One of the big public health stories over the past few years has been the sharp decline in the number of uninsured Americans since the implementation of the Affordable Care Act. This decline has not been even across the United States population, though. We know that poorer people, African Americans, Latinos, and other demographic subgroups have benefited more rapidly from this act than others. But it also turns out that there's a partisan component: Democrats are benefiting more than Republicans.
As Michael Tesler reported at the Monkey Cage last week, the percent of uninsured who are Democrats has essentially been cut in half over the past two years, while the percent of uninsured who are Republicans has barely budged. One might just dismiss this as a feature of demographics: Democrats tend to be poorer than Republicans and to live in states that have more aggressively adopted health exchanges. Yes, that's true, but Tesler actually controls for all sorts of demographic factors, including race, income, and state of residence, and still finds a large partisan effect. What's going on here?
The federal health-care system will quickly become the next president's problem after 2016, and that person will get blamed for things that go wrong.
One possible explanation is that Republicans are constitutionally less inclined to seek out a public service until they desperately need it. That would be consistent with some of the anecdotes we've seen about people who were opposed to Obamacare on ideological grounds but enrolled in it when a medical crisis hit their family. And conversely, Democrats may be constitutionally more comfortable with signing up for a government service. These differences, that is, may simply reflect the general attitudes of liberals and conservatives toward actions by the government and toward collective action in general.
Even if the government is not involved, after all, insurance is all about pooled money and calculated risk. When you buy health insurance as a healthy person (and if you expect to be healthy much of your life), you accept that a good deal of the money you put in will go to benefit other people. Republicans might simply be more likely to see this as a scam, while Democrats view it as a social responsibility.
But another related explanation for the partisan differences in health insurance enrollments just has to be the statements of partisan elites. We know from a long line of political science research that partisans tend to adopt the beliefs of those they see as their party's leaders, and then use those beliefs to interpret current events. This is why Democrats believed inflation had risen under Ronald Reagan (it had fallen dramatically) and why Republicans believed the deficit had grown under Bill Clinton (it had dropped considerably).
What were the messages of Republican elites with regards to Obamacare?
- Former vice presidential candidate Sarah Palin said the legislation would create "death panels" and called the bill "downright evil."
- Senator Ted Cruz likened it to Nazism.
- Conservative television and radio personality Glenn Beck said it would be "the end of America as you know it."
- Senator Tom Coburn promised that if it passed, "You are going to die sooner."
- Representative Michelle Bachmann said that "it literally kills women, kills children, kills senior citizens."
This is hardly an exhaustive list. Basically, if you were a Republican paying any attention to the news between 2009 and 2014, you heard leaders of your party promising that Obamacare would be dangerous for your country, for your business, and for your family. And unless you're somehow a member of a party whose leaders you dismiss as crazy, you probably internalized these messages to some extent.
These partisan differences may dissipate with time. As the Affordable Care Act's implementation continues and, at least thus far, does not seem to have destroyed the economy or American liberty or instituted mandatory abortions and sex-change operations, the bombastic rhetoric will eventually cool off. Additionally, it will not always be associated with Barack Obama. The federal health-care system will quickly become the next president's problem after 2016, and that person will get blamed for things that go wrong.
But for now, many Americans who did not have access to health insurance a few years ago now do, and quite a few of them are declining it because their party leaders have told them—wrongly—that it is deadly. One could certainly make a case that these people are heroic for adhering to their beliefs even at the risk of their own health. One could also make the case that people are going to needlessly go broke or even die because their party leaders wanted to score some political points.
What Makes Us Politic? is Seth Masket’s weekly column on politics and policy.