Has Obamacare Turned Voters Against Sharing the Wealth?

by Thomas B. Edsall,

With the advent of the Affordable Care Act, the share of Americans convinced that health care is a right shrank from a majority to a minority.

This shift in public opinion is a major victory for the Republican Party. It is part of a larger trend: a steady decline in support for redistributive government policies. Emmanuel Saez, an economics professor at Berkeley and one of the nation’s premier experts on inequality, is a co-author of a study that confirms this trend, which has been developing over the last four decades. A separate study, “The Structure of Inequality and Americans’ Attitudes Toward Redistribution,” found that as inequality increases, so does ideological conservatism in the electorate.

The erosion of the belief in health care as a government-protected right is perhaps the most dramatic reflection of these trends. In 2006, by a margin of more than two to one, 69-28, those surveyed by Gallup said that the federal government should guarantee health care coverage for all citizens of the United States. By late 2014, however, Gallup found that this percentage had fallen 24 points to 45 percent, while the percentage of respondents who said health care is not a federal responsibility nearly doubled to 52 percent.

Robert Blendon, a professor of health policy and political analysis at Harvard’s School of Public Health, wrote in an email that the character of the debate over health care began to change during the 2008 campaign. Before that, according to Blendon, the major issue was the moral principle of providing care for the poor. In the context of the presidential campaign, however, the public focus shifted:

Critics started raising concerns about the cost of these plans — higher taxes and premiums for those with coverage, more government interference in physician choices, and of course the potential of abortion coverage. People with coverage [83.7 percent of the population in 2010] became concerned about the implications for middle income people with these universal plans.

The Kaiser survey found strong opposition, 64-35, to the individual mandate requiring that everyone purchase health coverage. In contrast, a majority of respondents, 60-38, supported the employer mandate that requires companies with 100 or more workers to provide health insurance.

An earlier New York Times poll, conducted in December 2013, found that 52 percent of those surveyed believed that the Affordable Care Act would increase their medical costs; 14 percent said it would reduce costs. Thirty-six percent believed that Obamacare would worsen the quality of health care compared to 17 percent who thought it would improve it.

On the plus side for the Affordable Care Act, those surveyed by the Times decisively supported, 86-10, the requirement that insurance companies cover people with pre-existing conditions; the requirement to cover children in parents’ plans up to age 26 was supported 70-28; and 76 percent supported providing some help to poor workers who do not have employer-based coverage.

The conservative shift in public attitudes on health care and on issues of redistribution and inequality pose a significant threat to the larger liberal agenda.

The 2013 paper published in Public Opinion Quarterly that I mentioned at the beginning of this article, “The Structure of Inequality and Americans’ Attitudes Toward Redistribution,” suggests that Democratic programs providing tax-financed benefits to the poor are facing growing hostility.

The author of the paper, Matthew Luttig, a Ph.D. candidate in political science at the University of Minnesota, found that while “numerous political theorists suggest that rising inequality and the shift in the distribution of income to those at the top should lead to increasing support for liberal policies,” in practice, “rising inequality in the United States has largely promoted ideological conservatism.”

Divisions within the Democratic Party run deep and are not limited to health care.

In her announcement video on April 12, Clinton chose to emphasize cultural themes of family, same-sex marriage, education and women’s rights – taking the spotlight off income inequality. She avoided the issue of explicitly redistributive goals and focused instead on “roadblocks” facing workers trying to climb the ladder.

But this kind of evasiveness can’t last. Neither core Democratic constituencies on the left nor Republicans on the right will permit Clinton to remain guarded on these divisive issues. If conservative beliefs are strengthening in direct proportion to increasing inequality, however, Democrats are caught in a policy bind that has no short-term solution.

“The General Social Survey shows there has been a slight decrease in stated support for redistribution in the US since the 1970s, even among those who self-identify as having below-average income,” according to Saez and his three co-authors, Ilyana Kuziemko, a professor at Columbia Business School, Michael I. Norton, a professor at Harvard Business School, and Stefanie Stantcheva, a junior fellow at Harvard.

Even worse for Democrats, the Saez paper found that “information about inequality also makes respondents trust government less,” decreasing “by nearly twenty percent the share of respondents who ‘trust government’ most of the time:”

Redistribution is in trouble, and that is likely to tie American politics in knots for many years to come.

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