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Healthcare Reform: Poll Nuances Show It Won't Be a Big Drag in the Elections

Election campaigns, to steal a phrase from former President George W. Bush, "don't do nuance," and the results are easy to see in the barrage of attacks against healthcare reform. While some widely quoted poll results suggest that a solid majority of the public opposes the Affordable Care Act, the majority neither opposes nor favors the legislation, according to an analysis of 17 recent surveys by Robert Blendon and John Benson of the Harvard School of Public Health (HSPH). Most people wish that aspects of the law were different, but they don't want to throw it out entirely. So the Republicans and Tea Partiers who are shouting "repeal and replace" may not benefit as much as they expect from their rejection of reform.

An HSPH survey conducted Oct. 1-12 found that while only 18 percent of registered voters believed the law should be implemented in its current form, 31 percent wanted Congress to amend the statute in ways that would increase the government's role in healthcare. In contrast, 41 percent wanted to "repeal and replace" the legislation. So 49 percent -- nearly half of registered voters -- either supported the reform law or thought it didn't go far enough. That's a nuance that has so far escaped most of the pollsters: many people who find fault with the Affordable Care Act are not opposed to its philosophy, but don't think it's strong enough to get the job done. That's a rather different stance from the Republican battle cry that the ACA is a "government takeover of healthcare."

Blendon and Benson speculate that many of the people who'd welcome more government involvement are probably supporters of the "public option," which got watered down to nearly nothing during the Congressional debate. Of course, from the viewpoint of conservatives and insurance companies, the public option -- a government-sponsored plan that would compete in the state health insurance exchanges -- would inevitably lead to a single-payer system. And there's no doubt that that's what some public-option advocates desire. So, even if they tell pollsters that they don't like the reform law, it's not because they're against reform.

The battle lines are much more sharply drawn between likely voters. Among those who said they were going to vote for Democratic candidates, 73 percent favored the Affordable Care Act. Among voters who leaned toward Republican nominees, 80 percent opposed the legislation. Similarly, more Democrats than Republicans were likely to say that the reform law would have a positive impact on the economy. But overall, 38 percent of registered voters said the economy would be worse off because of the legislation, vs. 21 percent who said it would improve as a result. According to another poll, two-thirds of the public believes their taxes will be higher in five years because of healthcare reform.

How will this affect the election? To begin with, seven in 10 respondents to a Pew poll said that a candidate's position on reform would affect their vote. Sixty-seven percent of Democrats said they'd be more likely to vote for a candidate who favored reform, while 72 percent of Republicans said they'd be less likely to vote for such a nominee. Among independents, 29 percent would be more likely, and 37 percent would be less likely to vote for a pro-reform candidate. Considering the margin of error and the fact that the economy trumps healthcare as an election issue, these results indicate that reform supporters and opponents are in a dead heat.

Of course, the impact of healthcare on the election will vary from district to district and from candidate to candidate. But those who suggest -- mainly for partisan reasons -- that healthcare reform is like a ball and chain around the legs of Democratic candidates just aren't acknowledging the nuances in the poll results.

Image supplied courtesy of Flickr.