Pulling It Together: The Message from Massachusetts
The Massachusetts special election has roiled the political world and profoundly affected the prospects for health reform just when it looked like passage was a lock. Efforts are underway to put health reform legislation back together again on Capitol Hill, but not since powerful Ways and Means Chair Wilbur Mills fell into the Tidal Basin with Fanne Foxe in 1974, halting momentum on a deal on health reform that seemed ready to happen, has something this unexpected so affected the prospects for health reform at the eleventh hour.
Since the Massachusetts vote many have claimed it was a referendum on national health reform. To test that assumption with actual data we conducted a post-election poll of Massachusetts special election voters with the Washington Post and colleagues at Harvard University. The findings suggest that the story of health care and the special election is far more nuanced than some have made it out to be.
First, while health care policy did top the list of voting issues, the economy and general discontent with Washington also were significant factors for Brown voters. Second, and perhaps more importantly, Brown voters’ top complaint about health reform was not about the substance of the legislation itself or its perceived impact on them or their families, but about a policymaking process that they seemed to think had gone badly wrong.
For Brown voters health reform became a reflection of, and in some ways a proxy for, deeper concerns about how Washington works today. We saw health care play this kind of larger symbolic role once before in another special election that marked an historic moment in health reform: the 1991 Pennsylvania Senate race in which Democrat Harris Wofford pulled a surprise victory over Republican Dick Thornburgh. Our polls showed that health care was the number one issue in that race too. But in 1991 in Pennsylvania, health was largely a proxy for the deeper voter worries about the economy. That race marked the occasion of the first Kaiser poll and spurred our decision to get into the business of doing independent polling and survey research on health policy.
Our more recent post-election poll of special election voters found health care was the top issue in Massachusetts, both among those who supported now-Senator Scott Brown and among those who voted for Democrat Martha Coakley, named by about one in three voters as the primary factor in their vote. Overall, nine in ten voters said health care was a factor at some level in their voting decision.
When we asked those health care voters who went for Brown what they meant when they said reform efforts were a factor in their vote, the top response – offered by thirty percent of this group – revolved around their anger with some aspect of the political process. What about the process was making Massachusetts voters so “wicked mad”, as we famously say in Boston? Here is a flavor of what our poll respondents said in response to an open-ended question that enabled them to tell us what was on their minds:
“I don’t like the way that the healthcare plan is being handled. They have bought senators’ votes. They have paid off senators in Louisiana and Nebraska and they made a special deal with labor unions regarding the Cadillac healthcare plan. They fixed it.”
“I don’t like the way they vote on everything behind closed doors. Obama does just what he wants to do because he is president and no one really seems to know what’s going on.”
“There hasn’t been any meaningful discussions. They are behind closed doors. [They] need to back up and take this more slowly. We have universal health care in Massachusetts. Not perfect, but a model.”
“No one has told us anything that is going on in health reform. We have been given no specifics. I am recovering from leukemia and I have no idea of what coverage will be available and also the costs I will face.”
“[I am] offended they are pushing the health care bills down our throats. They are rushing the greater good by getting it done, instead of getting it done right.”
“I feel they are not looking out for the individual, they are looking out more for the political party. They are not listening to the people who elected them, just to the political party.”
“The health care bill [is being] rammed through, and it’s important to have this. With Coakley there would be less of a chance to have a better bill.”
This is not to say that opposition was solely about the process, or that all Brown supporters would back a public option and a boost in the subsidy levels if only these were first discussed in lengthy, open-door meetings covered by C-SPAN. Many Brown voters expressed opposition to the proposed legislation (22 percent) or concern about the personal impact of reform (13 percent). Still, it’s worth emphasizing that substantive objections to policy did not top the list. One reason is that people don’t understand the details of the legislation. Another is that Brown’s campaign focused less on the substance of the legislation – much of which is similar to the plan adopted in Massachusetts with his support – and more on his campaign argument that Bay State residents, who already have health reform, would have to pay higher taxes if national health reform passes, and on the special deals made in Washington to win support from key Democratic senators.
So what now? What do Massachusetts voters want their newly elected Republican senator to do on health reform when he goes to Washington? According to the poll, seven in ten voters, including nearly half of Brown supporters (48 percent), want Senator Brown to work with the Democrats on health care reform. The same opinions held for independents: nearly two thirds of independents (64 percent) say they want to see Brown work in a bipartisan way on the health care proposals put forward by President Obama and the Democrats in Congress. (And ultimately Senator Brown will need to run for reelection in Massachusetts, a state that elects Republicans but moderate to liberal ones).
Yes, health reform was a factor in my home state. But the message from Massachusetts seems to have been more about dissatisfaction with Washington and the political process than about the substance of health reform itself. Meanwhile, this same dynamic appears to be playing out in national views of health reform legislation. The proposed reforms have taken a beating in public debate and in the polls, including our own surveys which show the public split down the middle when you ask them for a general up or down opinion on the proposed legislation. But as our latest tracking poll shows, when we ask the public about the actual specifics of the legislation they tend to be much more supportive. Here too the public may be reacting more to the exaggerations of the debate, the inherent combativeness of the process and the general failure to communicate the ways in which the proposed legislation would benefit ordinary Americans than to the substance of the legislation itself.
Angry voters are angry voters, and it’s not necessarily good news for our political system, or for incumbents, if the voters are rejecting the process more than the substance. But it’s better news for health reform than the post- Massachusetts conventional wisdom would have us believe. It suggests both an opportunity missed and an opportunity still ahead to communicate more effectively with the public about what health reform will do for them.
also of interest
- Assessing Americans' Familiarity With Health Insurance Terms and Concepts
- Explaining Health Care Reform: Questions About Health Insurance Subsidies
- Visualizing Health Policy: Health Coverage Under the Affordable Care Act (ACA)
- Survey of Health Insurance Agents: Assessing Trends in the Individual and Small Group Insurance Markets