Political controversies surrounding healthcare reform law may continue

A comprehensive review of national opinion polls taken before and after Congressional voting and when President Obama signed into law a major healthcare reform bill last month has found that the law's signing did not lead the country to come together in support of this landmark legislation. Partisan differences are stark, according to researchers at Harvard School of Public Health (HSPH) who analyzed 33 independent opinion polls in an effort to gauge public support for healthcare change. These political differences have implications for the implementation of the legislation and for the 2010 Congressional elections as many potential voters want the law to be scaled back while many others want the law changed to expand government's future role.

The analysis, by HSPH's Robert J. Blendon, Professor of Health Policy and Political Analysis, and Research Scientist John M. Benson appears as an Online First Perspective in this week's New England Journal of Medicine (www.nejm.org)

"While the bill has been signed into law, the critical details of its implementation are far from fixed," said Blendon. "Partisan differences in views about what should happen to this law remain so great that a Republican victory in either House could change the direction of the current reforms."

In the weeks before enactment, none of 10 polls showed a majority of Americans favoring the legislation. The level of support for the bill did not change significantly from the end of August 2009, after it was debated over the summer recess in town hall meetings around the country, to when it was voted on and enacted in March 2010.

While in aggregate the American public did not support the legislation, the level of support varied greatly among individual groups of Americans. In a poll conducted Feb. 4-8, 2010, before the vote, about three fourths of Democrats (76%) favored enacting the legislation, whereas more than three fourths of Republicans (79%) were opposed. In addition, adults 18 to 29 years of age were significantly more likely than seniors (64% vs. 40%) to express support, nonwhites more likely than whites (69% vs. 38%), people from households with incomes under $50,000 more likely than those from higher-income households (55% vs. 36%), and women more likely than men (50% vs. 42%) to express support (ABC News/Washington Post poll).

In the days after enactment, two polling organizations asked specifically about the electoral impact and found that 35% to 38% of registered voters said they were more likely to vote against a candidate who supported the bill; 25% to 27% said they were more likely to vote for such a candidate; 34% to 36% said it would not make any difference in their vote (Quinnipiac University; Washington Post polls).

When asked what they thought Congress should do about the health care law in the future, 23% of the public said they thought legislators should leave it as it is; 27% thought Congress should make additional changes to increase government's involvement in the nation's health care system; and 47% thought Congress should repeal most of the law's major provisions and replace them with a completely different set of proposals (CNN poll).

"Political controversies surrounding this law may not disappear," the HSPH authors write. "Its provisions are to be phased in to actual practice over a long period, during which there will be three congressional elections and one presidential election."