Worth Discussing

A Closer Look at Self-Insured Voters and their Impact on 2014

Luke Frans | November 11, 2013

In recent weeks, more than four million individuals and families who rely on the individual marketplace for health insurance received notices that their health insurance plans will no longer be available due to new requirements stemming from Obamacare. While the negative impact of Obamacare reaches beyond a single group, many of those who self-insure find themselves with an unwanted front row seat as the law moves from a Washington abstraction to a kitchen table reality.

Given the unfavorable wave of news coverage, it’s worthwhile to take a closer look at who self-insured voters are and what influence they might have in 2014. We reviewed data from surveys in 2009 and 2012 to learn about this group, both at the beginning of the Obamacare debate and in the middle of the presidential election. As a result, this analysis does not reflect any shifts attributed to the government shutdown or the sub-par Obamacare launch.

1. The percentage of voters in the individual market is larger than their share of the population at large. Among the total U.S. population, 5 percent (or as many as 15 million people) pay for their health insurance individually, according to the U.S. Census Bureau. In the lead up to last year’s presidential election, 21 percent of likely voters were in the individual market. This figure is very similar to our finding in 2009 where the self-insured equaled 18 percent of registered voters. Exit polls did not ask if voters have health insurance or what type, so it’s difficult to estimate the final percentage of the 2012 electorate. Even if turnout of low-enthusiasm voters cut the percentage in half, the percentage of self-insured voters would still be larger than their share of the population. 

2. Like most voters with health insurance, self-insured voters are overwhelmingly satisfied with their coverage. Three-fourths (77 percent) of those self-insured are either very or somewhat satisfied with their plan. That’s not far off from the electorate at large where 84 percent report being very or somewhat satisfied. Therefore, the salient reason why President Obama is on the defensive regarding his “if you like it, you can keep it” pledge is not just because he misled voters. It’s because he did so on a topic where solid majorities of voters do indeed like their health plan and thereby assumed the law would not upend their coverage.

3. Strong satisfaction is not the same as apathy toward health care reform. Those with self-insurance may like what they have, but like the electorate at large, they increasingly feel the financial pinch of rising health care costs. This was the top priority for health reform among self-insured voters during the 2012 election: 41 percent controlling costs, 29 percent improving quality, and 24 percent covering the uninsured. Their priorities were the same prior to the health care debate dominating much of President Obama’s first term. In 2009, 41 percent of self-insured voters said controlling costs, 30 percent improving quality, and 16 percent covering the uninsured.

Based upon these last two points, it’s likely that self-insured voters will not accept the president’s claim that only “substandard” or “cut-rate” polices are going away. Such policies would not garner solid satisfaction or cause those who have them to rank improving quality below controlling costs.

4. Voters in the individual market are twice as likely to self-identify as conservative than Republican. The partisan makeup of the individual market is split, but these voters are more likely to self-identify as Independents (33 percent) and Democrats (36 percent) than Republicans (26 percent). These figures are likely attributed to challenges with the Republican brand rather than ideology. Among the self-insured, 50 percent identify as conservative, 19 percent as moderate, and 25 percent as liberal. In addition, the percent identifying as conservatives is slightly higher than the senior-dominated cohort who receives government coverage (47 percent) or those with employer coverage (43 percent). 

5. Self-insured voters are representative of the middle class voters Republicans need to reach. These voters are middle-aged (nearly two-thirds between the ages of 30 and 64) with middle class incomes (60 percent earn less than $100k a year). They are predominately white (74 percent), married (65 percent), and are more likely to live in suburban (31 percent) instead of urban areas (22 percent).

6. Despite favorable demographics, data during the 2012 campaign indicate Republicans underperformed with self-insured voters.  They held a favorable opinion of President Obama (51 to 45 percent), and an unfavorable opinion of Mitt Romney (49 to 43 percent). Congressional Republicans faced a similar 6-point deficit on favorability and a 3-point disadvantage on the generic ballot. These are not the type of numbers one would expect from this voter profile.

7. This voting bloc could have a decisive impact in close races in 2014. Four of the nine most competitive states that Senate Democrats are defending have self-insured populations at or above the national average (5 percent). These states are Montana (9 percent), South Dakota (8 percent), Iowa (6 percent), and Michigan (5 percent).  The trio of North Carolina, Arkansas, and Louisiana has a significant 4 percent each. The universe of voters among these percentages is smaller, but given their conservative bent and the probability of outpunching their weight at the ballot box, it’s understandable why several Democrats in these states are seeking to delay the individual mandate and make good on President Obama’s “if you like it, you can keep it” broken promise. Moreover, the urgency for red-state Democrats to put daylight between themselves and the White House on this issue is heightened as premium sticker shock hits home. According to new analysis from the Manhattan Institute for Policy Research, the self-insured in six of the nine most competitive Democrat-held Senate seats up in 2014 face an average premium hike greater than 50 percent, not to mention higher annual deductibles and steeper premiums for younger, healthier individuals.


Concluding Thoughts
Throughout the Obamacare debate, President Obama’s “if you like it, you can keep it” pledge tempered anxious voters concerned about a massive rewrite of health care but willing to give the law the benefit of the doubt. Yet the president’s new revisionist claim that only “substandard” or “cut-rate” health policies are going away is a tacit acknowledgement that Obamacare is more about empowering an all-knowing federal government than giving families the freedom and opportunity to choose health plans that meet their needs.

The president is comfortable downplaying the scope of those adversely impacted by Obamacare, as he repeatedly did in his excuse-laden apology with NBC’s Chuck Todd, but red-state Democrats up in 2014 do not have the same luxury. Vulnerable Democrats can ill-afford to double down on the expertise of Washington and slander the majority of voters who express high satisfaction with their plans. The only fault of these voters was to take the president at his word, and as a result, their health care coverage is being disrupted with higher premiums, out-of-pocket expenses, and taxes.

Keep in mind, many of the self-insured are not partisans. They are more likely to identify as Independents or Democrats than Republicans. In short, they’re representative of middle class voters Republicans need to reach. If Republicans can effectively speak to the anxiety caused by Obamacare, they’ll find an attentive audience, especially in battleground 2014 states.

Filed under: Political Climate, President Obama, and Health Care