Wednesday, September 9, 2009

Healthcare, Congress, and the Midterm Elections

Early last month, we asked “Will Healthcare Reform Survive the Tea-Baggers in August?” Well, now it appears that it all depends on your definition of “reform”.

For many progressives, reform is dependent on the creation of a public option as an absolute minimum. Ideally, many of them would prefer a single-payer system or even a national healthcare service. For others, reform is possible without a public option - even if they do agree with a public option, they still see the value in other reform measures, such as an end to pre-existing conditions.

In fact, Marc Ambinder recently wrote a very interesting piece in the Atlantic that Democrats have actually held together and healthcare reform will survive - even if it’s without the public option.

"After August, under the worst case scenario, there is majority support for the following major changes to health care: real (albeit limited) competition in the insurance industry (even absent a public plan). A cap on what a person pays for catastrophic illnesses. An end to insurance company recision policies. Guaranteed issue. A basic benefit package. Significant subsidies to help people who earn as much as $64,000 a year pay for health insurance. Better cost and coverage incentives. And lots more. Say what you will about these reforms -- maybe they're incremental -- but they're a foundation for center-left policy in the future."

But now some are wondering if the rowdy August recess and the Town Hall protesters have had some other meaningful impact: namely, putting members of Congress at risk in next year’s midterm elections.

From Gallup:

But will the healthcare debate sink Congress?

First, let’s take a look at Gallup’s most recent Congressional approval polls. While still low at 31%, it’s a bit of a boost since last year, when Congressional approval was at just 19%.

And most of that boost has come from Democrats (and a plurality of Americans identify as Democrats).

So while approval is still low, it does appear to be considerably better than it used to be for members of Congress.

Next we turn to our friends at where Joshua Grossman points to recent special elections in California and Iowa as evidence that Democrats - who control both chambers in Congress - are still “alive and kicking”.

"It’s certainly possible that Obama will antagonize the Democratic base by not advocating strongly enough for a public option in his health care proposals. It’s also possible that the drum beat of Republican attacks on everything associated with Obama and the Democrats will continue to drive down Democratic support among Independents. The pendulum tends to swing over time. But for now – looking at actual elections, not polls which can be spun any which way – there’s no hard empirical evidence of significant changes in the electorate’s behavior since November of 2008."

538’s chief blogger, Nate Silver, would likely agree. As we posted earlier, he recently used a model to find that a majority of Congressional districts probably approve of healthcare reform - and healthcare reform with a public option!

He even lists each member of Congress and how much their district probably supports or opposes the public option.

Yet Tom Schaller would probably disagree. He relays an analysis from the Cook Political Report which compares the 2010 midterms to the 1994 Republican Revolution. While most of the Cook report has to do with ethnic makeup of the electorate (white voters make up a considerably higher percentage of the turnout in midterms) there is some evidence that particular issues will play a significant role.

From the report:

"In 1994, it wasn't easy to be a Bush-district Democrat who voted for both the Clinton budget and the Brady handgun bill. In fact, out of the 12 Democrats who fit this description and ran for reelection, two thirds lost. So far this year, 20 of the 49 McCain-district Democrats have already voted for the "cap and trade" bill. If the House Democratic leadership insists on putting a health care bill with a public option to a vote, how many of these 20 can be relied upon to take on more political risk?

On the other hand, the lessons of 1994 might serve as a reality check for GOP challengers to Democrats who plan to vote against their party's leadership on both of this year's dominant agenda items, such as Reps. Bobby Bright (AL-02), Parker Griffith (AL-05), and Chet Edwards (TX-17). In districts with challenging numbers, the strategy of voting (and running) against party leadership has persisted for generations, if sometimes for only one reason. It works."

Schaller even points out that this may be why the Blue Dogs have been so reluctant to support a public option - despite Silver’s claims that it might actually help many of them.

Ultimately, though, it seems far fetched to say that healthcare reform will be the single biggest issue in next year’s elections. Most Congressional elections come down to the on-the-ground circumstances of competitive (typically open-seat) races and rather than a particular national issue. Voters might say that healthcare reform will be a major issue in their decision now - after all, now is the time that healthcare is a big issue - but voters tend to forget a lot in 14 months.

Furthermore, Congressional approval is usually pretty low, but incumbent members of Congress never seem to lose their seats. Americans hate Congress, but love their Congressmen.

Still, this isn’t the first time we’ve seen the 2010 midterms have been compared to 1994. In the end, there’s probably no good way to say - at this point - what impact the healthcare debate will have on the voters in November next year.

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