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Wednesday, January 19, 2011

What Do Americans Want Their Representatives To Do About Healthcare Legislation?

If members of the House of Representatives look to the American public for guidance on what to do about the healthcare reform law, what would they find?

First, they would understand that the law is controversial. The American public is divided on the law, with a tilt toward opposition or negative reaction to it. It is rare to find any polling, no matter how the question is worded, that shows a majority supporting the bill.

It has been pointed out that some of the opposition to the bill is based on a belief that it does not go far enough. The most recent Washington Post/ABC News poll, for example, found that 50% oppose the bill (wording: " . . . changes to the health care system that have been enacted by (Congress) and (the Obama administration)?").  Dividing those up based on further questioning shows that 35% say they oppose it because it goes too far, and 13% because it does not go far enough. It's not entirely clear what these descriptive terms (e.g., "goes too far" and "does not go far enough") mean when pollsters (including Gallup) use them.  Jon Cohen of the Washington Post, for example, shared with me data showing that the plurality of the 13% who say the bill doesn't go far enough are independents, not Democrats as might be expected. 

Most polling shows that these responses are strongly partisan, with Republicans opposed and Democrats in favor.

So House members imbued with the desire to reflect public opinion face the challenge of dealing with a public that is quite mixed in its sentiments about the bill -- with no strong, majority feelings in either direction.

(I am asked by reporters if there has been any change in support since the bill passed. There have been fluctuations from survey to survey measured by some organizations who track the bill. But I don't see evidence of a straight linear trend in either direction. See here for one example).

Do representatives gain guidance from Americans on the issue of voting for or against H.R. 2 of the 112th Congress? H.R. 2 says that effective as of the enactment of the bill, the healthcare legislation is repealed. H.R. 2 is not a nuanced, complex bill. It is binary, stipulating that if the bill is passed, the entire healthcare legislation is erased.

This presents representatives with a challenge. The 435 members of the House of Representatives are being asked to vote “yes” or “no” on a two-page bill. House members are not allowed to make partial votes, or qualified votes, or to split their votes into parts, or to rewrite the bill they are voting on. There is one bill, and the procedures allow the House members only one vote.

This isn’t to say that some House members, perhaps even all, would not in reality like to parse the procedure out into a more complex set of steps. In reality, that is likely to be what happens. Even if passed by the House, H.R. 2 will most certainly never become law. It will most likely not pass the Senate, which is still Democratically controlled, and would, in any event, be vetoed by President Obama. Thus, after the focus on this bill passes, the House will settle down into attempts to change parts of the law, or to not fund parts of the law and in essence end up modifying the law in significant ways.

But the up or down House vote comes first. What would Americans have their representatives do?

Several polls have asked just that question. We at Gallup asked Americans about this vote on Jan. 4-5 in as straightforward a way as possible: "As you may know, a vote is scheduled in the House of Representatives next week on a proposed bill that would repeal the healthcare overhaul legislation that became law last March. Would you want your representative in Congress to vote “yes” to repeal the healthcare law or to vote “no” and let the healthcare law stand?"

The results showed that 46% said "yes" and 40% "no." That left about 14% who were unsure.

A CNN/Opinion Research poll conducted Jan. 14-16, 2011 found 50% said they would rather see Congress "vote to repeal all of the provisions in the new law" if they had to choose between that option or letting Congress "vote to leave in place all the provisions in the new law" (42% chose the latter option).

Some commentators (see here and here) have opined that these types of questions do not get at Americans' more complex set of attitudes about the bill. That is certainly true. But neither does a basic presidential job approval question get at the complex set of attitudes that Americans have about a president. And certainly a horse race question asking Americans to choose one and only one candidate for whom they would vote does not get at the complex set of attitudes that Americans might have about each of the candidates involved.

The point is that H.R. 2, the bill being voted on in the House, also does not get at the complex set of actions that could be taken in relationship to the healthcare bill. The bill is a simple up or down on repealing the entire healthcare bill. House members have to vote yes or no. Therefore it is appropriate, illuminating, and important to ask the public what they would like their representative to do on just this particular bill.

The answers suggest that if it is a straightforward vote to repeal all of the bill or to let the entire bill stand, the “repeal” side would win. Not necessarily by a majority, because there are undecideds. But by a plurality.  The bill would "win" in a national referendum if the “undecideds” broke in the same direction as those who made a choice.

Now, on to the complexities. If H.R. 2 does not become law, what would Americans then want their representatives to do? In answer to that question, most data appear to suggest that if they had the choice, Americans would, in fact, opt to modify the basic healthcare bill in some fashion or the other. This is not the choice on the table with H.R. 2, as noted, but is probably what will end up ultimately comes to pass.

A USA Today/Gallup poll question we asked over this past weekend found that if given a number of options about what to do with the bill, 13% of Americans would keep the bill just as it is, and 32% would repeal in entirely. The rest, 53%, would opt to make minor or major changes in the bill.

A number of other polls have found similar results. So the reality of the situation probably will end up mirroring this second stage of American public opinion. Once the House vote on H.R. 2 is out of the way, both sides may work to make changes in the bill. Certainly the Republicans want changes. And President Obama this week said that he is willing to work to improve the healthcare bill. So we are likely to see minor and perhaps major changes in the bill in the weeks and months ahead. This general idea (i.e, making changes to the bill) fits in with American public opinion, as noted. Just what these changes should be will need to be more fully investigated in future polling.

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