Politics Counts: Health Care’s Effect on the 2012 Vote
The Obama administration’s health-care overhaul law has been front-and-center in the news this week as the Supreme Court debated its constitutionality – and to some extent its role in the 2012 campaign.
Much of the debate emphasized the law’s broad impact. Anyone who tuned into the coverage probably heard that health-care spending represents about 16% of national GDP.
But even though health care has huge effects on the economy and on the American people as a whole, those effects vary greatly from place to place. Nationally, the number of uninsured Americans has grown markedly in recent years and that spike has deepened a crisis for some communities. For others, however, those increased health-care challenges are not terribly noticeable.
Those differences become much clearer when you look at the uninsured on a map and particularly when you use Patchwork Nation’s geographic/demographic breakdown of 12 types of counties.
There are clear state patterns in the map to the left, based on 2009 Census data (the latest such Census data available by county). As one might imagine, communities in Massachusetts have much better coverage than communities in any other state. Texas, Nevada and Florida have much lower rates of coverage. But even within those broad patterns there are smaller ones to note.
Look at the major metro areas – the counties around Chicago, Denver, Detroit, Cleveland, Philadelphia, Pittsburgh and St. Louis – and in general you will see patterns of higher rates of insurance coverage. Those are the suburbs around those cities, places Patchwork Nation calls the Monied Burbs, where residents tend to have better jobs with better pay and better benefits, including health insurance.
Go further out to rural areas and you will generally see higher numbers of uninsured. That is particularly true in the South and West where two count types dominate: Minority Central counties, which have large numbers of African Americans, and Immigration Nation counties, which have large Latino populations. Those county types both have much lower income levels and fewer white-collar jobs.
What about places like rural Iowa, Minnesota and Wisconsin, which have high coverage rates? That’s because those counties hold high numbers of government jobs and older Americans. They mostly fall into two county types, the small town Service Worker Centers and aging Emptying Nests. Those older Americans may have longer-term jobs or pension plans that provide coverage or they be receiving Medicare. And the government jobs in them usually offer good health insurance.
Mouse over the map below to see the percent of uninsured by county. You can zoom in by using the scale on the left side of the map.
What can these numbers tell us about the issue’s impact in 2012? That’s complicated. Since the Obama health-care plan aims at extending coverage, you might imagine that as you walk up that scale of uninsured in the chart above, support for the plan would grow. But polls indicate that’s not exactly correct.
A recent survey from the Pew Research Center for the People and the Press found the public divided, but on the whole slightly supportive of the Obama health-care plan. But when you break those numbers down through Patchwork Nation’s county types, sharp divides emerge that seem to be more driven by political predisposition than anything else.
For instance, the Monied Burbs, which have some of the lowest numbers of uninsured, are among the Obama plan’s biggest supporters. Almost 48% say they approve of the plan, while 41% say they disapprove. Meanwhile, the socially conservative Evangelical Epicenters, which have much higher numbers of uninsured, tend to disapprove of the plan by a wide margin 55% versus 40% who approve.
The Monied Burbs are moderate swing counties that lean a bit to the left. The Evangelical Epicenters are rock-solid Republican.
That trend continues elsewhere. Look at the exurban Boom Towns and the big city Industrial Metropolis counties. Both are above the national average in their percentage of uninsured, but they have very different feelings about the plan, according to our analysis of the Pew poll. The Industrial Metropolis counties, which vote heavily Democratic, heavily favor the plan – 55% to 36%. The Boom Towns, which lean to the right, disapprove 49% to 44%.
It’s not completely that simple, of course. There are probably other factors in play. For instance, the plan’s mandate for individuals to buy insurance would hit less-wealthy communities more heavily. And some of the people in these communities may “disapprove” of the plan because it doesn’t go far enough. Other poll questions indicate that may be particularly true in the Boom Towns.
But the larger point, when you dig into the attitudes and numbers around the Obama health-care plan, is that the issue is difficult to project into the fall. The debate around it seems to be less about the specifics of the plan than it is the “idea” of the plan. Like the differences in health insurance coverage, that idea varies greatly from place to place. There are no easy political slam dunks in it.
And whatever the Supreme Court decides, it may be a tough fit for black-and-white campaign rhetoric.