Elections are over and now there is no question that the Patient Protection and Affordable Care Act (PPACA) will go into implementation. H.R. 3590 was nothing if not controversial. Introduced on September 17th 2009, signed by President Obama on March 23rd 2010 without bipartisan support, and upheld by a surprising 5:4 majority in the United States Supreme Court two years later on June 28th 2012, the Affordable Care Act has come a long way. Schoolhouse Rock never let on that it took Bill that long to become a law, and while some would have preferred it, not everyone was cheering when Nancy Pelosi came running down the capitol steps spreading the word that Bill passed.
While most Americans would agree that some type of healthcare reform is necessary, it is a drastically different story when it comes to how to reform healthcare, thus strong arguments were expressed for and against PPACA. Yet, polls are still showing the public to be very much torn on the issue of healthcare reform. Consider a Gallup poll taken following the SCOTUS ruling. The poll attempted to gauge the public’s perception of how the law would affect the economy: 78% of Republicans said it would hurt, 62% of Democrats said it would help, and Independents were somewhat ambivalent with 47% saying it would hurt, 34% saying it would help, and 19% expressing no opinion. While any partisan could easily argue that opposition was due to misinformation or support due to propaganda, it is a better bet that people were honestly wary of how PPACA will affect their lives. A 906 page law with references to varying percentages of poverty levels, IRS code definitions, and section amendments can make it extremely difficult to pour over. If you want to read it for yourself, you’re in for at least a day of reading and even then there is no guarantee that you won’t have to do further research.
Notably on Election Day 2012, five states had ballot questions to oppose enactment of the federal health plan in their states. According to the National Conference of State Legislatures, Amendment 6 in Alabama passed with 59% support, Prop E in Missouri passed with 61.8% support, LR-122 in Montana passed with 67.1% support, and Amendment A in Wyoming passed with 76.9% of the state voting for it. Florida’s Amendment 1 failed narrowly, with a close 48.5% voting in support. The close vote in Florida and the overwhelming opposition in the other four conservative-leaning states, is evidence that Independents are decisively undecided on the healthcare law.
This begs the question, why didn’t PPACA become an issue in the Presidential election? A law that remains this controversial could have been an asset to the challenger or the incumbent. For example, it might have helped Romney who could have made a case that the PPACA introduced overreaching government and a system that burdens businesses and discourages growth of small businesses. On the other hand, Obama could have used the law to his advantage by pointing to the instituted ban on lifetime caps and the requirement to cover persons with pre-existing conditions. However, the healthcare law was quickly brought up in Republican primaries and then dismissed early on in the national election, making scattered appearances at rallies here and there. The campaigns focused heavily on the economy or in Obama’s case Mitt Romney’s lack of a plan for the economy, however, neither candidate stressed healthcare.
Why was that? Possibly because plans for Obamacare borrowed appreciably from the healthcare law Mitt passed for the state of Massachusetts. Both acknowledged this in the first presidential debate. However, Obama was unwilling to point to the failures of Romney’s plan and so was Romney himself. The health plan in Massachusetts did extend coverage, but at a price, and the financial burden of their Commonwealth Care isn’t something to take lightly. Massachusetts holds place as the state with the lowest rate of uninsured non-elderly adults at 6.3% in 2010. This is impressive; however, the costs cannot be ignored. According to the Kaiser Foundation the state has the highest individual market premium rate in the country. Moreover, Massachusetts sees per capita costs that are 15% greater than the national spending on healthcare. Undoubtedly this leaves people asking where the money for national reform is going to come from and how costs are going to be reduced. It is important to note that physician reimbursement reforms are currently underway in Massachusetts.
It is likely that Obama did not wish to draw excessive parallels to a system that currently isn’t economically stable for the state especially in the context of an already slumping national economy. Doing so could only serve to diminish PPACA favorability. As for Romney, conservatives were anxious for him to be more outspoken on repealing and replacing healthcare, but it is possible that Romney acknowledged there was little he could do as President at this late stage. It is equally probable that he didn’t want to draw attention to the failures of the Massachusetts plan because it would erode his authority on the subject. There is also another possibility for both candidates: Following the SCOTUS ruling on PPACA, some of the passion settled on both sides of the law, and no stump speeches on healthcare would rouse an audience as much as a “here’s what I/my opponent did on the economy” or “here’s what I’m going to/did do for the economy”. Either way, it would have been healthy to have a robust national discussion on healthcare. Unfortunately, there wasn’t and hasn’t been enough clarity to encourage Americans to embrace the plan. Instead, the American response seems to be to shrug and mildly accept whatever is coming their way.