12/22/2009 04:20 pm ET Updated May 25, 2011

Health Reform: So What Happens Now?

So "what happens now" to President Obama's job approval rating, especially in the event that the health care reform legislation passes into law next month? That's the "big question" that my colleague Steve Lombardo asks below. I'd add one more that's just as big: Will passage of health care reform bill change attitudes about the legislation itself?

Let's start with the president's approval rating. Yesterday, Politico's Ben Smith noted his reporting over the weekend that an "administration official" had "predicted" that passage of the reform bill "will send Obama's approval rating up past 60 percent and restore his supporters' enthusiasm." Smith subsequently updated his post: "A senior White House official objects, and says the White House certainly doesn't expect a polling bounce."

Here's an educated guess: That "senior white House official" is someone far more familiar with trends in presidential approval ratings than the first "official." Our current trend estimate of Obama's approval percentage is 48% (50% if we exclude the Rasmussen tracking), with recent individual surveys ranging from a low of 44% to a high of 54%. A "bump" above 60% percent would be extraordinary.


It may not be obvious in Charles Franklin's graphic above, but presidents rarely see sustained approval rating spikes that big (i.e. changes that are not statistical noise or persist for more than a week or so). If you play with the interactive chart of Gallup approval ratings published by USA Today, you will see that virtually all of the real bumps of this magnitude over the last 30 years occurred as Americans "rallied around the flag" in the aftermath of crises like the 9/11 2001 or the taking of American hostages in Iran in 1979 or in the run-up to the wars in Iraq. Charles points out that when presidents recover from dips in approval, as Reagan and Clinton did, their recoveries are usually slow, steady and extended. They have not been about quick gains produced by some event that persist.

The other problem is that perceptions of the "health care legislation now being considered by Congress," or "Barack Obama's health care plan" -- as measured by the various polls included in our chart -- are typically more negative than positive. Sure, an important chunk of that opposition comes from the left (a result reconfirmed in this week's CNN poll), but opposition is still opposition. Some liberal voters unhappy with the current legislation may rally to the president once a reform bill passes, but how many is anyone's guess.

The bigger problem -- especially if you are hoping for a health reform bounce -- is that so few Americans believe they will personally benefit, and majorities worry about the impact on their own costs and the government's budget. Specifically,

  • Only 35% of the adults surveyed by the Kaiser Family Foundation believe the reforms will make "you and your family better off." Most of the rest think it will make no difference (32%) or leave them worse off (27%).
  • 53% of adults on the recent ABC/Washington Post poll said their own health care "will cost more" if the legislation is passed, as opposed to 33% who believe their costs will go up "if the current system is left as it is now."
  • 73% of registered voters surveyed by Quinnipiac University this week agree that "any health care plan that Congress passes and President Obama signs will add to the federal budget deficit," only 18% believe Obama will "keep his promise" that reform "will not add to our federal budget deficit over the next decade."

These perceptions bring me to the second question: Will passage of health care reform affect opinions about the legislation itself? Ben Smith's item yesterday also passed along an argument from Democratic Senator Chuck Schumer that polling on the reform bill will turn around "soon":

"When people see what is in this bill and when people see what it does, they will come around," Schumer said. "The reason people are negative is not the substance of the bill, but the fears that the opponents have laid out. When those fears don't materialize, and people see the good in the bill, the numbers are going to go up."

That assertion is the basis of a memo from Democratic pollster Mark Mellman that Politico and others reported today. Mellman concedes that voters express opposition to a "content-less" plan -- in other words, a plan they know little about:

Focus group research makes clear that voters know little about the substance of the plan--all they know is that some on both the left and the right don't like it and that it is the subject of intense controversy. In essence then, these questions ask people whether they favor or oppose "a controversial plan that is in constant flux." Understood that way, it is surprising we find any support.

Mellman goes on to argue that "the individual elements of the legislation," once described, "are very popular, as is the bill in total, when it is explained."

But those findings lead us to the really critical question: Will Americans come to understand the reform bill as Mellman's questions explained it, especially since most of the key provisions will not take effect until 2014? As I explained in a column earlier this year, seniors soured on the prescription drug benefit in Medicare after it passed. Their assessments reversed, but not until almost two years later when they finally started experiencing the benefit.

If the process of debating and moving the bills through Congress has not brought much clarity, where will attitudes go during the next two election cycles? Here are two very different views of the future. The first comes from the Weekly Standard's Michael Goldfarb:

Liberals seem to be under the impression that health care reform will be like a new entititlement, and that Republicans will run against it at their own peril -- as was the case with Social Security reform in 2005. And they may be right, but not until this monstrous bill actually goes into effect some time in 2013. Which means that for the next four years, Republicans will be able to say whatever they want about the health care reforms that were passed but won't come into effect for years. Republicans will be able to come up with another "death panel" every week.

To put this in some perspective, the "death panel" story was named "lie of the year" by the non-partisan, and Goldfarb's comment was deemed "divisive and intemperate" enough to merit nomination for one of Andrew Sullivan's "Malkin Awards."

The second view of the future comes from the Washington Post's Ezra Klein:

There's a lot of talk over whether the health-care bill should begin before 2014, and whether the long delay will give the GOP sufficient time to foment a backlash.


A year after the president signs health-care reform, the country will have largely forgotten about it. That's not to say it won't be mentioned in the elections, or argued over in occasional op-eds. But what keeps it on the front page? It's easy enough to write about health-care reform when it's dominating the congressional agenda. When it's waiting to be implemented? Or when it's being implemented, and the main effect is that 16 million people without political power now have health-care coverage? [As for the backlash,] I don't buy it.

As different as they are, both visions have some merit. The Republicans have made it clear they will not relent in efforts to paint the reform as a budget-busting government takeover, and Klein is probably right that the news media will move on to other topics. As such, I would not advise supporters of reform to take much comfort in the health care debate falling off off the front pages. Americans may forget about the bill for awhile, but when Republicans candidates bring it up in 2010, voters will have memories of what they learned in 2009. People won't "see the good in the bill," unless someone makes a concerted effort to tell them. If you believe in reform, I'd recommend listening closely to my friends Sheri and Allan Rivlin:

The answer is that we need more message discipline. We need more voices of support for the underlying effort at health care reform. For every blog post about the public option that will effect fewer than 10% of the public, there needs to be 10 posts about the other provisions of the bill - no more pre-existing condition exclusions, no dropping coverage for people who get sick, insurance exchanges that offer choice and competition, etc. And if Democrats do not stop attacking other Democrats as being too much like Republicans there will soon be a lot more Republicans around to sharpen the comparison.