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10 Key Facts To Read Before the Supreme Court Rules on Health Care Reform

Anticipation is building for the Supreme Court ruling on President Obama’s health care reform law, expected no later than June 28. The announcement will have a significant impact on the political landscape and set off a frenzy of news coverage and political analysis, but it will likely be several weeks before public opinion settles (especially given the July 4th holiday) and we can thoughtfully determine to what extent the decision is a game changer.

Even though the political landscape will reset following the verdict, there are still several well-established trend lines that provide helpful context for the imminent announcement and the prognostications to quickly follow.

1. It's about the cost of health care, stupid. Voters' top priority for health care reform is to reduce out-of-control costs. As the health care debate got underway in 2009, voters' guidance to President Obama and Congress on how to move forward with health care reform was clear: do something to control costs. In Resurgent Republic's June 2009 survey, half of Independents agreed (49 percent), ranking this priority above improving quality of care (23 percent) and covering the uninsured (19 percent).

   The Battleground Poll from December 2009 also found that lowering costs was the electorate's top priority for health care reform. What's more noteworthy, the survey asked voters to identify President Obama's primary goal. More than 6 in 10 voters (63 percent) said the president wanted to "make sure every American has health insurance," 11 percent said lower costs, and 7 percent said improve quality of care. From the beginning there has been a disconnect between what voters say is important in health care reform and the policies President Obama relentlessly pursued.

   Voters want common-sense health care reform that reduces out-of-control costs and keeps families and individuals in control of their own health care decisions, unlike ObamaCare.




2. The electorate believes the nation is worse off under the president's health care law. Strong majorities of Independents expect the health care reform law to increase their premiums, health care costs, the federal deficit, and taxes, while more believe it will hurt rather than help the quality of care. A national survey for the Young Guns Policy Center in March 2012 asked Independents how the health care reform law would effect the following categories:

   
   
   • Premiums – 56 percent of Independents think health insurance premiums will go up.
   
   
   • Health Care Costs – 60 percent of Independents say costs will increase.
   
   
   • Taxes – 60 percent of Independents believe their taxes will increase.
   
   
   • Federal Deficit – 64 percent of Independents believe the health care law will increase the deficit.
   
   
   • Quality of Care – by 2-to-1 Independents are more likely to say the health care law will decrease (29 percent) rather than increase (15 percent) their quality of care (45 percent say no effect).
   
   



3. Instead of making health care more affordable, a majority of Independents say their own health care costs have gone up since ObamaCare became law. According to a Resurgent Republic November 2011 survey, 52 percent of Independents believe their health care costs have gone up under ObamaCare (41 percent think costs have stayed the same and only 3 percent say costs decreased).

   Moreover, Independents are skeptical that the health care law lives up to its cost-cutting claims, according to the Young Guns survey. A majority of swing voters (57 percent) say taxes will increase for those earning less than two hundred fifty thousand dollars a year. Seven in 10 Independents reject the talking points that health insurance premiums for the average family will drop by two thousand five hundred dollars (68 percent) and that the law reduces health care costs for individuals, businesses, and the federal government (71 percent).

4. Most Americans believe the health care law is a drag on the economy. The health care law places new regulations and mandates on small businesses already struggling in an anemic economy. A recent study by the American Action Forum notes ObamaCare’s medical device tax could cost up to 47,000 jobs. In addition, the Congressional Budget Office estimates the health care law will shrink the labor workforce by 800,000 workers. Nearly three-quarters of Americans say it is very (39 percent) or somewhat likely (34 percent) that businesses will have to layoff employees due to the health care law, according to a CBS News/New York Times survey in March.

5. Most Americans do not believe they will personally benefit from ObamaCare. Not all of the law's provisions have been implemented, but there is faint optimism things will be better once the law is fully in effect. According to the average of 26 Kaiser Family Foundation surveys since the health care law was signed, 67 percent of Americans say their family will either be worse off (31 percent) or not experience much difference (36 percent). Less than one third (27 percent) believe their family will be better off due to ObamaCare. The average of CBS News/New York Times surveys during the same time found less than 1 in 5 Americans (17 percent) believe the law will help them personally. Gallup asked Americans in February to consider the healthcare law "in the long run" and 72 percent said the law would make their family’s healthcare situation worse (38 percent) or not make much difference (34 percent). Only one-quarter of respondents believed the law would make things better.

6. Voters are wary of more government involvement as the basis of health care reform. By almost 3-to-1, Independents prefer a health care system where "most Americans get their health care coverage through a private insurance company" (61 percent) rather than the federal government (24 percent), according to a June 2009 Resurgent Republic survey. One reason for this wide margin is swing voters believe quality of care suffers with more government involvement in health care. The same survey found by a 49-to-37 percent margin Independents believe more government involvement "will create long wait times for surgery, deny needed treatments, and hurt the quality of care" rather than "expand coverage for the uninsured, control costs, and improve the quality of care." The concern over more government intrusion into health care is still relevant today. According to a CBS News/New York Times poll in March, 54 percent of Americans believe the health care law creates too much government involvement.

7. Since becoming law, the intensity favors those who strongly oppose the health care reform law instead of those who favor the law. Based upon 11 polls conducted by CBS News/New York Times from March 2010 to June 2012, Americans who strongly disapprove of the law outnumber those who strongly approve by an average of 18 points (33 to 15 percent). In fact overall approval never climbs above 39 percent in this survey and reaches a ceiling in the low 40's in most other public polling. (The Huffington Post/Pollster average of all public polling on the health care reform law is 46.8 percent oppose and 40.2 percent favor.)

   The intensity gap also appears in a simulated debate. In Resurgent Republic's November 2011 survey, voters selected between the following statements:

   Congressman A says that health care reform has been good for America. It has provided health insurance to those who didn't have it, is controlling health care costs, and holding the insurance companies accountable.

   Congressman B says ObamaCare has been bad for America. It is raising health care costs, cut 500 billion from Medicare, and injected government bureaucrats into health care decisions.

   By 54 to 39 percent, Independents believe "ObamaCare has been bad for America," and when considering intensity, more Independents strongly support Congressman B (36 percent) than Congressman A (21 percent).

8. Swing voters oppose the individual mandate, and their displeasure has increased since the debate over ObamaCare began. As we await the Supreme Court ruling, the verdict among Independent voters is not in question. From June 2009 to January 2011, opposition to the individual mandate among Independents increased from 55 percent to 59 percent, including a 7-point jump in intensity (42 percent strongly supported the counter argument in 2011, up from 35 percent at the beginning of the debate). In both Resurgent Republic surveys, voters selected between the following statements:

   Congressman A says people without insurance make prices go up for those who have it by going to the hospital without paying, so to be fair the federal government should require everyone to purchase health insurance.

   Congressman B says the federal government has no business telling private individuals what they should or should not buy with their own money, including health insurance.

   Among Democrats, the individual mandate has become more popular with time. In June 2009, Democrats split on the individual mandate with slightly more in favor, 47 to 44 percent. In Resurgent Republic's follow up survey, there was a 17-point net swing in favor of the individual mandate among Democrats (56 to 36 percent), a mirror opposite of Independents. In a February survey, Gallup found 70 percent of Independents believe the individual mandate is unconstitutional. Also in the March Young Guns survey, 70 percent of Independents think the federal government "does not have the authority to require every American to buy health insurance or pay a fine."

9. Rather than spending the better part of his first two years trying to pass health care reform, Independents believe President Obama should have done more to focus on the economy. When the health care debate started in 2009, 50 percent of Independents agreed "health care reform is important, but now is not the right time with the country facing the most serious recession in modern times" while 42 percent said "our health care system is in crisis, and the federal government must invest in reform now to control costs, cover the uninsured, and improve the quality of care," according to a Resurgent Republic survey.

   Resurgent Republic focus groups conducted in Pennsylvania last June picked up on the same theme during the discussion with Obama Independents. Our memo analysis read in part:

   "Among the Pennsylvania Independents there was an undertone questioning why the president spent the better part of his first two years on health care and not their top priority of job creation. This notion led one male Independent to conclude that President Obama 'took his eye off the ball' and another said the president was more interested in getting a 'trophy.'" July 8, 2011

   Two years after the law was enacted, Independents still object to President Obama focusing on health care reform at the expense of the economy, based upon a Young Guns Policy Center survey. By 55 to 37 percent, Independents believe "President Obama did the wrong thing by focusing on passing health care reform his first year in office. He should have worked harder to get the economy going and creating jobs before moving on to other issues."

10. The health care reform debate caused many voters to view President Obama as "another politician." The nearly two-year debate over ObamaCare, cluttered with secret deal making and disregard of public opinion, irreversibly damaged President Obama's post-partisan brand – a perception far removed from how Barack Obama vaulted onto the national stage in 2004, "There are no red states or blue states, just the United States," or the "hope and change" manta of 2008. Most voters believe Members of Congress did not read the two thousand-page bill and think the law would not have passed had they done so (55 to 37 percent, according to a Fox News poll in April).

    In June 2010, shortly after health care reform became law, Resurgent Republic conducted a series of focus groups among Independent voters undecided in the upcoming congressional elections. Several voters expressed frustration with President Obama's job performance and the health care debate was a key rationale. Our memo analysis read in part:

    
    "For the Independents we talked with in Florida, the health care debate was another turning point. As a result of what they described as 'backroom deals' – citing the 'Cornhusker kickback' among others – they somewhat soured on their initial perception of Obama and seemed more likely to view him as ‘another politician.'" June 29, 2010

Filed under: Health Care