The last time Congress considered comprehensive health care reform in the early 1990s was during an era when neither party had a party identification majority and the margin between the two parties rarely exceeded four or five percentage points. But in 2009 we are in a different era, with completely different political realities.
A mid-July Washington Post-ABC News poll found the Democrats with a clear 53% vs. 38% party ID edge over the GOP, virtually unchanged since the president was inaugurated in January or elected last November. Yet this same poll showed a decline in the president's overall job performance mark and indicated that only a bare plurality approved rather than disapproved of his handling of health care (49% vs. 44%). To preserve their current partisan advantage, the President and Congress need to pass a health care reform bill that addresses the concerns of their Democratic supporters, not Republicans in or outside of Congress.
Democrats, especially young Millennials, who identified as Democrats over Republicans by nearly a 2:1 margin in a June Pew Research Center survey (56% vs. 30%), are significantly less likely than Republicans and older Americans to even have health insurance. Nearly nine in ten Republican identifiers, but only eight of ten Democrats are now insured. That number falls to less than two in three among Millennials (63%). In stark contrast, 96% of senior citizens (who, of course, already participate in a federal health care program) have health insurance.
Because they are less often insured, and perhaps because whatever insurance coverage they do have may not be as comprehensive, Democrats have greater difficulty meeting and paying for their health care needs than Republicans. As the following table indicates, half of all Democratic identifiers (and non-aligned independents) say they have trouble paying for the cost of a major illness and for health insurance. About four in ten are concerned with having to pay a larger share of employer-provided health insurance and for routine medical care and prescription drugs.
|Is each of the following a "major" problem for you and your family?||Dem/lean Dem||Independent||Rep/lean Rep|
|Paying cost of major illness||51%||54%||43%|
|Paying cost of health insurance||46%||52%||36%|
|Employer making you pay larger share of health insurance||38%||36%||30%|
|Paying for cost of routine medical care||38%||42%||27%|
|Paying for cost of prescription drugs||37%||42%||26%|
As a result, it's hardly surprising that virtually all Democrats (91%) and 80% of Millennials, but barely half of Republican identifiers (54%) favor "changing the health care system in this country so that all Americans have health insurance that covers all medically necessary care" or that a majority of Democrats (51%) believes that the country is spending "too little" on health care while a plurality of Republicans (46%) believe we are spending "too much." Nor is it hard to understand why few Democrats, especially Millennials, are put off by the possibility of greater federal government health care activity. In a May Pew survey, 69% of Republicans, but only 28% of Democrats and 36% of Millennials, professed concern about the government becoming too involved in health care.
The same July Washington Post- ABC News survey that signaled trouble for Obama on the issue of health care indicated that a majority of all Americans (54%) favor the legislation. This includes three-quarters of Democrats and six in 10 independents, but fewer than a quarter of Republicans.
In spite of claims by Republicans such as South Carolina's Senator Jim DeMint that congressional failure to pass health care legislation could prove to be Obama's "Waterloo," the matter is really an almost entirely Democratic concern. As E.J. Dionne reminded today's congressional Democrats, they "are not living in the Republican congressional eras of 1995 or 2003…they have the strength on their own to win."
Democrats have that strength because the country has entered a new political era, driven by the emerging civic Millennial Generation, in which the Democratic Party is now clearly the majority party within the American electorate and is in position to retain that majority status for decades to come. Most of that Democratic electoral majority personally need meaningful health care reform and expect Congress to enact it. The next several weeks will tell us whether congressional Democrats will take advantage of that new reality or look backward to the old realities of the past. We will soon see if congressional Democrats have the ability and courage to choose wisely and perceptively. The stakes in that decision for the Obama presidency, the Democratic Party, and the nation couldn’t be higher.