The curious incident of the dog in the night was the crucial clue for Sherlock Holmes in solving the mystery in "Silver Blaze." The guard dog simply did not bark -- the absence of what one might have expected, being the most revelatory event.
This is much the position we find ourselves in today monitoring Americans' attitudes toward health care reform. Being asked to assess differences following the passage of federal health care legislation is revealing for what is absent -- a change in attitudes. Our latest opinion research data almost a full year post passage looks eerily similar to the data immediately following the law's enactment.
A majority of Americans (52 percent) continue to tell us they oppose the new health care law that was enacted by the Obama administration and Congress in 2010. Dating back to the summer of 2009 and continuing through passage our polling has demonstrated net negatives for the health care plan.
Also striking in its consistency is the intensity of antipathy toward the health care legislation. Two-in-five voters (40 percent) strongly oppose this law, compared to only 22 percent who strongly support it. Importantly, a majority (53 percent) of the all important Independent voters who tend to decide elections oppose the new law -- another consistency in our tracking over the last year.
As always in the world of politics, it is this intensity difference which is driving the debate. A whopping 73 percent of Republicans strongly oppose the new law. However, support among the Democratic base is not intense enough to act as a counterbalance to GOP repugnance of the law. Only 43 percent of Democrats strongly support the law one year later – a 30 point intensity gap.
The president's health care plan has sat at the center of a national debate over federal spending and the role of government, which played a crucial role in the overwhelming Republican victories last November. Nearly seven of ten voters who participated in that election told us on election night that they recalled seeing advertising during the campaigns about the federal health care reform legislation. Stunningly, among these voters, 70 percent said the ad was negative about the plan, while only eight percent (8 percent) said the ads they saw were positive about the new health care law. Given that ratio, it is not surprising that 45 percent of 2010 election voters said they wanted their vote to be read as a signal to oppose the law, while only 28 percent indicated their vote was supportive of the law.
Granted, many Americans tell us they like key features of the new law. Specifically, they rate coverage for pre-existing conditions, the expansion of coverage, and children staying on their parent's plan until they are 26 years old as reasons to keep the law intact. However, these positive features are being swamped by concerns about the impact on the federal debt (55 percent say it will make the federal budget deficit larger); the perception government will be too involved in health care decisions (54 percent say it will lead to too much government involvement; 9 percent say not enough government involvement in the health system) and a concern that the law does not address the escalating cost of health care (55 percent say the cost of their health care will increase as a result of the law).
One new "dog" that has barked in our polling is the impact of news reports about the decisions by federal judges on whether the individual mandate is constitutional or not. When given the opportunity to provide a rationale for their opposition to the law, voters increasingly point to their belief that the government does not have the right to force people to buy insurance coverage and/or an assertion that the law is unconstitutional because of this provision.
An issue to be on the lookout for as the debate emerges -- if insurers do begin to pull out of markets, then the debate could morph into one of anxiety over losing current coverage, which voters overwhelmingly like (72 percent say the current health system is meeting their needs and the needs of their family). This emerging concern is likely coming much sooner than when health exchanges come on line in 2014.
What else is ahead? The politics of repeal are difficult to predict. Still, one thing is certain. The Republican nominee for president will support repealing this legislation.
In our firm's congressional polling in 2010 in Republican primaries, the top testing statement about why to vote for a candidate was his or her opposition to the Obama health care plan. Today, 82 percent of Republicans and 82 percent of those who identify themselves as supporters of the Tea Party Movement also support repeal. Independents and swing voters may waiver in their views of this law, but the nominating wing of the Republican Party has shown no signs of changing. There is no way a Republican will win the nomination without being actively and vocally in support of repeal.
Campaigns are about differences. There could not be a more fundamental difference between President Barack Obama's championing of this law and the eventual Republican nominee’s likely disdain for it. Therefore, as any sleuth might deduce upon examination of this data, we believe the debate over health care is far from over and will in fact be a cornerstone of the 2012 campaign. That prediction is really quite elementary.
Bill McInturff is a partner and co-founder of Public Opinion Strategies, a political and public affairs survey research firm. Lori Weigel is a partner.