After a lengthy and fierce debate in Washington and across the country about health care reform, voters in several states have the first opportunity to weigh in at the ballot box this week in a number of significant primary challenges. Many believe these primary races, along with the elections in upcoming months, will shed significant light on what the public thinks of the historic legislation.
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JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. After a lengthy and fierce debate here in Washington about health care reform, voters in several states have an opportunity to weigh in this week on what they think of the historic measure. Here to discuss what to look for on primary day, Mary Agnes Carey, senior correspondent for Kaiser Health News, and Bob Benenson, the senior elections analyst for CQ Roll Call. Welcome, Bob.
BOB BENENSON : Thanks for having me.
JACKIE JUDD: First question to you Mary Agnes, is this the day that Republicans have been anticipating and warning Democrats about?
MARY AGNES CAREY: Absolutely. All throughout the health care debate and as it wound down and the bill passed and the President signed it into law, Republicans have said that they are going to make health care a key issue of the fall election and they believe that voters will reject Democratic candidates because of the health care bill, so it is something they have put a lot of emphasis on.
JACKIE JUDD: And tomorrow some of the races will be a preview of what you have just described. Bob, is it overstatement to say there are some races where it will be a referendum on health care or is health care part of the larger thrust of big government, big government spending?
BOB BENENSON : Yeah I think it is part of the big picture. Obviously it was a hot button issue. It is not in the news. It is not in the headlines to the degree it was when the legislation was being debated. Right now, polls show that overall more people are still opposed to the legislation than support it. They support a lot of the details but not the overall legislation.
However, the economy, jobs, unemployment, that is the number one issue this year. The degree to which health care is seen as the Democrats pursuing an agenda that is a distraction from fixing the economy, or perhaps because of the spending involved, maybe making the economy worse according to this state of opinion. Then, they are going to be driven to vote against Democrats and for Republicans, just in response to that.
So, it may not be necessarily on the health care roll. Republicans, if they got control of Congress, would say it was, but it is not exactly that, but it is a very important issue.
JACKIE JUDD: There are a few races in particular tomorrow that I want to talk to you about: Pennsylvania, Arkansas, Kentucky, walk us through those and what role health care may play in those.
BOB BENENSON : Well, it is already a very interesting primary season. Incumbent defeats in a normal year are very rare. We have already seen a Republican Senator, Bob Bennett of Utah, and a Democratic Congressman Alan Mollohan of West Virginia defeated. That just shows you the angry mood people are in.
In Pennsylvania, you have got Arlen Specter. He was a Republican Senator for almost 30 years. He switched parties early last year and became a Democrat. He voted for the health care bill, but he is being challenged by a Congressman named Joe Sestak who is running to his left and saying Arlen Specter is not a Democrat, he is an opportunist. Vote for a real Democrat in the Democratic Primary. It is a very close race, and Arlen Specter is a survivor. You can't rule out him winning.
JACKIE JUDD: He is a survivor.
BOB BENENSON : But it will be a very tough chore for him. Pat Toomey, a very conservative Republican that used to serve in the U.S. House is waiting in the wings to run against the Democratic winner in November.
Then in Arkansas, you have Blanche Lincoln. All her career in the Senate, a centrist, moderate or center right Democrat, she also voted early last year against the original version of the health care bill, then she kind of sat on the fence for awhile, voted for it. She is also getting it from both directions.
The Lieutenant Governor Halter is running against her in the primary. He is also running as a truer Democrat, the labor unions who are a big Democratic support group have come in in force supporting him in opposition to Blanche Lincoln. The Republican have seen this as such a target of opportunity that practically every Republican in Arkansas is running for the Republican nomination for the Senate.
JACKIE JUDD: And Arkansas used to be a pretty friendly state for moderate Democrats, i.e., Bill Clinton.
BOB BENENSON : Absolutely, and in fact it is still the least, state in the south that has swung the least to the Republican Party over the years. It is still a very strong local Democratic base, but a conservative Democratic base.
JACKIE JUDD: And Kentucky.
BOB BENENSON : And Kentucky, this is an illustration of the tensions that are pulling the Republican Party apart, and that we saw in Utah, and that we have seen in Florida where the moderate Republican Governor Charlie Crist had a drop out of the Republican Primary and run for the United States Senate as an Independent.
Rand Paul who is the son of Ron Paul, who really made a name for himself as a Libertarian conservative crusader, running for President in 2008, has come in and he has upset the apple cart. The Republicans thought they had their nominee, an establishment candidate named Trey Grayson who is the Secretary of State, a protégé of Senate Minority Leader Mitch McConnell.
He was supposed to just cruise right in, but Paul is running on this Tea Party conservative activist anger against government in general, Washington in general, Grayson says he would have voted against the Health Care Bill right down the line but Rand Paul is running on this purest notion that a lot of the people in each party's base, that on the Democratic side you have to be a pure Democrat, not compromise.
JACKIE JUDD: So when it comes to health care, the health care issue, how do Democrats argue back? How do they campaign to defend their votes?
MARY AGNES CAREY: They say don't you want to support a candidate, a member of Congress that wants you to pay less for your health insurance, that wants to lower your health care costs, that wants to allow children to stay on your policies until 26?
I think candidates, and Bob is more of an expert on this than I am, they either embrace it and say I voted for this and I am proud of it or they may take a step back and not want to discuss it but I think the ones that believe in their vote, that they thought it was a smart move, that they can sell this to the voters and they can persuade them.
JACKIE JUDD: And they emphasize the piece parts of the legislation, which polling has shown by the Kaiser Family Foundation that when you break it down there is quite a bit of support.
BOB BENENSON : Yes, that is right, and what we are seeing in this election cycle is that voters are paying more attention to issues and to the elections and the candidates themselves, and the campaigns tend to be very concentrated. Arlen Specter had a several points lead in his Pennsylvania Democratic primary a few weeks ago, then all of a sudden Joe Sestak started bombarding with advertisements, calling him an opportunist, and he gets into competition.
The Scott Brown situation in Massachusetts – the special election in January for Ted Kennedy's former seat - that was basically a two week campaign. He was trailing by double digit margins and then all of a sudden he swept to victory. We have got five and a half months left before election day, so the Democrats have time to make exactly the case that Mary Agnes was describing.
This bill is good in so many ways. You have got Republicans running around talking about repeal; not revision, not fixing it, but repeal the whole thing. And that gives the Democrats leverage to say there may be some trimming around the edges that we will have to do because it is a big piece of legislation, but this is basically a good piece of work for the American people.
And as we start seeing parts of the bill take effect, like the insurance companies voluntarily beating the clock on dropping the recisions policy for instance, if they start seeing some positive effects from this bill and that teamed with the economy improving, which is still an open question, then the Democrats at least can attain some better footing in this election cycle and say no, we are not all wrong.
We are mostly right, and try and put the Republicans back on the fence. The Democrats main argument is that the Republicans are the party of no. They will oppose anything. Even if it was good, even if they agree with it, they will still oppose it to make the Democrats look bad. And if they can get some substance behind that by showing how some of the things they are doing are working, they might cut their losses.
JACKIE JUDD: Mary Agnes, a final question to you, even though, as Bob suggested, the health care law is now in the hands of the bureaucrats, the regulators, but do the election results, not only tomorrow but of course in November, can it impact how the bill is implemented over the long haul?
MARY AGNES CAREY: I think it certainly could. We have seen an example, Bob noted earlier implementation sometimes because industries step forward or the Administration steps forward to put some of these provisions into place earlier, coving kids up to 26, that was one the insurance industry voluntarily stepped forward on, but the Administration came out and moved up an implementation of the program they had to help companies provide health insurance for early retirees.
So, depending on tomorrow, how those results are and the fall results, you could see some other pushes for implementation perhaps earlier. I don't know if this could occur, but for example would there be a decision made that 2014 is too late to have exchanges come into place and subsidies.
For example, the Medicaid Expansion, those provisions are outside of the next Presidential cycle, but I think if a decision were made that the public needs to have more of those sooner to make the bill a success, you could have some of those discussion and if not for those provisions, for others, to come into place earlier.
JACKIE JUDD: Okay, thank you both so much. Bob Benenson, Mary Agnes Carey, you are appreciated. I’m Jackie Judd and this has been Health on the Hill.