How The Upcoming Elections Might Shift The National Health Care Landscape

By Richard Knox

Here’s a solid prediction about next Tuesday’s elections: They’ll be crucial to the future of universal health care in America — or at least its near-term future.

For those who believe universal coverage is a good thing, prospects aren’t good, judging from an analysis of 27 national polls scoured by researchers at the Harvard School of Public Health.

Taken altogether, the polls show increasingly negative views of the four-year-old Affordable Care Act among likely Republican and independent voters. That could tip control of the U.S. Senate to the Republicans, enabling them to attack the ACA through the budgetary process — crippling it even if they can’t repeal it without President Obama’s signature.

In this March 23, 2010, file photo, President Obama signs the Affordable Care Act. (J. Scott Applewhite/AP)

In this March 23, 2010, file photo, President Obama signs the Affordable Care Act. (J. Scott Applewhite/AP)

Six states with too-close-to-call U.S. Senate races are unfriendly territory for the Affordable Care Act, the 2010 law that aims to insure nearly all Americans.

In contrast to Massachusetts — where 57 percent support the ACA — fewer than half the voters like the health care law in New Hampshire, Colorado, North Carolina, Louisiana, Kentucky and Arkansas.

“These are states where President Obama is very unpopular,” says study author Robert Blendon. “And Obamacare is not popular in those states.”

The problem, for the president and ACA supporters, is greatly worsened by low turnout. Fewer than 6 in 10 voters are expected to cast ballots, and the polls show likely voters are less inclined to support the ACA than the public at large.

“In a low-turnout election, the voters are disproportionately the core of either party,” Blendon says. “And views on what should happen with the ACA are very polarized” between the two major parties.

More than two-thirds of Republicans say they’ll be less likely to vote for a candidate who supports the ACA. Not surprisingly, only 10 percent of Democrats feel that way.

But among independents, nearly twice as many would vote for an anti-ACA candidate than favor one who supports the four-year-old law. That’s bad math if you like the ACA — arguably the most significant piece of social legislation since Medicare and Medicaid were passed in the mid-1960s.

Blendon and co-author John Benson, writing in the New England Journal of Medicine published Wednesday, say the nation is “witnessing a very unusual situation.”

Usually after a controversial piece of legislation passes, the highly partisan fighting over it fades over time and “everybody agrees on where we’re going,” Blendon says. Or an election with a larger turnout settles the matter by bringing out voters who have a less-polarized, more middle-ground view. This year — four years after the ACA became law — “neither of those is true,” the Harvard professor says.

He and Benson think that’s largely due to a “cultural shift” among Americans on the core principle behind the ACA – namely, that it’s the federal government’s responsibility to make sure all Americans have health care coverage.

In 2006, nearly 70 percent of Americans supported that principle. This year, only half do.

What’s caused this erosion in the foundation of the ACA?

Blendon is convinced one big reason is the unprecedented hailstorm of ads attacking Obamacare.

The Harvard group notes that $418 million was spent through the beginning of this year on negative ads on the ACA, versus only $27 million on ads by supporters of the law.

And up through mid-October, Americans have been barraged with more than 1.3 million TV ads on health insurance – nearly $800 million worth, according to a report published today by the Kaiser Family Foundation.

More than half of these ads urged uninsured Americans to sign up for new, government-subsidized coverage under the ACA. But among the political ads, the great majority of Republican-backed advertisements that mentioned health disparaged the new law.

In contrast, the Kaiser report notes, “Democrats have been steering away from the ACA this election cycle.” Only 15 percent of Democratic candidates’ health-related ads mention the law.

Given this highly charged atmosphere, it’s not surprising that 73 percent of Republicans and nearly half of independents say the health care law will have a negative impact. “These are not likely part of the five million people who got additional coverage” under the law, Blendon says.

But if the Republicans take control of the Senate in the next Congress, that doesn’t mean the ACA will be repealed.

First, President Obama isn’t likely to sign a repeal bill. Apart from that, not all of the ACA’s opponents want to kill it.

Polls show that less than a third of voters want repeal. Another 23 percent want to “scale back” the law.

“If the Republicans win, they will try very hard to make the ACA smaller,” Blendon says. “If they are in the majority, the president has to face the reality that he cannot pass any legislation for the remainder of his term, or get his judicial appointments approved. So my prediction is the president will reluctantly agree” to changes in the ACA.

But that’s not likely to be the end of the story. Because the electoral dynamics could be very different in 2016.

For one thing, a presidential election will “dramatically enlarge the pool of voters, attracting more minority voters and more young people,” Blendon says. “And you will increase the number of people who believe that extending coverage to everyone is a good idea.”

And then there are the dynamics within the Democratic party: If the ACA is watered down, “they’re going to be outraged,” Blendon predicts. “Democrats will feel they have to come out and fight. So it will energize the Democratic party base to try to get something bigger, not something more modest.”

As for the Republicans, Blendon says, “they’ll have to paint a picture of what their more moderate policy would look like. They don’t have to do that now.”

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