This year’s primary elections were once anticipated as an early referendum on health reform’s political fortunes. Across the nation, candidates on both sides of the aisle staked out clear positions on the law — with Democrats generally touting reform’s benefits and Republicans calling for the overhaul to be repealed and replaced. This split mostly holds true in California, with top Republican hopefuls for office unanimously opposing the law.
However, the Golden State’s unique political dynamics may force the winning Republican candidates to back off their opposition to the reform law.
Reform as Wedge Issue
After the overhaul was enacted in March, both political parties embraced health reform as a key wedge issue for this year’s midterm elections. Many Republicans viewed the sweeping overhaul as a “gift” that would allow them to campaign on fears of government overreach and rising health costs. Democrats, meanwhile, hoped to tout a legislative victory and the law’s immediate benefits for the nation’s seniors, a key political constituency. Both sides have worked to shape public perception, even as debate over reform has cooled off. The White House organized events last week to celebrate new prescription-drug rebates for seniors. Meanwhile, U.S. House Republicans held a vote yesterday that called for a repeal that, while destined to fail, served as a symbolic effort to get Democrats on the record as supporting the controversial individual mandate.
Public polls on reform are mostly inconclusive, but the interpretation reflects a political split. Joel Benenson, the White House’s chief pollster, says that most Americans don’t favor an outright repeal but want to give the law a chance to work. In contrast, a national poll conducted by the conservative-leaning Rasmussen Reports found that 58% of respondents favor repealing the law, with 82% of Republicans saying they back a repeal.
This conservative opposition was borne out on the ground in recent primaries. Some congressional Republicans with long records of voting for conservative issues — like Sen. Bob Bennett of Utah and Rep. Bob Inglis of South Carolina — suffered primary rebukes, in part for initially favoring a health reform compromise rather than outright opposing the law.
California Landscape May Force Tactical Shift
Both Rasmussen Reports and the independent Field Poll have found that most California residents support the overhaul. As a result, state Republicans hoping for top office may have to perform a balancing act, having already staked out positions against the law.
Republican gubernatorial candidate Meg Whitman has said that she would “strongly encourage” her attorney general to file suit challenging the constitutionality of the law. Senate candidate Carly Fiorina also has pledged to work to repeal it.
Having survived their primary battles, Whitman and Fiorina have reasons to move closer to the political center on many issues. Beyond the polling on health reform, California’s registered Democrats outnumber Republicans by 2.3 million and conservative candidates historically fail to win statewide office.
However, Whitman and Fiorina risk alienating their conservative base by shifting their stance on reform. Fiorina is supported by 80% of residents who strongly favor repealing the overhaul, according to Rasmussen Reports. In addition, Republican National Committee Chair Michael Steele said yesterday that the RNC will fund a major effort to win open offices in California — given toss-up races for both the governor and Senate positions — which could constrain the candidates’ flexibility.
Meanwhile, California Democrats have released a new television advertisement that tries to “draw a favorable contrast with those who opposed reform and now seek to repeal it,” according to Health Access.
Looking Down the Road
As Politico notes, the rhetoric over repeal may clash with the reality of the law, as new regulations and agencies continue to take effect. Even if Republican candidates win this fall, they will face challenges when trying to overturn already implemented provisions. Meanwhile, Republican consultants who work with industry clients say they are concentrating on understanding the regulations, not changing them. William Pierce, a former official at HHS under President George W. Bush says firms realize it’s in their “best interest to make the law work the best for them.”
Moreover, there’s an X-factor that could mute the impact of both parties’ efforts to use reform as a wedge issue: Public interest in the overhaul has dropped off as other issues have surged. According to Pew Research, which tracks weekly news coverage of top stories, health care has not been among the nation’s top six stories since April 22. According to Republican pollster Bill McInturff, the debate over health reform’s impact “has been kind of squooshed” by coverage of the oil spill in the Gulf of Mexico.
However, our digest highlights plenty of news coverage of reform developments. Here’s a look at other key stories from across the nation.
In the States
- Pennsylvania insurers are likely trying to boost revenues by increasing rates ahead of new limits slated to take effect in 2014, according to state insurance regulators, the AP/Google News reports. Insurance Commissioner Joel Ario said regulators have found evidence that certain companies are expanding their use of individualized medical questionnaires and drug profiling for small group insurance plans. He also said insurers have attempted to “identify and drive up premiums for the most vulnerable groups” before new limits take effect in 2014 as part of the health reform law (Scolforo, AP/Google News, 6/10).
- HHS Secretary Kathleen Sebelius has asked Vermont Gov. Jim Douglas (R) to reconsider a plan to reduce the benefits that the states’ seniors receive if they are eligible for the $250 Medicare prescription drug rebate checks under the new health reform law, The Hill‘s “Blog Briefing Room” reports. The plan would affect Vermont’s low-income seniors who are enrolled in VPharm, which provides supplemental pharmaceutical coverage to those who do not qualify for Medicaid assistance. In a letter to Douglas, Sebelius said the rebate checks are “intended to provide fiscal relief to seniors, not states,” adding, “Seniors who enter the ‘doughnut hole’ have serious illnesses, take more medication, and need additional financial help” (Pecquet, “Blog Briefing Room,” The Hill, 6/11).
On the Hill
- President Obama recently signed an executive order that creates a National Prevention, Health Promotion and Public Health Council, which is authorized in the new health reform law, CQ HealthBeat reports. The council comprises Cabinet members and other administration officials and is tasked with generating a national public health strategy that incorporates goals for improving the health of U.S. residents and will recommend strategies and deadlines for achieving the goals. In addition, the council will deliver annual reports on its progress over the next five years (CQ HealthBeat, 6/11).
- House Ways and Means Committee ranking member Dave Camp (R-Mich.) on Friday sent a letter to Internal Revenue Service officials asking for information about how the department plans to notify tanning service providers of a new 10% tax on the service under the new health reform law, CQ HealthBeat reports. Camp sent the letter after IRS announced details of the new tax on tanning salon patrons, which was included in reform legislation as a funding mechanism. Camp said the tax details were announced “quietly,” compared with the IRS’ more “extensive” mailer initiative to promote a small-business tax credit (Norman, CQ HealthBeat, 6/11).
- HHS on Friday announced nearly $25 million in grants that will fund one- to three-year demonstration projects focusing on alternative dispute resolution programs, developing guidelines and medical error disclosure, following through on a promise President Obama made to curb medical malpractice costs, the Wall Street Journal reports. Last September, Obama in his joint address to Congress directed HHS to reduce malpractice costs separately from the new health reform law (Adamy, Wall Street Journal, 6/11).
- Virginia-based insurance company nHealth earlier this month announced that it had been forced out of business because of the new health reform law, but annual financial filings with the National Association of Insurance Commissioners indicated that the company already lost $10.6 million between 2008 and the first quarter of 2010, well before the new health reform law was enacted, Politico reports (Kliff, Politico, 6/11).
- Several influential state physician delegations during the American Medical Association‘s annual policymaking meeting in Chicago last week expressed concern about the group’s positions in the national health reform debate, the Chicago Tribune reports. The delegations called on AMA to revise its stance on a planned 21% cut to doctors’ Medicare reimbursements, a greater push for medical malpractice reform and better physician Medicaid payments (Japsen, Chicago Tribune, 6/13).
- The new health reform law will have little effect on deductible costs in 2011, according to a new PricewaterhouseCoopers report, the AP/Chicago Tribune reports. The rise in costs instead can be attributed to a continuation of a high medical inflation rate. Overall, employers who offer health insurance will experience a 9% increase in their medical costs in 2011 and likely will ask employees to contribute more toward the cost of coverage, according to the report (Murphy, AP/Chicago Tribune, 6/14).
- Most of the respondents to a recent survey by the Deloitte Center for Health Solutions said they are satisfied with their current health coverage but have concerns about potential changes under the new health reform law, CQ HealthBeat reports. The study found that 36% of those surveyed believe they will be “better off” under the overhaul, while 43% feel they will be “worse off” (CQ HealthBeat, 6/10).
Holes in the System
- About 45 million U.S. residents do not have dental insurance, according to a CDC report issued on June 9, Reuters reports. Reuters notes that it is unclear how the new health reform law will affect dental insurance. The overhaul requires U.S. residents to have health insurance beginning in 2014, but does not mandate that individuals purchase dental or vision plans (Heavey, Reuters, 6/9).
- Although “much has been said” about the influx of baby boomers expected to “swarm” the U.S. health care system in the coming years, “[o]verlooked in the conversation” is the group of health care professionals — general practitioners, specialists and nurses — who also are baby boomers, the Washington Post reports. According to the Post, health care economists and other experts say that large numbers of retirements in the health care provider community over the next 10 to 15 years are expected to “greatly weaken” the nation’s health care workforce and cause many people to face difficulties finding a physician or nurse (Fears, Washington Post, 6/14).