Nov 12

Written by: Mark Blum
11/12/2010 1:46 PM 

by Doug Dority and Mark Blum

It’s no secret that the electorate is deeply divided over health reform. Exit polls from last week’s midterms showed that 48% of voters supported repeal, while 47% supported either strengthening the law or leaving it as it is.   This is hardly a mandate to repeal or replace the 2010 federal health reform.

Political analyst Stuart Rothenberg observed,  “Yes, voters want more and better jobs and are worried about spending and a larger role for government. But anyone who thinks this election is a mandate to repeal the entire Obama health care bill or abolish the Department of Education or repeal any amendment to the Constitution is somebody who truly doesn’t understand public opinion or elections.”

Nevertheless, the 2010 midterm elections will change in the health reform playbook for both Republicans and Democrats. 

The midterm elections were, first and foremost, a voter protest at the slow pace of economic recovery and job creation two years after they gave Democrats control of the White House and both chambers of Congress. The economy and unemployment were the top concern for 61% of voters on November 2nd, according to exit poll data. Health care was the top concern for only 19%, and most of these voted Democrat.

Don’t expect those facts to translate into a scaling down of “Repeal and Replace ObamaCare” rhetoric in the 112th Congress.  As long as public support for the Affordable Care Act remains as deeply divided as it is, repeal of federal health reform will remain an integral part of Republican electoral and legislative strategy.  It will be pounded as a wedge issue in the chambers of Congress, with the continuing goal of dividing moderate Democrats from their party base and splitting off independents who voted Democrat in 2006 and ’08.

That strategy was sufficient for the minority party.  But as a party in leadership, it won’t be enough.

Why Support for the ACA has Hit a Low ceiling
Weak public support for the Affordable Care Act is rooted in the conspicuous absence in the law, despite its daunting scope, of a focused and coherent strategy to reduce growth in health costs borne by working households and businesses.  The reform law contains important provisions that polling shows to be consistently popular among informed Republicans, Democrats, and Independent voters – the prohibition of preexisting medical condition exclusions, elimination of caps on coverage, and family coverage for children up to 26 years old, for example.  Yet, hyperinflation in health costs remains the #1 health care concern for 85% of Americans who have health insurance (and more than 93% of actual voters).  

Barack Obama campaigned on reining in rising health costs in 2008, and voters endorsed his vision.   During the 15 months health reform incubated in Congress, however, Democrats’ focus morphed from bending the cost curve to expanding access to insurance coverage -- an intensely important issue for the 15% of uninsured Americans, but a secondary, largely altruistic concern for insured voters who comprise most of the electorate.   The health care crisis that voting Americans are actually experiencing is a crisis of insurance premiums rising 3 to 4 times faster than their wages -- and they see no coherent plan in the Affordable Care Act to reign it in.

This year, the cost crisis intensified with a nationwide 12.8% jump in the employee share of insurance premiums. In a sign of employer skepticism that federal reform will reduce health costs, businesses across the country instituted their own brand of cost containment. This year, businesses broke from a decade-long practice of holding insurance premium shares constant and shifted nearly 100% of the 2010 premium increases to their workers.

New Imperatives for Both Parties
Americans want results, and they’re impatient to get them. Republicans exploited voter impatience to win the largest turnover of House seats since 1948.  But voter impatience will become a vulnerability for House Republicans in 2012, if the electorate perceives that the GOP squandered the responsibility of leadership they were given, investing time and energy in futile effort to repeal health reform, rather than achieving reduced growth in health costs or accelerated creation of jobs.

That is where the opportunity exists for taking health reform from wedge issue to the solution American voters want.

At a press conference the morning after the midterm election, presumptive House Speaker-elect John Boehner said, "We have 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."  

While Democrats hold the majority in the Senate (and the President holds the veto pen), wholesale repeal of the Affordable Care Act in the 112th Congress is nearly impossible.   But enacting common sense reforms to bring down the cost of health care is not.

Now is the time to challenge Speaker Boehner and his House Republicans to meet the standard they have set for themselves. The GOP majority should be held accountable for doing everything possible to reach agreement with a Democratic-led Senate on reforms that will bring down the costs of health care that voters want, regardless of whether they can repeal the Affordable Care Act.

It is also time to challenge the President and Democrats in Congress to meet Republicans with their own proposals to rein in runaway health costs.  This amounts to a discussion of improving the Affordable Care Act that Democratic leaders didn’t want to have for another administration or two.  Postponement is no longer an option – not unless Democrats are prepared to serve passively for the next two years as defendants in Republican-run repeal hearings.

Senate Majority leader Harry Reid has indicated he is prepared to “tweak” the health reform legislation, if needed.  Tweaking won’t be enough.   Voter skepticism that the Affordable Care Act will rein in health costs delivered the Democrats a “dead-cat bounce,” rather than the lift many expected from their signature legislation.  To win back support from independent and cross-party voters, Democrats need to complete the unfinished business of health reform; they need to advocate convincing solutions to America’s health cost crisis.

Where the Solution Lies
Former HHS Secretary Tommy Thompson has said Republicans and Democrats actually agree on 80% to 90% of what is needed to rein in health costs.  Evidence supports him.

Surveys conducted by respected pollsters like Republican Bill MacInturff and Democrat Celinda Lake have shown that voters across the political spectrum consistently support health care reforms that will improve quality of health care and lower costs by strengthening the capacity of family doctors to provide the care coordination and individualized support patients need to be healthy. Their polling shows that Democrats, Republicans, and independents find common ground in supporting proposals America’s Agenda national labor unions and businesses have jointly endorsed that would place greater emphasis on disease prevention, eliminate co-pays and deductibles for chronic disease treatment, develop a national health information technology network of electronic medical records, and establish personal medical teams of health professionals coordinated by a primary care physician.

“We have to focus on what unites us,” said Secretary Thompson, “not on what divides us.”  There will be no lack of opportunities to find out if that’s possible.

The House Republicans’ obligatory vote to repeal “ObamaCare” will be perceived as mere political theater if it is unaccompanied by the proposal of serious reforms that would rein in health cost hyperinflation.  Democrats would commit a serious strategic error if they don’t engage Republicans in an effort to find common ground on reducing the costs of quality care.

Medicare reform is a similar proposition.  Both political parties understand that cuts in benefits (including raising the eligibility age) will bring a senior backlash   Yet, fee-for-service Medicare costs are rising at the same steep rate as commercial fee-for-service medicine, creating a drag on efforts to reduce the federal deficit. A serious initiative to rein growth in Medicare costs through accelerated implementation of proven, team-based approaches to high-quality care delivery would be in the best interests of both parties – and the American people.

The Affordable Care Act provides unprecedented new opportunities for states to strengthen the patient-doctor relationship through design of state health insurance exchanges that promote modernized, team-based care support, incent quality improvement and rein in excessive cost growth, as well-functioning health care markets should.  As long as the Affordable Care Act remains the nation’s law, elected state leaders of both parties should be challenged to seize the full potential the law provides to assure that their constituents have a choice of high quality care at affordable cost.

When it comes to core economic concerns like high unemployment and runaway health costs, voters are looking for solutions, not ideology. The American people have elected a divided Congress that can do its business only by reaching bipartisan agreements.  Both parties are on probation. The party that steps forward with real solutions, not wedge issues – and reaches across the aisle to get the People’s business done -- will be rewarded in 2012.


Doug Dority, former International President of the United Food and Commercial Workers is President of America’s Agenda: Health Care for All.  Mark Blum is America’s Agenda’s Executive Director.  America's Agenda brings together U.S. businesses, labor unions and government leaders who share a common commitment to achieving access to affordable, high-quality health care for every American.



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