ACA and Elections

VII. Key Issues: Regulation & Reform >> C. Health Reform >> Affordable Care Act (ACA) >> ACA Repeal >> ACA and Public Opinion >> ACA and Elections (last updated 2.25.17)


Under President Obama (inclusive of 2016 election results), Democrat U.S. Senate seats fell from 55 to 46 and House seats from 256 seats to 194. Democrat governerships slipped from 28 to 16, with state legislative seat losses of 958.
By the 2014 elections, Democrats had lost more than 900 state legislative seats, 69 U.S. House seats and 13 U.S. senate seats, all the most since World War II. Democrats also have lost 11 governorships.

ACA in the 2016 Election

An Obamacare Agenda For President-Elect Trump. “Although it came late as a campaign issue, Obamacare was on the ballot again on Tuesday. And it lost big. According to exit polls, 45% said they thought the law had gone too far. Only 18% said it was about right. That follows years of public opinion polls consistently showing approval of the law under water. Voters have opposed the law since before it passed. Former House Speaker Nancy Pelosi and other determined liberals ignored the hundreds of thousands of people who marched on the Washington Mall on September 12, 2009, to protest their agenda. After that, deep-blue Massachusetts elected Republican Scott Brown to the Senate in early 2010 in an effort to build a firewall against final passage of the law. That failed when the White House devised a tortured and narrow path to final passage in March, but Democrats paid a high price when 63 House Democrats who voted for the law lost their seats in the 2010 mid-term elections… After years of broken promises from Obamacare advocates, voters will have little patience if Republicans fail them. So what can be done?” (Forbes, 11.10.16)

Presidential Race

  • Trump Favored in States with Rising Healthcare Costs. “Those who developed a preference for Trump may have rationalized and reinforced their support for the GOP nominee in terms of issues such as healthcare costs, said Geoffrey Skelley, an analyst for The University of Virginia’s Center for Politics. And voters who remained on the fence until late in the election campaign tended to support Trump over the Democratic nominee, he said. Skelley said premium increases in 2016, plus the 2017 rate hikes announced in October, may have tipped the Electoral College numbers in Donald Trump’s favor… Further increases in healthcare costs didn’t do Clinton any favors, election data shows. For instance, in Pennsylvania, the announced rate hike for 2017 plans was 29.08 percent; North Carolina, 19.23 percent; and Iowa, 33.41 percent. Trump carried all three of those states. The average premium increase for benchmark plans in 2017 was 22 percent.” (Patient Daily, 2.21.17)
  • According to Wall Street Journal (11.11.15),  All candidates have taken the position that the ACA should be repealed but to date, only Jeb Bush, Bobby Jindal, and Marco Rubio have put out detailed places for replacing it. Before dropping out, Scott Walker also had released a comprehensive replacement plan built around age-related tax credits, capped Medicaid and greatly expanded health savings accounts. Details of each plan are here.
  • Ben Domenech at The Federalist has argued (12.2.15) that the ACA may become the stealth issue that determines the outcome of the 2016 election: “Once Obamacare launched, it was supposed to be a political boon for Democrats. It was supposed to give them the ability to count on a newly engaged group of Americans who saw the government as providing them significant and helpful subsidies that prevented them from being concerned about their health coverage. Instead, its mismanagement and failure to live up to President Obama’s promises has given Republicans an opportunity they intend to exploit.”
  • Comparing the 2016 Presidential Candidates’ Health Proposals. (Commonwealth Fund, September, 2016)
  • Where Trump and Clinton Stand on Health Care and Medicare. (Next Avenue, 8.12.16)

Hillary Clinton (D).

  • Hillary Clinton’s Comprehensive Agenda on Mental Health. (Clinton Campaign, 8.29.16)
    • Japsen, Bruce. (9.1.16) Why The On-Demand Industry Likes Clinton’s Mental Health Plan. “From telemedicine companies to firms gathering data to mine insurance claims to find out whether patients are at risk for addiction and substance abuse, Clinton’s plan, unveiled this week, is being praised by advocates for improving the nation’s mental health by moving to a value-based system.”
    • Editors, National Review. (8.30.16). Hillary’s Mental-Health Plan Isn’t the Solution. “Although serious mental illnesses, such as schizophrenia and bipolar disorder, directly affect less than 5 percent of the population, they are overwhelmingly responsible for some of our most grievous social ills, from homelessness to mass shootings. Focusing limited government resources on serious mental illness should be the priority of our mental-health apparatus. But Hillary Clinton’s newly released ‘Comprehensive Agenda for Mental Health,’ while distinguishing between those who suffer mental-health problems and those burdened by serious mental illness, neglects the latter almost entirely. She proposes to maintain, or even bolster, the policies that have left the seriously mentally ill untended for decades.”

Donald Trump (R).

Gary Johnson (L).

Jill Stein (G).


  • Voting for Hillary? It May Cost Your Life. “Hillary Clinton stands for still more expansion of government control than has already been implemented under Obamacare. Clinton’s goal of a ‘public option’ means a locked-down, government-run, single-payer socialized medicine plan that would close off your medical freedom and end private practice of medicine for the foreseeable future… Hillary Clinton began her push for total government-run medical care when then President Clinton appointed her to head the 1993 task force secret meetings for ‘health-care reform.’ The Association of American Physicians and Surgeons fought against the illegal secrecy of the task force meetings in 1993, and secured the release of the documents to the National Archives. Copies of many of these documents are online. Mrs. Clinton’s modus operandi of deleting documents required to be produced in legal proceedings was evident in 1993: A number of the floppy disks, purportedly containing documents that had to be preserved by law, were blank. This was not made public on a broad scale at the time. Clinton’s failure to produce all of the secret task force documents is even more troubling in light of the current investigation into Clinton’s more than 30,000 deleted emails from her time as secretary of state.” Vliet, L, M.D. (WND, 7.21.16)
  • Will the Never Trumpers ‘Own’ ObamaCare if Clinton Wins? “The one thing that America can count on due to ObamaCare’s effective demise is that the debate over what our nation’s healthcare system will look like is going to be rejoined in 2017, and whoever is elected president will be the key player in that decision. Never-Trumpers who have beaten drums against the government takeover of one-sixth of the economy through ObamaCare will, through their decision to, at best, provide aid and comfort to Democratic nominee Hillary Clinton, have made the decision that they are willing to trade away any chance of a GOP repeal. Under a Clinton presidency, Republicans in Congress will find themselves defending the existing system against demands by Clinton that, at the least, the people be provided a public option choice that allows eligible applicants to choose to become part of the already overburdened Medicare system rather than using a private insurance option. Under Clinton, the public option pathway to single-payer would become odds on favorite to become law, and the socialized medicine battle will have been lost.” Manning, Rick. (The Hill, 8.3.16)
  • Where Clinton Will Take ObamaCare. “Except for the fact that it is occurring right before the elections, the four largest national health insurers dropping out of ObamaCare is not a problem. This is the plan. Eliminating the facade of private insurance is how ObamaCare ‘morphs’ into HillaryCare and ultimately into a single-payer plan like Medicaid or Medicare. This is exactly what Mr. Obama and the Clintons wanted to begin with. Right on cue, they are now campaigning for a Bernie Sanders-type nationalized health-care system. For the ObamaCare of today to be transformed into the HillaryCare of 1993 and finally into a nationalized health-care system, a president is needed who has the willpower to impose the coercive details, nail down hard deadlines and unleash agencies to tighten controls and squeeze the life out of private insurers. In 1993 Hillary Clinton unapologetically proposed to do just that. If she is elected president she will have the unilateral power under ObamaCare to do it. The loss of what remains of Americans’ health-care freedom is an election away.” Gramm, Phil. (Wall Street Journal, 10.17.16)

Senate Races

  • ObamaCare Exits being Felt in Senate Battleground States. “Eight of the states that will determine the Senate majority in November are likely to see significant reductions in the number of insurers participating in ObamaCare marketplaces. The likely departures of insurers in Illinois, Wisconsin, Florida, Pennsylvania, Ohio, North Carolina, Arizona and Missouri are pushing the healthcare law toward the center of some of the most competitive Senate races in the country. GOP strategists say Obama-Care’s troubles this year are morphing into a perfect storm for their candidates, providing a boost in a year when the party is defending 24 Senate seats. ‘It feels like there’s a sleeping giant that’s about to awaken on the campaign trail,’ veteran Republican strategist Ron Bonjean said. ‘It really does seem like an easy target, an easy layup for Republicans to score points.’” (The Hill, 9.13.16)

House Races

Gubernatorial Races

Impact of the Election on ACA Repeal

ACA in the 2014-2015 Election


  • New York Times (2.16.14).
    • “As Democrats approach the 2014 midterm elections, they are grappling with an awkward reality: Their president’s health care law — passed almost entirely by Democrats — remains a political liability in many states, threatening their ability to hold on to seats in the Senate and the House.”
    • “As a result, party leaders have decided on an aggressive new strategy to address the widespread unease with the health care law, urging Democratic candidates to talk openly about the law’s problems while also offering their own prescriptions to fix them.”
    • “The shift represents an abrupt change from 2010, when House Democrats tried to ignore the law entirely and ‘got their clocks cleaned,’ said Senator Christopher S. Murphy, Democrat of Connecticut, referring to the more than 60 seats that Republicans picked up to regain control of the House.”
  • Dean Clancy, at U.S. News and World Report reports (6.19.14):
    • “Health care is now firmly at the top of voter’s minds, according to research by The Polling Company for FreedomWorks. Full disclosure: I helped conduct this research. Voters usually name ‘health care’ as one of their ‘top 10’ issues. But right now it’s one of the ‘top three,’ along with ‘jobs / economy’ and ‘government spending.’
    • “An unpublished January poll by Heart-Mind Strategies for the Heritage Foundation is even more striking, finding health care to be in the ‘top one’ – that’s right, the No. 1 issue on voters’ minds.”

Senate Races

  • Miami Herald (3.27.14): “Six Senate Democrats Thursday unveiled proposals to make changes in the Affordable Care Act, the health care law under fire from conservatives and Republicans. Two senators, Mary Landrieu, D-La., and Mark Begich, D-Alaska, are considered among the most vulnerable Senate Democrats this year as they face tough re-election efforts. Joining them in proposing new ideas for the health care law are Sens. Heidi Heitkamp, D-N.D., Mark Warner, D-Va., Angus King, Ind.-Maine and Joe Manchin, D-W.Va.”

House Races

  • (6.11.14). “House Majority Leader Eric Cantor’s shocking primary loss Tuesday night all but kills any chance of the House voting on an Obamacare replacement bill this year. The prospects of Republicans rallying around a replacement policy and scheduling a vote was already an uphill endeavor — one that few expected to actually happen. After all, the House GOP had been trying to agree to a plan for several years already. But the loss of the House leader who was most closely allied with the lawmakers seeking a vote is probably an insurmountable obstacle.”

Gubernatorial Races

ACA in the 2012 Election

  • Blendon, Robert J., John M. Benson, and Amanda Brulé. Understanding Health Care in the 2012 Election. New England Journal of Medicine 367, no. 17 (2012): 1658-61.
    • Polls show that health care is the second most important issue for likely voters in deciding their 2012 presidential vote. This is the highest that health care has been ranked as a presidential election issue since 1992.
    • When likely voters were asked to choose from a list of issues, an approach similar to that used in election-day exit polls, one in five (20%) named “health care and Medicare” as the most important issue in their 2012 voting choice, far behind “the economy and jobs” (cited by 51%).
  • Rau, Jordan. Health Law Was A Wash In The Election, Poll Finds. Kaiser Health News, 11.13.12.
    • “After two years of noise and stridency on the 2010 health care law, the Affordable Care Act ended up being a wash in the presidential election, a new poll finds.”
    • “Both President Barack Obama and Republican Mitt Romney ended up getting equal support among voters who said the law was a ‘major factor’ in their vote for president, according to the poll from the Kaiser Family Foundation conducted shortly after last Tuesday’s election. (KHN is an editorially independent program of the foundation.)”

ACA in the 2010 Election