The ACP Advocate Blog
by Bob Doherty
Thursday, November 4, 2010
To repeal or not to repeal, that is the question
Did the mid-term elections produce a mandate to repeal the Affordable Care Act?
Yes, says John Boehner (R-OH), Speaker of the House in waiting. Within hours of learning that the GOP had picked up at least 60 House seats, he pledged to "do everything we can to try to repeal this bill and replace it with common sense reforms to bring down the cost of health care." Senate Minority Leader Mitch McConnell (R-KY) chimed in by promising to push for outright repeal, and if that doesn't work, to try to undo it "piece by piece."
Meanwhile, Senator Harry Reid (D-NV), who presumably will remain as Majority Leader in the new 112th Congress, albeit with a much smaller majority, offered to consider "tweaking" the legislation but not to "denigrate the great work we did." A chastened President Obama also indicated a willingness to consider "reasonable changes" in the law but said that it was the "right thing to do." He also acknowledged that the process that produced the legislation was an "ugly mess" but that the "outcome was a good one."
The truth is that the voter's gave a split decision - literally. According to exit polling of a random sample of more than 18,000 voters conducted for the Washington Post, almost half of the voters said that the law should be repealed. But "almost the same number" felt it should be kept or expanded. Moreover, health care lagged well below the economy as an issue, with over 90% expressing concern about the economy while only 18% mentioned health care as a top voting concern. Many Democrats who voted for the Affordable Care Act were voted out of office, but so were many who voted against it.
The results from state referenda also were mixed. Colorado voters voted down a "symbolic" referendum to exempt the state's residents from some of the law's mandates, but voters in Oklahoma and Arizona gave approval to similar measures.
An article that appeared in the New England Journal of Medicine a few days before the election predicted the voters' split decision. Robert Blendon and John Benson analyzed 17 independent polls and found that "more than 7 months after the health care reform law was enacted, a majority of Americans neither favor nor oppose it." Many provisions of the law are popular, they report, but Americans also are concerned that the law will damage the economy and add to the federal debt. On the question of whether the law should be repealed, "18% of registered voters believed that Congress should implement the bill as it currently stands, 31% thought Congress should make additional changes to increase the government's involvement in the country's health care system, and 41% believed that Congress should repeal most of the major provisions of the bill and replace them with a completely different set of proposals."
The bottom-line is that the evidence - from numerous polls taken before the election and from the exit poll of those who actually cast their votes - does not show a mandate for repeal. Rep. Boehner and Senator McConnell, though, are accurately reflecting the views of most registered Republicans, who overwhelming disapprove of the law. Democrats, on the other hand, mostly support it, and independents are divided.
This is not to suggest that President Obama has been successful in selling the country on health care reform. Quite the opposite: the fact that seven months after it passed, most voters still don't know how they feel about it, suggests that the White House has not persuaded a skeptical public that it will be good for the country. But the GOP also has not persuaded a skeptical public that it should be repealed.
Instead, over the next weeks and months - and quite likely, through the 2012 Presidential election - the battle to influence public opinion will continue. But right now, the public's views are unsettled enough that neither the politicians who advocate for repeal, nor the politicians who advocate for staying the course (maybe with some "tweaks"), can have all that much confidence that they have the public on their side.
Today's question: What do you think the voters were saying about repeal of the health reform law?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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