While most normal red-blooded Americans are focusing on the NCAA basketball tournament, Washington is paying attention to another "sudden death" tournament going on in the nation's capital.
As early as Thursday, the House of Representatives will cast its votes on whether to approve the December 24 bill passed by the Senate and a side-car "corrections" package, using the "majority rules" reconciliation process.
If the vote fails to get a majority in the House, health reform is dead. Or at least the type of reform that would make a dent in reducing the numbers of uninsured. While Congress might extend some existing health programs that are set to expire, and probably do something to stop the next round of Medicare pay cuts, that's about it. I see no chance that they would "start over" and pass reforms to cover more people or ban insurance companies from turning down people with pre-existing conditions.
Like basketball fans rooting for or against a particular team, I know that some readers of this blog fervently hope that the legislation will fail, while others feel just as strongly that it should pass. (Later this week, I will have more to say about how ACP is approaching the final votes.) Yesterday, Health Affairs published a fascinating new study that helps explain why we Americans are so divided on health reform
The researchers looked at polling from 1999 to today that shows that a person's views on health reform are related to two factors: (1) their partisan and ideological leanings and (2) how much they think the uninsured already get decent care. The first factor - that someone's political views are a major influence on how they view health reform - isn't particularly surprising. One would expect Republicans to be more opposed to using government to expand coverage, and Democrats more in support.
More interesting is that people differ in their perceptions of the care available to the uninsured. Overall, the authors' write, "In 2009 a majority of survey respondents (56 percent) still perceived that the uninsured are able to get necessary medical care." Support for health reform "was significantly more popular among people who perceived that the uninsured are unable to get care (72 percent) or able to get care with great difficulty (75 percent) than it was among those who perceived that it is not too difficult (38 percent) or not at all difficult (31 percent) for the uninsured to get care ... These associations persisted even after political party and demographic characteristics."
And who were the people most, and least, likely to believe the uninsured get needed care? "Democrats are far more likely than Republicans to believe that the uninsured have difficulty gaining access to care. Senior citizens are less aware than others of the problems faced by the uninsured. Even among those Americans who perceive that the uninsured have poor access to care, Republicans are significantly less likely than Democrats to support reform."
The fact that large swaths of the American electorate believe that the uninsured are getting the care they need flies in the face of evidence - such as the study that I blogged about on Friday - that people without coverage are more likely to die prematurely than those who have insurance.
Because of this continued divide, the author's state that "even if President Barack Obama signs health reform into law, its future political support could be uncertain. A shift from Democratic to Republican control of either congressional body could mean the reduction or elimination of funding for insurance subsidies. Subsidies are essential to a coverage expansion that these critical constituencies ultimately deem unnecessary." Republicans already are making it clear that they will seek repeal if the bill passes Congress and is signed into law, even though that is not likely to happen as long as President Obama is in the White House.
In this sense, this week's elimination round vote, as crucial as it is, will not settle the long-standing divide in the electorate on the role of government in subsidizing care for the uninsured, or even on the basis question of whether the uninsured already get the care they need.
Today's question: Why do you think most Americans believe that the uninsured can get the care that they need, when studies show otherwise? And why does a person's view on this question tend to track with their partisan leanings?