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RealClearPolitics HorseRaceBlog

By Jay Cost

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Polling on Health Care Reform

Over at Pollster, Charles Franklin performs some fascinating analysis on public opinion on health care. He puts together a series of trend lines based upon different "smoothing" techniques, which cut down on statistical noise to varying degrees. Despite all these different methods, he still finds the same basic trendline:


This shows that the country is now about evenly divided on the various health care proposals working their way through Congress. Support for the bill dipped during the summer, but has risen to pull about even with opposition.

This is not a great result for proponents of the current reforms bills. The trick is that it has to pass through the United States House of Representatives and the Senate. It's an inferential fallacy to assume that because a bare majority of respondents support the proposals (supposing they do), a bare majority of members of Congress would, too.

To appreciate this, consider the following histogram. It outlines the distribution of Obama's share of the 2008 vote by congressional district.

Obama Vote by Congressional District.jpg

Obviously, congressional districts are far from uniform! The modal category here is actually soft support for McCain, where Obama won between 40% and 50% of the vote. Yet the political battle over health care will inevitably be fought in those districts that softly supported Obama. According to Franklin's analysis, health care reform is polling slightly under Obama's vote share in 2008. So, those districts where Obama won narrowly, not decisively, are probably where the main political battle will occur. It's reasonable to assume that if the nation is now evenly divided on the reform measures, those districts taken all together are divided, too. Many of them should be divided internally as well.

This highlights a core problem the Democrats have in the Congress. They win a lot of districts by blowout margins. This makes them safe for the party, but it means that their voters are packed into relatively few districts, suggesting that to pass large-scale policy reforms such as the one being debated now, the Democrats have to find support in districts where Republicans do well, even in bad years for the GOP like 2008.

This problem becomes all the more salient when we consider the practical playing field - namely, that the bills working their way through the Congress are unlikely to get any Republican support. If the Democrats plan to pass it all by themselves, there is going to be quite a bit of pressure on many members.

Obama Vote by Congressional District Democratic Districts Only.jpg

As we can see, there are a lot of Democrats in McCain-voting districts. So, if it is the case that the McCain voting districts are opposed to the health care bills, the Democrats are going to need at least a few representatives to vote against their constituents to get the bill through the House. That is a huge request to make, especially considering how salient this issue is. It's never a good idea to vote against your district on an issue that your constituents are paying close attention to.

Up to this point in the analysis, we've assumed that support/opposition to the bills mirrors the 2008 vote. It likely does not follow the 2008 vote perfectly, and there are probably at least a few notable deviations. The problem is, we just do not know how support breaks down by district. We lack reliable polling on this front. Importantly, many members probably lack such knowledge as well. Polls are expensive to contract and polling by congressional district is problematic. So, many members likely do not have a systematic read on their districts, the kind of knowledge that can be acquired via scientific surveying. They could, of course, rely on methodologically questionable analyses that "find" that certain reform measures are overwhelmingly popular, but I would not suggest that.

Instead, they have to rely on other metrics - like telephone calls, emails, attendance at town halls, and so on. This is why - even if the August town halls did not move public opinion against the bills - they were probably still quite consequential, as they gave members a sense of how their districts were feeling about the reform measures. Because turnout in congressional midterms is always less than presidential elections, even if those town hall outbursts represented a minority position in a district, it still cannot be taken lightly. After all, in a midterm election a member can be tossed from office by an opposition bloc that, during a presidential year, would constitute a minority.

While Senators have better access to polling, and therefore they probably have a more systematic perspective on their districts, the health care bills still face many of the same challenges in the Senate. This is the distribution of Obama's vote by state.

Obama Vote By State.jpg

Again, we can conclude here that the main locus of debate will be in states that went for Obama softly. And when we look at states with Democratic Senators - we see basically the same thing as we did when we looked at the House.

Obama State Dems.jpg

Again, for a bill to become law, Democrats are going to need some members from McCain states to support it, unless they can pull in some Republicans. This again suggests that an even split in support for health care is more of a hindrance than a help in getting a bill through.

-Jay Cost