Americans Focused on Health Law Process as Much as Outcomes
As the Senate continues to work on changing the nation's healthcare system, Americans may be as focused on how their elected representatives are going about the process as they are on the legislation itself.
As I pointed out in reference to Congress' attempt to come up with a budget bill, the most important element of contemporary American public opinion is the indisputable fact that Americans believe the whole governing process is broken. The public's general contempt for the body of elected representatives who represent them in Washington has never been more evident.
Congressional job approval is at 21%, confidence in Congress is at 12% (the lowest of any of 16 institutions tested), and a quarter of Americans name the government itself as the most important problem facing the nation -- far more than mention any other single issue.
Government is more important as a perceived national problem than healthcare. Mentions of the latter have settled down to 7%. Our annual surveys also continue to show that fewer than one in five Americans consider healthcare to be in a crisis, although the majority do see it as having "major problems." Kaiser Family Foundation polling shows that relatively few Americans consider repealing and replacing the Affordable Care Act to be the most important priority for Congress and President Donald Trump.
Thus, the current focus on healthcare in the Republican-controlled House and Senate, while important, provides an opportunity for elected representatives to show what they can do to address an even more important issue: their own conduct, behavior and ability to produce timely and acceptable outcomes.
Congress' track record isn't great. Americans witnessed the inability of government to reach agreement on its basic budgeting functions in 2013, with the resulting government shutdown. That, in turn, led to the lowest congressional approval ratings in Gallup's history -- ratings that have recovered only marginally.
The Founding Fathers of our nation certainly recognized that making decisions on policies affecting a large and diverse group of citizens would not be easy. They anticipated "factions" and set up the whole government apparatus to take those factions into account, assuming there would be vigorous debate and discord. This was evident in the acrimonious back and forth that ultimately led to the creation of the Constitution itself. But however anticipated these problems may have been, the public's respect for the way the process is working more than 200 years after the Constitution took effect has become alarmingly negative.
Senate Republican leaders clearly face a number of challenges. Healthcare has evolved into one of the most complex domestic policy issues in the country, evident in the public's contradictory desires. Polling shows that Americans want pre-existing coverage to be included in any new healthcare legislation and want poorer Medicaid recipients to continue to be included. But Americans also want premiums to go down.
Plus, Senate Republican leaders are operating with low expectations. Americans at this juncture are considerably more positive about the Democrats' ability to handle healthcare (55% say the Democratic Party would do a better job) than the Republicans' (36%).
So it's clearly a challenge, and it's perhaps not surprising that Americans aren't happy with what they have seen of the Senate bill so far. Most polling with which I am familiar shows that Americans are significantly more negative than positive about the bill, although many say they don't know enough to have an opinion.
But there is guidance from our data on how Americans would like their elected representatives to function.
We know that Americans, as a whole, want their elected representatives to compromise in order to get laws passed and to get things done, rather than to stand on ideological principles. We know that Americans believe that members of Congress are motivated by the interests of big-money donors, lobbyists and party bosses rather than by the interests of the people they represent. They want that changed.
The challenge for congressional leaders wrestling with healthcare is thus to convince the people they are doing two things: 1) taking into account constituent interests and what's best for the country as a whole, rather than rigid partisan or ideological mandates or special interests, and 2) showing a sense of compromise in order to get things done.
Congressional leaders may claim that they are already doing these things. If so, that message has for the most part failed to percolate down to the people. The effort to change the nation's healthcare thus provides yet another opportunity for Congress to change the public's views of the men and women they elect and send off to Washington to represent them.