by Maggie Mahar
crossposted with Health Beat
The media continues to report that the Massachusetts vote was a referendum on health care reform — and that this has the White House worried. If so, the White House is wrong. Take a look at polling conducted by Hart Research Associates for the AFL-CIO on the evening of the election, revealing who voted for Brown –and what those voters said. Then consider separate polling done by the Washington Post together with the Kaiser Family Foundation and Harvard University. Read both reports, and you’ll have a very hard time believing that Scott Brown’s election represents a mandate on healthcare legislation.
Finally, factor in the eye-opening Kaiser Family Foundation January tracking poll, and what it reveals about what voters do and don’t understand about health reform legislation. If most voters have only a hazy idea of what is in the legislation, you really can’t say that they voted against the Senate bill.
Who Voted for Brown ?
Democrats who are disillusioned that Obama has not pushed further on health care reform? Upper-middle-class voters who believe that Obama doing too much, going too far, and may well hike their taxes? No, the surprise is that Brown was elected by Massachusetts’ working class, and they were not focused on health care legislation.
Non-college men voted for Brown by a 27-point margin (59% to 32%), and non-college women also voted for Brown by 13 points (while college women went for Coakley by 13 points).
If you look at all college graduates, Coakley won this election by five points among college graduates, but lost the non-college vote by a 20-point margin. This represents a huge swing among non-college voters since 2008, when Obama won by 21 points, for a net swing of 41 points.
What happened? How did Democrats lose so many working class voters? Many of the non-college voters who chose Obama a year ago were Latinos and African Americans. This time, they stayed at home, according to election eve and election night polling done jointly by the Republican firm American Viewpoint and the Democratic group, Lake Research Partners on behalf of the nonpartisan group Women’s Voices. WomenVote. (Unmarried women and younger voters also came out in fewer numbers. )
Keep in mind that a minority of white voters pulled the lever for Obama in 2008—he needed non-white voters to carry him over the top. Apparently this time Democratic organizers in Massachusetts didn’t work very hard to bring out their vote, or to explain to minority communities that, even if they didn’t particularly warm up either candidate (which I can well imagine), this vote could be important for health care reform.
The Hart poll was done on the evening of January 19, when pollsters conducted a telephone survey among 810 voters in the special election for U.S. Senate in Massachusetts. The survey has a margin of error of ±3.8 percentage points. (The pollsters note that “the survey data were weighted to be consistent with the actual election results, yielding a five-point margin for Brown –50% Brown, 45% Coakley, 1% other candidates, 4% refused).
In the end, the pollsters observe that the results of this election “were not a call to abandon national health care reform.” 82% of voters were aware of Scott Brown’s opposition to health care legislation supported by President Obama and congressional Democrats, but “it had virtually no net impact on the Senate election.” Here is the money line:
“Those who knew Brown’s position [on reform] were as likely to say it made them less likely (39%) to support him as to say it made them more likely to support him (41%).”
A few HealthBeat readers have suggested that Massachusetts elected Brown because they have seen health care reform in their own state, and do not like it. But the poll reveals that two-thirds (67%) favor the Massachusetts health insurance law that ensures nearly universal coverage, including 53% of Brown voters
Moreover, the poll confirms HealthBeat reader Pat S’s argument that the vote had more to do with personality than issues: “Considerable evidence exists that this election was largely about the individual candidates, Coakley and Brown, more than a referendum on President Obama or the Democratic agenda.”
By 61% to 33%, Massachusetts voters said they were picking the best candidate to be their U.S. senator, rather than “sending a message to Washington.” Drill down, and look only at Brown’s voters, and you’ll find that they, too, say they were selecting the best candidate, not sending a message to Washington about the direction of the country (52% to 42%). People simply liked Scott Brown better. His personal rating from voters was 51% positive to 32% negative (net +19 points), while Coakley had much weaker personal ratings at 40% positive and 37% negative.
Voters were not expressing dislike for the president: Massachusetts’ electorate give Obama much better ratings than Coakley (52% positive, 33% negative), and approval of the job he is doing (52% approve, 38% disapprove).
Insofar as they were voting on issues, those polled reported that they were most concerned about the economy and jobs. Electing a candidate “who will strengthen the economy and create more good jobs” was the single most /very important factor according to 79% of those polled.
Health care reform placed a distant second: “Electing a candidate who is committed to controlling health care costs and covering the uninsured” (single most/very important factor) among only 54% of all voters. The working class voters who elected Brown have been hit hard by the economy. That is their immediate concern. As Hart notes:
“Economic dissatisfaction played a large role in Brown’s victory. The majority of voters who said the Massachusetts economy is not so good or poor (52%) voted for Brown by 56% to 39%. However, voters who said the economy was excellent, good, or fair supported Coakley by 52% to 43%.”
A Second Poll
Over at the Washington Post, Ezra Klein reports on the Post/ Kaiser/ Harvard poll srv/politics/polls/WaPoKaiserHarvard_MassPoll_Jan22.pdf , a second survey that tried to determine why voters chose Brown.
This Washington Post-Kaiser-Harvard poll was conducted by conventional and cellular telephone Jan. 20-21, among a random sample of 880 voters in the Massachusetts special election. The margin of sampling error for the sample of voters is plus or minus four percentage points.
After reviewing the results, Klein observes:
“The results make it untenable to argue that the election had nothing to do with national issues in general or health-care reform in particular. But it makes it similarly hard to argue that the state is firmly opposed to health-care reform, or that Scott Brown’s election is a mandate against the bill.” .
I agree, but I would go further. When I took a close look at the questions and the results in the Post/Kaiser/Harvard poll, I discovered that it tended to confirm much of the Hart research.
First, 91% of Brown’s voters considered the economy and jobs “extremely important or very important” compared to 84% of Coakley’s voters.
More importantly, 88% of Brown’s voters thought “leadership and personal qualities” were “extremely important or very important” compared to just 69% of Coakley’s voters. (This supports the notion that, to a large degree the folks who picked Brown were selecting someone they liked, without worrying as much about the issues. )
Granted, 93% of Brown’s voters said that health care reform is “extremely important or very important,” but as Ezra notes,
“48 percent of Brown’s voters think that Brown should work with Democrats on the health-care reform bill rather than partner with Republicans to sink the effort altogether. Which suggests that though Brown’s election was far from an affirmation of President Obama’s agenda, nor was it a call for relentless obstruction.”
There are many contradictions in the way Brown voters responded to the Washington Post/Kaiser/Harvard poll’s questions. (This is not unusual. Human beings are, well, peculiar creatures. We often disagree with ourselves. And Brown’s voters do not all agree with each other.) On the one hand the vast majority of Brown voters who were polled say they are opposed to the health reform legislation—but their reasons for disliking it vary widely. Many in the media have suggested that those who voted for Brown were disgusted by all of the deal-making and the way Democrats cave to special interests.
But when Brown voters who said that healthcare was “extremely” or “very important” were asked to be more specific, only 13% of Brown voters said they “Didn’t like the way it was being handled; politics; deal-making; closed doors lack of transparency.”
What is striking is just how varied the responses were:
– Nine percent of Brown voters said healthcare is important because they “generally support reform or the current bill. Just 22 percent said they put healthcare reform near or at the top of their list because they are generally opposed to reform or the current bill.
– Fourteen percent said healthcare is important because they’re concerned about the cost of the bill—increased taxes, government spending and the deficit.
– Twelve percent of Brown voters said health care reform mattered to them because they are opposed to government involvement in health care.
What may be most telling is that among Brown voters who think health care and health care reform is “extremely or very important” only 2% agreed that “everyone should have health care; healthcare is a right.”
When explaining why healthcare is important to them, none named the “need for more/better coverage for the uninsured.” This suggests that many of Brown’s voters may be opposed to the legislation because they are opposed to the basic idea of universal coverage—whatever form the legislation takes.
By contrast, when explaining why they are focused on healthcare 21 percent of Coakley’s voters said “everyone should have healthcare; it is a right;” and 8 percent mentioned the need for better coverage for the poor.
This suggests that many of Brown’s voters are conservatives or libertarians who don’t believe that a civilized country has a responsibility to make healthcare available to everyone. They believe in “personal responsibility.” Everyone should take care of themselves and their own families.
The fact that so many African-Americans, Latinos, didn’t turn out helped skew the results; the majority in these communities do believe that healthcare is a right.
How Can People Oppose Legislation They Don’t Understand?
But the strongest argument suggesting that the Massachusetts vote was not a vote against reform can be found in a Kaiser Family Foundation study that polled households shortly before the Massachusetts election. http://www.kff.org/kaiserpolls/8042.cfm The survey showed voters sharply divided on the legislation along Democratic and Republican party lines, with Independents evenly divided (41 percent support the legislation; 43 percent don’t)
But most importantly, the polling showed that most voters have only a dime idea of what is in the bill. According to Kaiser, “The poll finds that even after a year of substantial media coverage of the health reform debate, many Americans remain unfamiliar with key elements of the major bills passed by the House and Senate.”
– Nearly 40 percent did not know that the bill would prohibit insurers from denying coverage because of pre-existing conditions.
– The majority of seniors had no idea that the Senate bill would help close the Medicare “doughnut hole” so that seniors would no longer face a period of having to pay the full cost of their medications.
– Forty-eight percent of all Americans had not heard that the legislation would offer tax credits to small businesses to help them buy insurance for their employees.
– Forty-one percent are not aware that if they have employer-based insurance, the reform legislation will not change existing arrangements.
– More than one quarter of all Americans had no idea that reform legislation would provide subsidies to help low-income families buy insurance.
– Thirty-seven percent did not realize that insurers would be forced to provide a basic benefit package, defined by the government—no more “Swiss Cheese policies” filled with holes.
– Sixty-three percent were unaware that insurers will no longer be allowed to charge women more.
In each case, those polled responded more favorably to the legislation as they heard about these provisions. For instance, when they were told about the tax credits for small businesses 73 percent said they would be more likely to support the bill.
In general, the more respondents learned about the bill, the more positive they were. “It’s one thing to talk about the public’s perception of health care reform legislation, which right now is in some ways negative, but it’s another to tell people what’s actually in the bill and when you do that people are more positive,” said Kaiser President and CEO Drew Altman.
Why do so few Americans know what is actually in the legislation? A blizzard of misinformation has created much confusion. In newspapers and on television, you regularly hear that ordinary Americans will be forced to buy insurance they cannot afford (no mention of subsidies or caps on out-of-pocket payments which should virtually eliminate medical bankruptcies.) You read that small businesses won’t be able to afford a mandate (no mention of tax credits.)
Americans have been told that the Democrats are making no effort to rein in spending (no mention of the pages and pages of proposals that would cut Medicare costs, paving the way for lower health care bills throughout the system.) They are warned that Medicare beneficiaries will be hurt (no explanation that Medicare cuts are targeting unnecessary care that puts patients at risk without benefits; no mention that the bill will help close the donut hole that now forces Medicare patients to pay for their drugs out-of-pocket.)
We have been told that insurers will continue business as usual (no mention of the provision that prevents them from putting a lifetime cap on benefits, or the plank in the legislation which says that insurers must spend a certain percentage of the premiums they receive on healthcare. If they don’t spend it, they are required to give their customers a partial refund.)
The other reason most people aren’t aware of what the Senate bill would do is because they are busy. They are working. They are raising children. They don’t have time to pay attention to the devilish details. In some cases, they don’t have the education or the powers of concentration needed to absorb and analyze this legislation. That’s not what they do for a living.
Why can’t some of the analysts boil the bill down to a few pages, and six power-points? Because the benefits are all in the details, and often those details are interlocking. You cannot understand one without understanding another. (I’ve written a three-part post that tries to cover all of the important points—both the pros and the cons. See Glass Half-Empty, Glass Half-Full, parts 1, 2 and 3)
But the truth is that re-forming a $2.6 trillion industry that serves (or at least should serve) millions of very different people—young and old, sick and healthy, poor, working-class, middle-class, upper-middle-class and wealthy requires thousands and thousands of adjustments. Just spelling out what will be covered requires many pages, and many amendments.
For instance, did you know that the legislation would require that insurers cover vision and dental care for children? That’s just one of those adjustments that will make all of the difference for some families.
– Finally, it is true that some Americans are strongly opposed to both the Senate bill and any reform legislation.
As Kaiser’s January tracking poll observes: “Views on the proposed legislation seem indelibly partisan: A solid majority of Democrats (64 percent) support the proposals being discussed, while an even larger majority of Republicans (76 percent) oppose it. When it comes to the enthusiasm gap, strong feelings are significantly more predominant on the right, with twice as many Republicans saying they ‘strongly oppose’ the proposed legislation as Democrats saying they ‘strongly support’ it.”
“Political independents, that critical swing group, are divided down the middle: with 41 percent supportive and 43 percent opposed.”
The bottom line is this: the Massachusetts special election does not serve as a referendum on health care legislation. The voters who chose Brown chose him for myriad reasons. They say that they knew he opposed the legislation; about half of his voters counted this in his favor, while half counted it against him. Go figure.
The White House should ignore the Massachusetts election.
Nationwide, most voters have only a sketchy idea of what is in the bill. . So it’s impossible to talk about whether they favor or oppose current legislation. People can’t reject something they don’t understand – unless they are simply against reform on first principles, i.e. they don’t believe in universal coverage.