Imagine a Congress and a president of the same party working on health insurance reform. They write up a piece of legislation, and it’s not popular. Within two weeks of its introduction in Congress, the bill garners just 41 percent support from the American public, and the opposition party is completely against it. People protest. People yell at lawmakers. The lawmakers pass the bill anyway, and the party and president are summarily punished in the next election: They lose a ton of seats in Congress. That was President Obama, Democrats and the Affordable Care Act in 2009 and 2010. Minus the passing-the-bill part, that was President Bill Clinton, Democrats and “Hillarycare” in 1993 and 1994 too.
Now imagine a bill that’s even more unpopular, and you have House Republicans’ health care legislation in 2017, the American Health Care Act. The bill is aimed at repealing and replacing parts of the ACA. It’s polling worse than the ACA and the Clinton effort, and history suggests that it could have disastrous consequences for the GOP.
First, the basics: The AHCA is much more disliked than the ACA and Clinton’s health care reform bill were when they were first introduced. Across nine surveys, the AHCA has garnered an average of just 32 percent in favor compared with 45 percent opposed.
|Morning Consult (3/13)||46||35||+11|
|Morning Consult (3/19)||40||37||+3|
|Public Policy Polling||24||49||-25|
Health care is difficult, so it shouldn’t be too surprising that people dislike the Republican health care bill. What is surprising is how quickly opposition has coalesced. More people supported than opposed Obama’s health care bill in every poll before July 2009. Two weeks after Clinton’s health care bill was introduced in October 1993, it had plurality support — 46 percent in favor to 41 percent opposed — in an average of four surveys.
Just as scary for proponents of the GOP’s bill is that the status quo (the ACA, aka Obamacare) is more popular than unpopular for the first time in seven years, and opposition to changing it is growing.
As recently as December, the Kaiser Family Foundation, a health policy research organization, found that 49 percent of Americans said the ACA should be repealed, compared with 47 percent who said it should not be. In a March Kaiser survey, 51 percent said it should not be repealed, and 45 percent said it should be. In other words, the trend is in the wrong direction for Republicans.
The same thing happened to Democrats with the ACA and Bill Clinton’s health care bill. Although Americans were initially open to Obama’s health care reforms, the bill that eventually morphed into the ACA had more opposition than support from the public within two weeks of its introduction in Congress. (Opposition climbed even higher before the bill was passed in March 2010.) And although Clinton’s bill started out as relatively popular, just 39 percent were in favor and 50 percent were opposed in an average of surveys in July and August 1994. Clinton gave up on the legislation that August.
Second, enthusiasm is on the side of those against change — just as it was in 1993 and 2009. In the most recent Fox News poll, only 17 percent of Americans strongly favored the AHCA. (Pollsters often ask respondents if they have a strongly favorable, somewhat favorable, somewhat unfavorable or strongly unfavorable view.) Forty percent strongly opposed it. SurveyMonkey and YouGov polls show comparable splits. These numbers look a lot like an NPR poll from late July 2009, in which only 25 percent of Americans were strongly in favor of Obama’s health care bill and 39 percent were strongly against it. The Clinton health care bill was more popular at the outset, but even in early November 1993, a Wirthlin Group survey found that those strongly opposed (27 percent) outnumbered those who were strongly in favor (21 percent).
Those strong feelings were important in 1993 and 2009 because they foretold an opposition that would prove loud and durable. Congress heard those voices in 1993 through hundreds of thousands of phone calls and letters from angry constituents. You saw this strong opposition in the raucous congressional town halls of 2009. The AHCA is facing the same type of opposition at angry town halls this year. In 1993 and 2009, that deep disdain grew among the public as the bills became better known.
Third, and perhaps the most worrisome for AHCA proponents: Many self-identified Trump voters are not supporting the bill. Trump won the election without a plurality of the national popular vote, and Republicans tend to win more seats in the House and Senate than their national vote percentage would lead us to expect. These factors suggest that many congressional Republicans can survive as long as their base stays with them.
Right now, though, the share of Hillary Clinton voters who oppose the Republican bill is much larger than the share of Donald Trump voters who support it.
|POLLSTER||CLINTON VOTERS OPPOSE||TRUMP VOTERS SUPPORT||DIFFERENCE|
|Morning Consult (3/13)||63||68||-5|
|Morning Consult (3/19)||63||61||+2|
|Public Policy Polling||77||43||+34|
In an average of eight recent polls that included data on whom respondents voted for in 2016, only 60 percent of Trump voters said they supported the bill. Put another way, about 40 percent of Trump voters, on average, don’t support the AHCA.1 That means Republican primary voters may be less likely to punish GOP members of Congress for not voting for the bill than President Trump would like. Further, even if Republicans have tried to inoculate themselves in safe districts for the general election, the lack of support for the bill from Republican voters means that some of these members from typically safer districts could be vulnerable against Democrats if health care becomes a defining issue in the 2018 midterm elections.
The relative lack of support from Republicans resembles the lack of support from the Democratic base for Clinton’s and Obama’s health reform efforts. By July 1994, as the public turned against the Clinton health care bill, only 58 percent of self-identified Democrats were in favor of it in a Yankelovich Partners survey. A much higher 76 percent of Republicans were against it. A Pew Research Center poll taken at this point during the Obamacare debate found that 61 percent of Democrats were for the bill and 76 percent of Republicans were against it. A CBS News survey taken immediately after the ACA passed had a similar finding. In both the 1994 and 2010 midterms, the imbalance between opposition from Republicans and support from Democrats presaged a higher percentage of Republicans voting for Republican congressional candidates than Democrats voting for Democratic congressional candidates. Democrats lost more than 50 seats in the House in both elections.
Of course, public opinion on health care in 2017 might not follow the path of either the Clinton or Obama health care reform efforts. There are still a lot of Republicans who are undecided on Trump’s health care bill (about 25 percent in an average of recent polls). With the severe polarization in politics, these voters may come home. And as I mentioned in a previous article, polling indicates that Americans are open to some incremental changes to the ACA. I wouldn’t bet on public opinion on the AHCA swinging positive, though. SurveyMonkey finds that the Americans who are following the debate most closely are those most likely to oppose the bill, which suggests that as more Americans learn about the AHCA, more may turn against it. That, again, matches what we saw during the ACA debate in 2009.2 The fact is that the AHCA just isn’t that popular, and if Republicans pass it, they will probably be enacting a health care law that most Americans do not want. In the past, trumpeting such a plan has had steep electoral consequences.