What the Health Care Decision Means for the 2012 Elections

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Demonstrators protest as they await a decision by the US Supreme Court on the constitutionality of the Affordable Healthcare Act.

The Supreme Court’s decision today affirms the constitutionality of Barack Obama's signature health care law and the individual mandate that was at the heart of the case. If the polls on the health care law are any indication, however, it will not reconfigure the politics around it much. That debate will simply ratchet up again, hardening the already deep divisions on whether the law is necessary or good for the country.

This decision completely alters the narrative of Obama’s presidency leading into the election, though. This legislative achievement was the policy priority where the president chose to invest his significant post-election political capital with a Democratic Congress. It wasn't Social Security. It wasn't the tax code. It wasn't immigration reform. It was health care.

And the Supreme Court has let him keep it.

Next Steps for GOP:

Just because the law is constitutional doesn't mean Republicans are losing all their talking points. They can still campaign on repealing "Obamacare”; and if the law remains as unpopular as it has been, that may be a winning argument.

More silver lining for the GOP: they now have something they can point to when detractors call the conservative-majority Supreme Court partisan, political, and too eager to give Republicans what they want. Hardly, they can say, after today's ruling. Defending the Citizens United ruling just got a little easier.

President Obama, meanwhile, can claim a massive victory. With the question of constitutionality settled, the president will be able to return to selling reform to the public. He can call it not only necessary, but right. Some stray Democrats might even come back to the fold after avoiding association with unpopular legislation that may have been struck down by the Supreme Court anyway.

Today's decision may also elevate the issue of how Obama or Romney would handle potential Supreme Court appointments over the next four years. Had the Affordable Care Act been struck down, Obama would have had a decision to make about attacking the judiciary on the campaign trail, and making the need to appoint more sympathetic judges a talking point. Now that the law stands, and the deciding vote came from George W. Bush appointee John Roberts, it's an open question as to what each candidate would say about the sort of person they would put on the bench.

Electoral Implications: The View from Swing States

Americans’ views on the health care overhaul have been closely split along partisan lines since its passage in 2010. The Supreme Court arguments and the intricate back and forth about its constitutionality did not break the deadlock. A Pew poll this month found Republicans overwhelmingly oppose the law, Democrats overwhelming support it. The self-described independents in the poll favored overturning the law completely, and these unaffiliated voters in the poll split evenly on whether they leaned Democratic or Republican.

However, public opinion varies when Americans are asked about specific provisions in the law, as Five Thirty-Eight’s Nate Silver and The Washington Post’s Greg Sargent have pointed out. Turns out, a majority of Republicans support subsidies to help low-income families pay for health insurance, and more than three-quarters of Republicans think insurance companies should be banned for denying coverage because of pre-existing conditions.

But as in all calculations in America’s divided politics, the real math that matters is in just a handful of states.

It’s important to note that uninsured Americans have not, by and large, seen this law as a boon for them. They continue to report frustration with the cost of health care and dissatisfaction with their care, according to a Kaiser poll in May. But this group of Americans are also aware that even when the health law goes fully into effect, they will still need to figure out how to get covered. And twice as many expect the mandate would leave them worse off than better off.

Overall, a majority of swing state voters called the health care law “a bad thing” in a February USA Today/Gallup poll in dozen states that expected to be close. More than seventy percent said it had no effect so far, and once it did, more than four in ten expected the law would make things worse for their families, compared to just two in 10 who thought it would help. 

But in the end, health care costs are not registering on polls of the top concerns of voters. Americans told Gallup again this month that the economy and unemployment were their top concerns. Only six percent mentioned health care.

That’s similar to December 2008. Just five percent of Americans said then health care was the country’s biggest problem, ranking equal to “ethical or moral decline” as a top concern. down from May of 2008, when 14 percent of Americans mentioned health care

That could change, of course, in the wake of this decision. As Republicans showed in the 2010 midterms, there’s nothing that galvanizes voters more than having a policy decision to protest against. After today, the GOP still has exactly that.