Healthcare Reform Big Issue in Elections

Leading up to the November elections, the political parties spent countless hours and millions of dollars debating the merits of the Patient Protection and Affordable Care Act (HR 3590). Republicans criticized Democrats who voted for or supported healthcare reform, citing surveys showing many Americans opposed the law. Some Democrats defended the legislation and touted it as a landmark accomplishment in helping uninsured Americans, while others chose to ignore the issue or even derided the law because of its polarizing nature among the public. The bill, passed on March 23, 2010, contained several provisions that would take effect 6 months later. They included not charging copayments for preventive care, making it illegal to deny coverage for children, allowing people <26 years of age to remain on their parents' health plans, and not allowing health insurers to rescind coverage. Democrats had hoped those new rules would aid their cause. Since the law’s enactment, however, there has been heated contention as to its potential impact, and polls indicated split opinions. A Kaiser Family Foundation poll released in late September, 6 weeks before the elections, found that 49% of respondents viewed the law as favorable while 40% viewed it as unfavorable. Among likely voters, the numbers were closer: 46% favorable and 45% unfavorable. The remaining respondents said they had no opinion. In addition, 26% said the law should be repealed. The reform’s complex nature was also apparent, with 53% of respondents indicating they were confused about the law, an increase of 8% from the August poll. Not surprisingly, there were large differences between the political parties. Among Democrats, 75% said they favored the law and 31% indicated they were strongly in favor of the law. Among Republicans, 73% said they viewed the law as unfavorable and 53% as strongly unfavorable. People who described themselves as politically independent were divided: 42% said they were in favor of the law while 45% viewed it as unfavorable. Meanwhile, a CNN/Opinion Research Corporation survey released on September 28 found that 47% of respondents answered that “Congress should repeal most of the major provisions in that bill and replace them with a completely different set of proposals,” while 26% said “Congress should make additional changes to increase the government’s involvement in the nation’s healthcare system,” and 23% said “Congress should leave the bill as it is.” The remaining 4% had no opinion. During the campaign season, many Democratic candidates rarely mentioned healthcare reform, avoiding the topic because of its unpopularity. In fact, a Politico article published on September 16 cited statistics from Kantar Media showing Democrats had spent $930,000 criticizing healthcare reform and only $300,000 promoting the law since Congress’s August recess. At that time, Kantar Media mentioned opponents spent 7 times more money on anti-reform advertising ($14 million) than supporters spent on pro-reform advertising ($1.8 million). That contrasted sharply with the early May statistics, which indicated anti-reform advocates spent 2 times as much money as pro-reform advocates. As September 23 approached, the date several important provisions began, President Barack Obama and other Democrats were more forceful in their support. In the backyard of a home in Falls Church, Virginia, on September 22, President Obama gathered with several Americans who benefited from the bill. A Reuters article said participants included a woman with cancer who previously could not get coverage and another woman who was unable to buy an insurance policy to cover her son’s eye surgery. Politico also reported that, closer to the November 2 election day, Democrat-friendly groups became more aggressive in their public relations campaign. The Health Information Center was launched to explain and defend healthcare reform. And groups such as Health Care for America Now, Families USA, US PIRG (Public Interest Research Groups), Young Invincibles, and Main Street Alliance held rallies and events to educate people about the law, according to Politico. Democrat Harry Reid, the Senate majority leader from Nevada who helped push through the healthcare reform bill, stood up for the law during his campaign. He criticized his opponent, Republican Sharron Angle, on healthcare-related topics, according to the Los Angeles Times, although surveys showed most Nevada voters opposed the reform. Seen as a major backer of the bill and with Nevada’s unemployment rate the highest in the United States, Sen. Reid’s tenure remained murky, as polls found the race in a near dead heat. In Ohio, Democrat Representative John Boccieri also faced a challenging situation. On November 7, 2009, Rep. Boccieri voted against healthcare reform. However, in March, he and 7 other Democrats changed their votes and supported the final legislation. A New York Times article described how local citizens considered Rep. Boccieri as someone who didn’t listen to their concerns about the law and questioned his independence from President Obama. Rep. Boccieri explained that he changed his mind after Congressional Budget Office estimates predicted the final bill would cost $940 billion over 10 years and reduce the deficit by $143 billion. The earlier House version of the bill that Rep. Boccieri rejected had projected costs of $1.05 trillion and deficit savings of $104 billion. In Wisconsin, Democratic Senator Russ Feingold didn’t shy away from the issue, either. According to the Associated Press, Sen. Feingold and President Obama joined together at a late September political rally at the University of Wisconsin-Madison. They defended the healthcare reform bill, with President Obama mentioning the provision allowing people <26 years of age to remain on their parents’ health insurance plans as particularly important to the college crowd. Sen. Feingold also touted his healthcare reform vote in a television ad. The Associated Press reported the ad focused on Sen. Feingold’s fight to stop insurance companies from denying coverage to Wisconsin children with preexisting conditions. It also claimed Ron Johnson, his Republican opponent and local business owner, would allow insurance companies to raise premiums with no discretion. Mr. Johnson countered with an ad criticizing Sen. Feingold’s healthcare reform vote, claiming he didn’t listen to many Wisconsin residents who opposed the reform, or what Mr. Johnson termed the “Obama takeover of health care.” If elected, Mr. Johnson said he planned on trying to repeal the healthcare bill. Many other Republican candidates shared Mr. Johnson’s disdain for the legislation. As part of its strategy to gain control of Congress, Republicans in the House of Representatives released a 46-page document called “A Pledge to America” and an accompanying website (pledge.gop.gov) which provided an overview of the party’s beliefs and plans on several topics such as the size of government, spending, economic conditions, and national security. The Republicans also devoted several pages to healthcare reform. “The American people wanted one thing out of health care reform: lower costs, which President Obama and Democrats in Washington promised, but did not deliver,” the group wrote. “Instead of expanding the size and scope of government with more debt, higher taxes, and burdensome mandates, Americans are calling for reforms that lower costs for families and small businesses, increase access to affordable, high-quality care and strengthen the doctor-patient relationship. We have a plan to do just that.” Later in the document, in a section titled “Our Plan to Repeal the Job Killing Health Care Law and Put in Place Real Reform,” the Republicans discussed broad steps they hope to pursue. They want to reform medical liability insurance, allow people to purchase healthcare coverage outside of the state in which they live, expand health savings accounts (HSAs), allow patients with high deductible plans to use HSAs, strengthen the patient-doctor relationship, expand state high-risk pools and reinsurance programs, make it illegal for insurance companies to deny coverage based on preexisting conditions, eliminate annual and lifetime spending limits, establish a prohibition on taxpayer funding for abortions and insurance coverage subsidies pertaining to abortion, and repeal the healthcare reform bill. The final action seems unlikely, at least in the short term. President Obama can veto any repeal bill, even if it withstands a filibuster in the Senate. The Washington Post reported in early October that Republicans hoped to hold oversight hearings to publicly refute the bill and attempt to gain momentum heading into the 2012 presidential elections. In a Politico article in September, unnamed Republicans said the only way for a repeal to potentially occur is if a Republican becomes president. However, even then, a full repeal will be difficult to achieve because major benefits will be in place by 2014, less than a year after the president takes office. “There is only a certain limited amount of things you can do,” Sen. Tom Coburn (R-OK) told Politico. “You can get a vote to repeal it, and the first thing [President Obama] will do is veto it. That is an exercise in futility. What you have to do is go to the specific areas where money is spent to implement it and put a limitation on the expenditures.” The Politico article mentioned several ways Republicans may attempt to thwart the reform. They could try to have states opt out of the individual mandate provision which forces individuals to purchase insurance; hold back the $5 billion to $10 billion that the Health and Human Services Department and the Internal Revenue Service need over the next 10 years to implement the law; insert language into an appropriations bill that prohibits federal workers from implementing the law; or focus on getting rid of the >$100 billion in discretionary spending in the law, which could lead to dozens of programs being unfunded, although none that would be essential to the law’s success, according to the article.—Tim Casey