Editor's note: This column was co-authored by Hadley Heath Manning.
Republicans are struggling with how to handle Obamacare and its manifestations. How best to respond to fallout from the pending Supreme Court King v. Burwell decision? Should Congress use reconciliation this summer? If so, to what end? And more fundamentally, for the duration of Obama’s presidency, what progress can be made in health care given the presidential roadblock?
A new survey sheds light on all those questions, and key considerations, such as what the American people—including the conservative base--expect from Congress.
McLaughlin Associates, on behalf of Independent Women’s Voice and our Bridge to Better project, surveyed 1,000 likely voters between May 19th- 22nd.
No surprise, American voters disapprove of Obamacare 52% to 44%. But the survey provided important insight into what Americans want to do with the unpopular law. Only one-in-four voters want to either keep the law as is (4%) or make minor changes to it (21%). On the other side, 20% want full repeal with no further legislative action, 28% want it repealed and replaced, and an additional 22% would keep the law, but with major changes. This is an important finding for Republicans: Most Americans want more than just repeal. They want a better health care system, either after repeal or by significantly changing current law.
Clearly it's not just conservatives who want a change from ObamaCare. In fact, important swing voters also want reform. Among the 16% of all voters who are not voting for Republicans in Congress but disapprove of the job President Obama is doing, that rises to 61% supporting repeal/replace or major fixes, and an additional 25% simply wanting repeal.
These preferences shape perspectives on the different legislative challenges ahead.
The Supreme Court will rule this month on the King v. Burwell case, which contends the IRS has been illegally giving subsidies and enforcing mandates in states that did not create health exchanges, contrary to the explicit language of the law. If the Court rules against the IRS, people in at least 34 states would no longer be subject to the individual and employer mandates, while an estimated 7 million people would no longer benefit from federal subsidies that go to insurance companies to help pay for their insurance. Some may therefore lose their insurance. When respondents were provided an evenhanded explanation of the potential effects of a decision for the plaintiffs in King v. Burwell, only 11% wanted to let the court decision take effect and do nothing. Twenty-nine percent (of whom 76% are Democrats) wanted Republicans to vote with Democrats to change the law and reinstate the subsidies and mandates.
But 13% saw it as an opportunity to make major changes, even knowing President Obama would likely veto them. Among those who wanted a solution other than the reimposition of the Affordable Care Act, the most popular approach, at 27%, was the provision of a limited, targeted plan that provides temporary transition assistance while also making sure the mandates and tax penalties no longer apply in those states. Approval of that approach rises to 29% in states that would be affected by the decision, and to 30% among swing voters.
If the Justices are concerned about likely political outcomes of their decision, this is key: Americans overwhelmingly support addressing those who may be harmed as a result of the Supreme Court ruling to enforce the law as written. Congress and the President should be able to find enough common ground to make needed changes and their decision could be the impetuous for creating a superior health care system.
Among conservative GOP voters, the basis for the contention that nothing will be done, support for transition assistance actually rises to 42% (v. only 14% who want to do nothing and let the court decision take effect), and another 18% who want to propose major changes.
Americans want reconciliation (the budget process through which only 51 votes are needed to pass the bill out of the Senate, rather than the usual 60 votes) to be used strategically to make real progress, not to score meaningless political points. Even among conservatives, only 26 percent wanted reconciliation used to pass full repeal (which would inevitably be vetoed by the President), while 61 percent wanted reconciliation used to make incremental changes to Obamacare that delay or undo some of the harm of ObamaCare in the short term.
By over two to one, 46% of respondents wanted to use reconciliation to provide assistance, undo some of the harm, and build a bridge to full repeal and replace in 2017. Among conservative members of the GOP, contrary to what leaders of assorted grassroots organizations contend, 61% supported the second option and only 26% wanted a full repeal vote.
Respondents were also asked whether they would support or oppose the statement “Reconciliation should not be used for a full repeal show vote that will be vetoed and will ultimately leave ObamaCare intact, but instead should be used for something that advances real reform that would be hard for President Obama to veto because even Democrats will feel they need to be for it.”
Almost six in ten voters, 59%, agreed with the statement – only 21% disagreed, and 20% didn’t know. And that agreement held across the board, with the only slight divergence being Democrats agreeing less (53.5%) and GOP voters agreeing more (63.6%).
The poll clearly showed that voters want a strategy that achieves actual outcomes, not just trades on good intentions. When asked which approach conservatives should pursue to oppose ObamaCare while President Obama is still in office, the majority – 55% to 24% - support limited targeted measures that prevent harm to average Americans while slowing or delaying the law and keeping every interest on board for full repeal in 2017, over solely pushing full repeal. Among conservative GOP voters, that differential rises to 59% to 29%.
Americans even embraced a long–term, strategic approach to the medical device tax. That tax is currently singled out for full repeal in the GOP budget. When it is explained that the medical device industry would have little incentive to expend any effort repealing ObamaCare in 2017 if this tax is repealed, only 22% of respondents favor repealing this tax now. The majority would prefer to suspend the tax “so the industry isn’t hurt, but then make clear that the full repeal of their tax will only occur when the entire law is repealed and all of the American people are granted relief at the same time” (34%) or leave the tax in place (21%).
Should incumbents care? They should if they care about being re-elected. 59% favor the candidate who will “accomplish actual strategic changes to ObamaCare like repealing the individual mandate.” Only 15% are more likely to vote for the candidate who will “only vote for a full repeal of ObamaCare, even though they know it will never make it past President Obama’s veto.” The full-repeal chorus is of course strongest among conservative GOP voters, but even there only 30% support full repeal while 64% support actual strategic changes. Looking at Independents, accomplishment is favored 63% to 13% over high minded intentions that in the end leave ObamaCare unaffected. Among swing voters, that split increases to 67% to 15%.
So as the Justice’s consider their decision, and GOP leadership, members, and outside groups consider their short and long term strategy, it is worth noting that the American people want and expect action. Yet they want action that isn’t overreach or purely symbolic, but measures which free Americans from mandates, improves their freedom and choice, provides transition assistance to the victims of an ill-conceived law, and builds a bridge to better solutions in 2017.