HCR Attitudes in Presidential Swing States

A couple of days ago, USA Today had an article with the headline “Swing states poll: Health care law hurts Obama in 2012.” Indeed, the Gallup-conducted poll had a number of negative findings on voters' reactions to the 2010 health care reform law. By a 53%-38% margin, swing-state voters saw passage of the law as a "bad thing" rather than a "good thing" (the margin was a little closer, 50-42, nationally). Slightly more swing-state voters (15%) claimed the law has hurt, rather than helped (11%), them and their families. By an even larger gap (42-20), these respondents expected the law to do more harm than good in the long run.

Gallup also examined presidential "horse-race" numbers in the swing states, and it is these results that suggest possible oversampling of Republicans or other house effects in a GOP direction (as has happened previously with Gallup, here and here). Here are Gallup's recent swing-state horse-race numbers, compared with those of two other swing-state polls taken in the past few weeks (below the bar graphs are the states included in each respective poll, with grey indicating omitted states).

As can be seen, USA Today/Gallup is the only mid-February swing-state poll (at least that I'm aware of) showing President Obama trailing his possible GOP opponents. Rick Santorum leading Obama by 5 percentage points in the swing states (and by 3 nationally) is inconsistent with virtually any other poll.

The other two swing-state polls, by Fox News and Purple Strategies, show Obama leading the GOP contenders by varying margins.

Assuming that preference for Obama in the presidential election would be positively correlated with favorable attitudes toward health care reform, one can raise the following question: If Gallup's methodology has systematically depressed Obama's numbers in the swing states, has it also depressed support for the new health law?

Poll on Individual Mandate

Via Talking Points Memo, a new CNN/ORC poll (November 11-13) shows 52% of Americans supporting the individual-mandate component of the 2010 health-care-reform law. The requirement that all Americans purchase health insurance (with subsidies for some) has been one of the least -- if not the least -- popular elements of the reform law. The wording of the survey item (from Polling Report) is as follows:

"As you may know, the health care bill passed in 2010 includes a provision that will require all Americans who do not have health insurance to get it. Do you favor or oppose that provision?"

That seems to me like pretty clear wording. In June (apparently the last time CNN/ORC polled on this issue), 44% favored the individual mandate (the June wording, which is also shown on Polling Report, is very similar to that used in the recent survey). There really may be some shifting taking place in public opinion or this could be a one-time "blip." Future polls will help indicate which.

Dip in ACA Favorability

In the Kaiser Family Foundation monthly health care polls, the percentage of Americans expressing a favorable opinion toward the Affordable Care Act (the new law enacted in March 2010) has been in the low 40s nearly every month from August 2010 to September 2011. In the new October 2011 poll, however, favorability is down to 34%, compared with 51% who express an unfavorable attitude. We'll keep an eye on the Kaiser polls over the next few months to see if this month's drop in approval is a one-time blip or the start of a sustained trend.

Is Cook Right About ACA Being "Very Unpopular"?

Via Political Wire, I came across this article in which Charlie Cook appraises the current state of the 2012 presidential election. Though not really the focus of the piece, it claims that President Obama's "signature legislative accomplishment of health care reform remains very unpopular."

Now, I'm not saying the health care reform policy (either when it was working its way through the Congress or as an actually enacted law) has ever been wildly popular. However, "very unpopular" doesn't strike me as an accurate characterization, either. Just to make sure I wasn't missing any new polling data that would support Cook's view, I visited Polling Report's compilation on health policy. Here is what I found...

In the Kaiser Family Foundation's latest Health Tracking Poll (in the field during roughly the past week, July 13-18), 42% of Americans rated the health care reform law favorably and 43% unfavorably (with the rest unsure or refusing to say). This finding confirms the impression I (and other observers) have had, that public opinion is divided or mixed on the policy.

Another poll listed in the repository is that by Ann Selzer for Bloomberg. It is somewhat dated by now (June 17-20), but it used a question wording that seems unique:

"Turning to the health care law passed last year, what is your opinion of the law? It should be repealed. It may need small modifications, but we should see how it works. It should be left alone."

A majority of respondents (51%) went with the "see how it works" option, suggesting patience and possible receptivity of the American people to the law. The poll found 35% support for repeal and 11% for leaving the law as is. (Here's a link to the Bloomberg News article on the poll).

Scrolling further down the Polling Report archive, we see some additional June polls (primarily from early in the month), when a larger number of survey outfits were measuring public opinion on the health law. These tended to show the unfavorable response outdrawing the favorable one more substantially (by 10 percentage points in the AP-GfK poll; by 11 in the CBS News poll, and by a hefty 17 in the CNN/ORC poll).

However, CNN/ORC has been one of the few polls to probe an issue that was discussed extensively in the past on this blog: opposition from the left. CNN/ORC uses this follow-up probe with respondents who said they opposed the law, "Do you oppose that legislation because you think its approach toward health care is too liberal, or because you think it is not liberal enough?" The June 2011 results then break down as follows:

39% favoring the law in the first place
36% opposing the law for being too liberal
14% opposing it for not being liberal enough

Now, again, I am not expecting health care reform to be an asset for Obama as he seeks re-election next year. If I can play amateur political consultant, I think he'd be better off emphasizing whatever amount of job growth takes place in the next year and the capture of Osama Bin Laden. However, I believe the evidence shows public opinion on health care reform to be more mixed and nuanced than Cook's apparent dismissal of it as "very unpopular."

McKinsey Poll on Employers' Likely Moves

As many readers of this blog are probably aware, management consulting firm McKinsey & Co. recently released a poll of employers who provide health-insurance coverage to employees. The findings, which suggested that a substantial number of companies might terminate such coverage, has created a firestorm in policy circles and the political blogosphere. Here are two recent articles, defending and criticizing the McKinsey survey's methodology.

How Americans Obtain Health Insurance (If They Have It)

Gallup reports trend lines in its polling of Americans' reported sources of health insurance (or lack of insurance). The percentage of Americans reporting they have employer-based health insurance has declined gradually over the last few years from approximately 49% to 45%. Insurance via government program (e.g., Medicaid, Medicare) has been edging up and now slightly exceeds one-quarter of the population.

The percentage of Americans who report being uninsured has held steady at slightly over 16% from 2009-2011. Some elements of the 2010 Affordable Care Act (health care reform) have already gone into effect. However, as noted in the above-linked Gallup article, the country's persistent economic difficulties have presumably dampened any gains in health-insurance coverage thus far from the 2010 law.

ACA provisions that are most likely to reduce the ranks of the uninsured -- new mechanisms to purchase health insurance (known as "exchanges"), tax credits for many purchasers, and expansion of Medicaid -- don't go into effect until 2014 (implementation timeline).

What Predicts Attitudes Toward Health Care Reform?

John Sides examines research on how perceptions of fairness and inequity, partisan attitudes, and personal health status appear to predict (or not predict) attitudes toward government health care reform plans (via Pollster).