Health Care Reform and Public Opinion
Having previously discussed how the 2010 health care reform made it onto the decision agenda and eventual passage vis-à-vis Kingdon’s theoretical framework, this paper attempts to understand if and how public opinion helped shape and drive Congress to the eventual passage of the controversial and historic Patient Protection and Affordable Health Care Act. Specifically, this paper will attempt to show that public opinion was instrumental in creating the initial political space necessary for the introduction of health care reform proposals, but that partisan bickering, cost-projections, and deep distrust of Congress eventually led to a rather mixed picture of public opinion. In turn, this mixed picture makes it difficult to draw any definite conclusion on support for health care reform legislation. Nevertheless, nearly equally divided favorability ratings a year after the passage of the act may be indicative of the notion that health care reform legislation moved policy in the direction of the median voter by splitting opinion right down the middle and thereby likely creating a new status quo.
Creating Political Space
First, this paper accepts the broadly held view among political scientists “that public opinion and public policy are, in fact, related” (Brady 5) and also accepts the notion that “shifts in citizen preferences toward government yield governmental response aligned roughly with citizen preferences” (Brady 6). With this in mind, the important assertion that “the most common mechanism through which public opinion moves policies is election where there is a large turnover in congressional seats,” (Brady 5) leads to the initial claim made in this paper—that public opinion created the political space necessary for health care reform to become potential legislation. This political space was largely created by the 2008 election cycle and the subsequent change in the party composition of both Houses of Congress that resulted in Democratic majorities. Since it seems logical that public opinion has a much more direct impact through the direct elections of representatives and senators rather than on the actual formation of legislation in Congress, it is also fair to suggest that public opinion during the 2008 elections shifted the electoral and political outcomes to the left on the “left-right continuum” (Brady 6) and reflected a liberal mood swing among the voting populace. This mood swing, in turn, resulted in the election of many officials who considered health care reform an important priority, rendering health care reform more salient than it had been in over a decade.
Exploiting Political Space
Second, this paper suggests that the political space created after the 2008 elections allowed the Obama administration and others to propose and eventually bring to a vote a health care reform bill—something that had eluded the Clinton administration in the 1990’s. Yet, as this process moved forward, it also became quite clear that public opinion and its impact was much more difficult to gauge when simply taken with respect to health care reform as opposed to elections, where public opinion arguably plays a much greater and more direct role than in the passage of legislation. For one, polls—perhaps the most commonly used gauge of public opinion on political issues and saliency—suffers from a broad set of limitations including the fact that “few polls estimate the cost of reform,” (Brady 8) often lack clarity about the actual reforms being considered, and can fluctuate widely depending on the questions asked of respondents. Moreover, while the 2008 elections perhaps mirrored the liberal mood swing of the electorate discussed above, studies have shown that “public opinion favoring healthcare reform or opinion estimating satisfaction with personal health care moves very slowly over time” (Brady 16) and arguably much more slowly than electoral mood swings. In other words, it is difficult to suggest that the public opinion shift which brought about the political change of 2008 necessarily also showed a national mood shift on specific policies such as health care reform. However, it is fair to suggest that the 2008 political change created institutional distortions that—even with hypothetically evenly split public opinion—through “electoral, partisan and commitment variables” yielded results that may have differed “from the public opinion choice” (Brady 13) and resulted in the passage of health care.
Time is Money… and Political Capital
Although historic health care reform legislation was eventually passed, the “long-drawn-out process, the different cost estimates and the special deals for members like Senator Nelson (Dem – Nebraska) and pro-life Democrats on federal funding helped turn opinion against reform” (Brady 3). In this rather chaotic lead up to the eventual passage of health care reform, some polls showed both support and opposition for Obama’s health care reform proposals. In light of this conflicting data, the messy process of churning out actual legislation renders it evident that public opinion does not necessarily move in a unidirectional manner and is often influenced by Congress rather than just vice-versa. As a result of the length of the legislative process, support for health care reform legislation slowly deteriorated. Partisan cost-estimates and continued bickering in Congress—often to the point of ludicrous and malicious claims—did not aid health care reform legislation in terms of maintaining public support either, although they did validate the theoretical claim “that as the cost of the policy increases, the support for it declines” (Brady 18). Health care reform was not unique in this respect, with people largely favoring health care reform and expanded coverage “if such goods are seen as freely provided” (Brady 18). In other words, public opinion seems to fluctuate significantly throughout the slow-moving legislative process and outrage (or lack of information) associated with perceived costs of any given piece of legislation.
An Equally Irritated Public?
A closer look at polling today, however, appears to suggest that the Patient Protection and Affordable Health Care Act of 2010 may have moved policy into the direction of median public opinion. In fact, now that one year has passed since the healthcare bill was signed into law, “Americans are split in their opinions of it, with 46% saying it is a good thing and 44% a bad thing” (Healthcare, Gallup). These numbers, however, stand in sharp contrast to polls from 2003 that suggest that up to “62% of respondents preferred a universal health insurance program, in which everybody is covered under a program like Medicare that's run by the government and financed by taxpayers, compared to 32% who preferred the current system” (Washington Post Poll). These drastic differences can, of course, be in part attributed to the general fallacies of polling data discussed above; however, this paper asserts that the closely divided state of opinion today reflects the fact that health care legislation has moved in the direction of the median voter since the passage of the 2010 reform and, more broadly, reflects Congress’s delayed action toward a policy outcome more in tune with public opinion. Although it is difficult to make sense of polling data without a strong referent, it is likely that the near 50-50 split in opinion on health care is the result of a newly created status quo that will make health care reform efforts in the near future extremely unlikely given that such a change would carry deep political costs for politicians.
Works Cited
Brady, “Public Opinion and Congressional Policy,” The Oxford Handbook of the American Congress, eds. Schickler & Lee (2011).
"Healthcare Law Remains Divisive One Year Later." Gallup.Com - Daily News, Polls, Public Opinion on Government, Politics, Economics, Management. Web. 29 Apr. 2011. <http://www.gallup.com/video/146747/Video-Healthcare.aspx>.
"Washington Post-ABC News Poll: Health Care." The Washington Post: National, World & D.C. Area News and Headlines - The Washington Post. Web. 29 Apr. 2011. <http://www.washingtonpost.com/wp-srv/politics/polls/vault/stories/data102003.html>.
