Understanding health care in the 2012 election.

The outcome of the 2012 election will have far­ reaching ramifications for the future of U.S. health care. Rarely in a national election have the two major candidates’ views about health care been so diametrically opposed. The views of President Barack Obama and Republican presi­ dential nominee Mitt Romney differ on whether the 2010 Affordable Care Act (ACA) should be implemented or repealed, whether Medicare and Medicaid should remain in their current forms with their current level of commitments, and whether the availability of abortion services should be further restricted. In addition, the can­ didates differ on whether the historically high federal budget deficit1 should be addressed with spending cuts alone or whether the solution should include some tax increases and whether more of the spending cuts should come from defense or from the domestic arena. This last decision will probably affect the level of future federal health care spending in areas such as the National Institutes of Health, the Centers for Disease Control and Prevention, and community health centers, among others. Here, we examine the role of health care in the 2012 election by drawing on the results of 37 independent telephone polls (with both land­ line and cell­phone respondents) in a project supported by the Robert Wood Johnson Founda­ tion. Examination of these polls as a group pro­ vides insight into the evolution of the public’s thinking. Our analysis focuses on public percep­ tions of the current political environment sur­ rounding health care, the role of health care as a voting issue, and the importance of specific health policy issues to individual voters’ choices. Polls show that health care is the second most important issue for likely voters in deciding their 2012 presidential vote (CBS–NYT, September 2012; HSPH–SSRS, 2012; see box for polls). This is the highest that health care has been ranked as a presidential election issue since 1992 (CNN–NEP, 2008).2 When likely voters were asked to choose from a list of issues, an approach similar to that used in election­day 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%) (HSPH–SSRS, 2012) (Table 1). One factor that influences election outcomes for incumbent presidents is the public’s assess­ ment of their record — in this case, the Presi­