ACHE: Political Outlook for 2012, Highly Polarized, No Chance of Consensus

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Political analyst Ronald Brownstein launched the American College of Healthcare Executive’s 2012 Congress in Chicago this week with a scathing review of our elected officials’ inability to govern due to a hardening polarity in Washington. That, coupled with Congress’s low approval ratings, translates to this: The future of health care reform is ensnared in a high stakes game of chance, leaving health care providers swinging in the wind until the conclusion of the 2012 elelction. With party line voting in Congress at its highest level since post-Civil War Reconstruction and Congress’s approval rating down to 9%, not only is the election impossible to call at the moment, but it is equally difficult to know what President Obama’s health care policy would be replaced with should he lose the election. The health care law has inflamed more opposition than anything since Brown versus Wade, Brownstein says, with states refusing to establish insurance exchanges and Supreme Court arguments less than a week away. If Obama is reelected, his veto pen will be last line of defense against Republican efforts to repeal legislation. If the Republicans manage to take the White House and Congress, we are looking at a very different direction: Mitt Romney wants to end federal entitlement to Medicaid, convert it into a block grant, and limit its growth to 1% of GDP annually, ending the expansion of Medicaid under the Accountable Care Act. For Medicare, the Republican path is even more divergent, Brownstein says. The Republican house voted along party lines for a premium voucher program under which the federal government would issue beneficiaries a stipend every year. “All candidates are promising to repeal the health care law,” Brownstein notes. “It is a little less clear what would replace it. Without the law we would be looking at 60 million uninsured.” The current number of uninsured is 49.9 million. While President Obama has expressed a willingness to ask Americans to pay more for their entitlements, the Republicans are lining up behind rolling back funding for government to a time preceding the launch of Medicare, 1960. Romney recently proposed a 20% decrease in tax rates. “One reason so little has happened since 2011, is both parties believe the voters will strengthen their hand,” Brownstein observes. “In other words, Washington is on hold through the 2012 campaign. Will 2013 be like 2011, or 1997, when Bill Clinton was able to get quite a bit done with a Republican Congress?” Predictions and Plays Complicating all of this is the fact that neither party has support for its political vision, and Brownstein points to the huge waves of change that have broken over Washington in the past decade: In 2006, the Democrats won 30 seats in the House; in 2008, President Obama picked up nine states that voted Republican in 2004; and the pendulum swung back again in 2010, when Republicans won more seats in Congress than they had since 1938. “The last three elections could be described as a vote of no confidence,” Brownstein says. “This has been a lost decade, and one in which we have seen a collapse of faith in the government and the electoral process.” Brownstein says the Republican party is a bigger institution than the Democratic one, but divides almost in half between what he calls the managerial wing (more affluent, more moderate, more religiously secular) for whom Romney is an acceptable choice, and the populist side (less affluent, more socially conservative) for whom Romney is a harder sell. Although Rick Santorum has emerged as the leader of the populist wing of the party, we are at a point in the race where demography trumps momentum, he says. “Romney will tough this out, but he will win ugly,” Brownstein says, taking the coastal states and Illinois, but losing the interior and the South to Rick Santorum. What will emerge, he predicts, will be a party that is sharply divided along lines of religion, ideology, and class. Brownstein observes that President Obama is in a stronger position than he was eight months ago, but he is not secure. “If Obama is at 47%, he is likely to win,” predicts Brownstein. “Obama is right around there, sometimes below, sometimes above.” During a grueling fight for the nomination, Romney has had to take positions that will follow him into the election, which could prove to be liabilities in the important Sun Belt states that along with the Southeast, Brownstein believes may decide the election. In calling the Arizona immigration law a model for nation, Romney will be hard-pressed to find support among Hispanics and his positions on contraception are likely to alienate educated white women. Then there is what Brownstein calls rich-guy Tourettes. “He can’t stop talking about the money,” says Brownstein. “Romney is emerging from this with a weaker approval rating than any other winning candidate than Clinton in 1992. But Clinton did re-set.” Three Variables Brownstein predicts that Romney will wrap up the nomination in June and emerge a competitive candidate in a race that will be determined by three variables. The direction of the economy. If things are getting better, as they are right now, Obama will benefit. Can Obama turn out his base of young people, minorities, and college educated whites. Brownstein notes that the first two groups are hurting badly, and that they will need to see some economic improvement. The white-collar professional swing vote, historically a Republican demographic that has been migrating toward Democratic since the 1960s. “We are living through what I call a class inversion,” Brownstein says, noting that the formerly Democratic blue-collar demographic is now the base of the Republican party. Those lines converged under Clinton, Brownstein says, and crossed when Obama won 7% more college-educated white voters than McCain. To win, Obama needs to widen the gap between white voters with and without college education. Based on recent history, Brownstein predicts that this election will leave Washington even more divided than it is today, extolling the need for a spirit of far-reaching nationalism. “All of this should inspire a certain humility in our parties,” he notes. “No matter who wins, the best advice is these three words: Don’t unpack everything.”