Dear George,

I have been pondering the effect of the new health care legislation on the 2010 and 2012 elections. The Republicans think that there will be backlash against the Democrats for passing this “highly unpopular” health care legislation. They have completely lost touch with average Americans.

Let us analyze the situation based on what we know about voting behavior. First, there is a problem for the Democrats: many of the major provisions, such as the Exchange, do not go into effect until 2014 – well after both the 2010 and 2012 elections. The question is: is there enough in the new health care law to give enough voters a positive experience with it by 2010 and 2012? Let me list the provisions that take effect in 2010 or before:

1. Those who presently cannot get insurance because of a pre-existing condition will be able to buy insurance from a state high-risk pool (with some help from federal subsidies). (Usually, high-risk pool insurance is very expensive with minimal coverage.) Starting six moths from now, children with pre-existing conditions can no longer be excluded from coverage on the family policy. However, this leaves out millions – those adults with NO pre-existing condition who simply cannot afford health insurance will not be helped until 2014.

2. Insurers will be required to permit children up to age 26 to stay on family policies.

3. Small businesses will get tax credits to help pay for health insurance for their employees.

4. Tighter restrictions on annual limits will be imposed. (Ultimately, in 2014, they will be banned under policies sold on the Exchanges.) Lifetime limits on benefits will be prohibited starting six month from now.

5. Insurers will no longer be able to rescind insurance when claims are filed.

6. An appeal process will be established so people will have someone to hear the case when a particular procedure or claim is denied. But the insurance companies themselves will oversee the process. There will be state agencies established with independent review power. (But how much “power” are states going to have vis-à-vis large insurance companies?)

7. Seniors will not experience any change in Medicare and will benefit from the added provision for fully paid annual physicals and a (slow) closing of the prescription drug “donut hole.”

There are two major, overall problems with the health care legislation that voters will experience immediately:

One is that most of the administration and enforcement of the provisions are left to the states. With a number of states wanting to nullify the act, and others not able to afford new agencies, how much will actually get done?

The huge increases in insurance premiums will go on unabated. Indeed the insurance companies will have an excuse to charge even more since they must now insure people who they previously could avoid insuring. They presently make money by cherry picking only healthy individuals, dropping them if they became too sick and putting limits on lifetime and/or annual payouts. No competition is provided for in the legislation. Without real competition, premiums will continue to skyrocket. The only thing I see that has happened in Congress that might help provide competition and thus keep premiums in check is a bill that has passed the House – a bill that no one seems to have noticed. This was sponsored by Tom Perriello and ended the decades-long exemption of health insurance companies from anti-trust laws. What has happened to this bill in the Senate? Why isn’t Barack Obama pushing it?

The good news is that all the scary things that Republicans have been saying about the bill will not come to pass (because they were never in the legislation). Many among the public will come to realize that the goblins were not real. (Maybe they will stop believing Republican propaganda.) There will be no death panels. There will be no increase in taxes (except for the very rich.) The government will not take over health care. People will not have to deal with a government bureaucrat. (Doctors will still have to deal with the insurance company bureaucrats to get permission to go ahead with necessary procedures.) The federal deficit will not increase because of health care. Etc., etc.

The one thing that could cause some voters to dislike the legislation intensely is the provision that almost everyone must buy insurance. But that does not kick in until 2014.

So on the whole, the public should have good experiences with the health care provisions in the bill and come to like it more and more. But this assumes that premiums will remain at least stable – an unlikely assumption.

Looking at the larger picture, the political climate for Democrats should be substantially improve. The passage of health care legislation will make Obama and the Democrats look much better. The major reason that job approval ratings were going down for Democrats was that nothing was getting done. (The Republican strategy of “give them no wins” was working.) This change in overall political climate will be huge. Remember the 1994 election in which Democrats were trounced? That was largely because health care reform did not pass – Clinton could not deliver on his 1992 campaign promise. This time, there is delivery.

The Republicans have kept citing polls which indicate that a majority of voters are against the health care legislation. I can cite just as many polls which show a majority in favor of the bill’s provisions. See the piece I wrote back in August about the illusion of public opinion when using polls. Actual experience with the new health care legislation by November will trump any current casual reaction to poorly worded poll questions by a misinformed electorate.

And, as I have pointed out back in January, the election of Scott Brown in the Massachusetts was not a harbinger of an anti-Democratic tide in the country. This is one of the most misinterpreted elections I have ever seen.

One unique data point from Massachusetts does not demonstrate a trend, yet so many commentators and political leaders have continued to cite that election as evidence that Democrats are in trouble, especially over health care. Let me remind you that we had two special elections for vacant General Assembly seats here in Virginia in January. David Marsden (D) won Cuccinelli’s vacated seat in the Senate and Eileen-Corn (D) won Marsden’s vacated delegate seat. Also, several weeks ago a poll in the Fifth congressional district showed Tom Perriello leading all challengers.

Democrats should start believing in themselves and the good things they propose to do for the American people. My studies show that very few voters (about 3 percent) follow the Rush Limbaughs of the world. Unfortunately, the media loves food fights (or worse) and so these fringe commentators and groups get a lot of free publicity and are made to seem much larger than they really are. Reporting good things does not improve media ratings so we Democrats seldom see ourselves on the media.

In summary, if the economy is not better by November, Democrats will be in trouble. But as far as the health insurance reform is concerned, the enactment of the health care legislation should help Democrats in November unless insurance premiums keep skyrocketing or it is not effectively administered. Do Republicans really want to campaign against a new law which covers children with pre-existing conditions, prevents insurance companies from dropping you when you get sick, helps small business employers get health insurance for their employees or fixes the “donut hole” etc. etc. Do they really want to tell those with pre-existing conditions to forget about getting health insurance – just go ahead and die like many thousands have? (I guess the right to life applies only to the unborn.)

David RePass (Electronic mail, March 26, 2010)