On the Ballot: Health Care Reform

To some degree, the elections across the country next year likely will be referendums on health care reform, but more so in Arizona than most ...
by | November 18, 2009

To some degree, the elections across the country next year likely will be referendums on health care reform, but more so in Arizona than most places. That's because in Arizona there will be an actual, real referendum on health care reform.

Arizona voters will weigh in on a state constitutional amendment that backers say would forbid governments from requiring everyone to have health insurance or requiring citizens to participate in a single-payer system. The first part is more significant than the second part: An individual mandate is a key feature of both the U.S. House and Senate health care bills.

To ballot measure junkies, this issue in Arizona might sound familiar. Just last year, the state rejected a constitutional amendment that would have done virtually the same thing. That vote was exceptionally close. The measure failed by around 8,100 votes.

Of course, that was before health reform became such a hot political debate. Arizona's conservative legislature decided to give the effort another try by voting to place a slightly modified version of the proposal on the ballot next year.

Arizona might not be alone. Conservative legislators in around 20 states are promoting constitutional amendments to try to thwart the individual mandate. Undoubtedly, the proposals will stall in some states. In others, rules for constitutional amendments (such as requirements that the proposals be approved in successive sessions of the legislature) will preclude public votes right away. Still, it seems fairly likely that other states besides Arizona will weigh in on the topic next year.

The actual policy significance of these constitutional amendments is debatable. Usually, federal law supersedes state law. Most legal scholars seem to believe that a state constitutional amendment won't be able to prevent the federal government from implementing an individual mandate.

Regardless, the political significance is clear. Even in states where the proposal never makes the ballot, legislators will be going on record as being for or against a key component of health care reform. These votes seem likely to turn a contentious federal political issue into a state one.

So, what does the politics of the individual mandate look like?

The Washington Post recently polled the question:

11. Would you support or oppose a law that requires all Americans to have health insurance, either getting it from work, buying it on their own, or through eligibility for Medicare or Medicaid?

The result: 56% in support, 41% opposed. Clearly, the American people like the individual mandate.

However, AP-GFK also recently polled the question:

Would you favor, oppose, or neither favor nor oppose a law that would require every

person to have health insurance, and pay money to the government as a penalty if they

do not, unless the person is very poor?

The result: 28% in favor, 64% opposed. Clearly, the American people hate the individual mandate.

I'll give a CNN poll the opportunity to break the tie:

Now here are a few provisions in the health care bill passed by the U.S. House. Please tell me whether you favor or oppose each one.

Requiring all Americans who do not have health insurance to get it:

The result: 49% in favor, 49% opposed. Oh well.

When polls are finding such conflicting results, usually it's a sign that voters don't have very firm views. When it comes to the individual mandate, that makes sense.

While the issue appeared in the Democratic presidential primaries last year and has occasionally intruded on other elections (such as the 2006 Ohio governor's race), most voters haven't spent a lot of time thinking about it. In this year's health reform debate, it's been striking how vastly more tangential issues, such as end-of-life counseling, have received more attention than the individual mandate.

But, state-level debates on the individual mandate -- whether it's being voted on in legislatures or on the ballot -- likely will finally cause the public to focus on the subject. Then, we'll have a much better idea whether voters are for the concept or against it.

Josh Goodman
Josh Goodman  |  Former Staff Writer
mailbox@governing.com  | 

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