overwhelmingly prefer President Obama over his Republican challenger, Obama currently holds 60 percent of the vote among unmarried women, a 10 point drop since 2008.  Obama’s margin has been decimated with this group; he now leads Mitt Romney by 27 points—13 points shy of his margin against McCain in 2008. Whether Obama can consolidate and hold his lead depends on unmarried women who could comprise a quarter of the electorate.

It is critical that Democrats get these voters right. We know from our recent survey on the Ryan budget that these voters are deeply moved by the right issues. On that survey, unmarried women moved dramatically after learning what the Republican budget would do to the most vulnerable—Obama’s margin against Romney increased by 10 points and his total vote among unmarried women increased 6 points, from 63 to 69 percent (in other words, back to the support he enjoyed among unmarried women in 2008.)

On this poll we find that unmarried women learn the most about health care and shift the most on that it will make it better.  They are the audience for the health care debate.

Unmarried women and the health care reform law

Support for the health care law among unmarried women is much higher than average, but not nearly as it should be (56 percent favor, 34 percent oppose).  They do not enter this election bringing support in margins that might drive a greater vote.

Consider the following:

  • Fully 25 percent of unmarried women ages 18-64 are uninsured, compared to 15 percent of married women.[2]
  • Three quarters of married women have employment-based health insurance, compared to half of unmarried women.[3]
  • Because unmarried women mostly rely on a single income, their coverage is uniquely vulnerable to recessionary pressures.
  • Unemployment among single mothers increased by 40 percent last year.[4]
  • More than four in ten (43 percent) of unmarried mothers reported not filling a prescription because they could not afford it last year.[5]

In light of this reality, what is most striking is that only 34 percent strongly believe the health care will affect them, 9-points lower than voters overall.  Only half (51 percent) of unmarried women believe they are better off under this legislation. 

That is the great irony.  Indeed, right now, those most critical of the law—Republicans and conservatives—are the ones who think they will be impacted.  While just 58 percent of unmarried women say they will be affected by the law, 72 percent of Republicans—and 76 percent of conservative Republicans—say they will be affected. A continuing debate on the law could well change that.

This reflects progressives’ clear failure to convey to these critical voters the importance of this law in their own lives. At the outset, just 51 percent of unmarried women say they will be better off under the Affordable Care Act—19 points more than those who believe they will be worse off.  Over the course of this survey—after hearing a Republican statement against the health care law, facts about its key reforms, and an even debate on both sides, women shift dramatically.  The initial 19 point margin increases to 29, with 58 percent saying they will be better off. 

This represents a fairly dramatic two-to-one shift—the kind of energy that has the capacity to move these voters into the electorate and turn out for Democrats.

The health care debate: battles to a draw

We tested the Republicans’ strongest attacks—the arguments they are currently using to advocate repeal. Their strongest attacks assert that the health care law will decimate Medicare, make it difficult for small businesses to create jobs, and that the federal government is now in the business of telling people what to do with their own money.  

This is the nuclear arsenal in their campaign to repeal ObamaCare.  But at the end of the survey, after all of the arguments, the issue still comes to a draw.  The Republicans’ most powerful package cannot shift the issue when proponents of health care reform inform and engage.

Repeal politics will backfire

The place where Democrats really break ahead is pushing back against governors who are refusing to cooperate with Medicaid expansion in their states, thus hurting working families and denying tax credits for small businesses.  This debate takes unmarried women to their largest number, 62 to 30 percent, a 32-point margin. 

Most important benefits in health care reform

We have known for a long time that the individual elements in the health care law are more popular than the health care law itself.  We tested a battery of elements in the health care law and asked voters which two they most favor. 

Among all voters and among unmarried women, the three most popular elements of the health care law are allowing children to remain on their parents’ insurance up to age 26, preventing insurance companies from denying coverage to children with pre-existing conditions, and requiring insurance policies to cover preventive care for women.  Among all voters, four in ten say that allowing children to remain on their parents’ plans and preventing insurers from denying coverage to children with pre-existing conditions are most important to them.

Half of all unmarried women said that preventing insurance companies from denying benefits to children with pre-existing conditions was one of the most important elements of the health care law.  And a third said allowing children to remain on their parent’s plans and requiring policies to cover preventive care for women are critically important.

In regression analysis, several of these items emerged as strong predictors of shifts over the course of the survey, suggesting that educating voters about what is in the law increases its popularity.  Coverage for children and charging men and women unequal rates were the most potent across the survey. Preventing insurance companies from denying children with pre-existing conditions predicted support for the health care reform law at the end of the survey.  This was also potent in driving the shift on whether respondents believed they would be better or worse off under the new health care law.  Barring insurance companies from charging women higher rates than men also was strong in driving this shift.

Most important arguments defending health care reform

As they were in 2008, voters remain deeply angry about the high cost of health care, rising insurance rates, and a benefits system that leaves many screwed when they are in deepest need.  The best narrative frameworks pinpoint the inequities in the system.  The strongest framework among all voters and also among unmarried women says that by repealing the health care law, insurance companies will be able to charge women higher rates than men and not cover critical preventive care for women.  Among all voters, more than half (53 percent) said it raises doubts about Mitt Romney and the Republicans and a quarter (26 percent) said it raises very serious doubts.   Among unmarried women, it was much stronger—63 percent said it raises doubts for them and a third said it raises very serious doubts.

However, while the second strongest case among all voters focused on the law’s impact on the most vulnerable, among unmarried women two other frameworks emerged as more powerful.  Unmarried women are particularly concerned about insurance companies driving up costs and making profits for dropping ill policy holders—almost two-thirds (64 percent) said this raises doubts for them about Mitt Romney and the Republicans and more than a fifth said it raises very serious doubts. 

(INSURANCE COMPANIES)Mitt Romney and the Republicans want to turn health care decisions back over to insurance companies and prescription drug companies who are driving up health care costs and making billions of dollars in profit lowering benefits and shedding people who get ill, but who invested millions of dollars in paying for Republican campaigns.

The second most powerful message among unmarried women focuses on the impact rising health care costs have on middle class pocketbooks.  More than half (60 percent) said this raises doubts about Mitt Romney and the Republicans and nearly a quarter (23 percent) said it raises very serious doubts.

(MIDDLE CLASS)The middle class is being smashed in this country and rising health care costs are a major part of the problem.  By repealing this law, Mitt Romney and the Republicans put at risk every middle class family who could lose everything because of some major illness and their insurance company deciding to cut them off.

Framing the health care debate for unmarried women

We tested a battery of facts about the health care law’s impact on women among a split sample of respondents and noted that these facts were not more powerful—in fact less so—among unmarried women.  Indeed, unmarried women are less responsive if it is explicitly directed at them.  These women do not want to be appealed to on health care in the context of benefits for just women; they support it more when framed as benefits for all.  Nonetheless, the most specific doubts that are most important to them relate to issues impacting women.  But importantly, the framing has to be universal, not targeted.

Many unmarried women face critical pocketbook realities that Democrats can and should engage in the health care debate.  Some of these women are under age 30 and unable to access health care unless they are able to stay on their parents’ plans.  And with the exception of widows and the elderly, these women are exceptionally vulnerable in a system that privileges dual earners.  The loss of a job means inability to access insurance.

Democrats should engage

Democrats do not come out of this debate weaker or harmed—even as Republicans are throwing everything at this issue.  Their position on repeal leaves voters dumbfounded that Congress is not working every day to fix the economy but instead refighting old battles.  And Republican governors’ intransigence could cost them in a big way at the ballot box.

Democrats have put very little into this fight—the bulk of the information voters hear about the health care law is wholly negative.  This issue has the capacity to engage voters who are most impacted by it—most importantly unmarried women and young voters—if only Democrats muster the courage to utter the words “health care” again in public.

[1] This memo is based on a national survey of 700 likely 2012 voters, plus an oversample of 200 unmarried women, conducted June 23-28, 2012 by Greenberg Quinlan Rosner for Democracy Corps and Women’s Voices Women Vote Action Fund. Unless otherwise noted, margin of error= +/- 3.7.   Women’s Voices Women Vote Action Fund is a 501(c)(4) organization focused on policies and enhanced civic engagement to help unmarried women and other under-represented segments of the American electorate.  It encourages parties, campaigns, and other groups to promote policies and civic engagement opportunities that strengthen our democracy.

[2] U.S. Census Bureau

[3] Ibid.

[4] Joint Committee, U.S. Congress, “Comprehensive Health Insurance Reform: An Essential Prescription for Women.” 

[5] IWPR/Rockefeller Report, Women and Men Living on the Edge, October, 2011. 

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