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Health Care Reform Counterfactuals

- March 9, 2012

The new piece by Nyhan, McGhee, Masket, Greene, and me on health care reform’s effect in the 2010 election– see my earlier posthas gotten some attention.  Naturally, what has gotten the most attention is a simulation where we try to see whether the electoral penalty for supporting health care, which we estimate at about 6 points, would actually have been enough to cost any individual Democrats their seats.  Our simulation suggests that it cost the Democrats about 25 seats.  Both Kevin Collins and Jonathan Chait pushed back at this simulation, so let me respond.

First, here’s what we did.  We have a model in which we estimated the penalty for Democratic House incumbents who supported the Affordable Care Act (we use the March 2010 vote).  We then entertain this counterfactual: every Democrat who was running in a competitive House district and voted for the Affordable Care Act didn’t in fact cast that vote.  So the penalty disappears for these incumbents.  Would that have “given” them enough vote share to win the race?  That’s the question we answer.  Contra Chait, we are not exactly “leaping to a conclusion.” We’re actually doing math here.

Second, let’s be clear on how the 5 of us think about this simulation or any such simulations.  I’ll quote from the piece:

bq. However, there are important caveats to this counterfactual analysis, which varies only the votes for health care reform cast by Democratic House members in competitive districts. The real political world is more dynamic. We have no way of knowing, for example, whether more Democratic dissent in the House would have doomed the health care bill and thereby led voters to see the Obama presidency and Democratic Congress as failures. It is also possible that the failure of health care reform would have demobilized some Democratic donors, interest groups, and voters in 2010. Although our results suggest that Democratic supporters of health care reform lost votes as a consequence, counterfactuals about the number of seats lost inevitably leave out many other factors and possibilities.

Chait acknowledges these caveats, but says we do so “without incorporating [them] into their conclusion.”  That’s sort of odd, in that the caveats appear in the section of the article entitled “Conclusion.”  And the abstract of the article is also careful to say that support for the ACA “may have cost Democrats their House majority.”  Emphasis mine.  I think it’s perfectly clear that we recognize the limitations of the simulation, and I hope that any further media coverage of our piece will reflect that.

Third, and most importantly, let’s discuss the substance of Collins’ and Chait’s objections.  Chait first reiterates the point we make above: that the failure of health care could have hurt the Democrats too.  So we agree here.  But he then raises another objection that echoes Collins.  Collins says:

bq. we should expect that news and ads would cover other issues more heavily, so the coeff[icient]s on those other votes should increase.

Chait says:

bq. But if the House had voted down health care reform, some other issue would have become the “big vote” and, probably, have become the proxy for out-of-control liberalism, or back-room dealing, or whatever voters didn’t like about Washington, right? There could have been renewed attention to stimulus, cap and trade, or many other things. Democrats in 1994 gave up on health care reform, but Republicans turned the crime bill – which Democrats intended as a political sop to the center – into the emblem of liberalism run amok.

Quickly on 1994: Gary Jacobson’s analysis suggests that Democrats were punished for support for the 1993 budget and NAFTA, but not necessarily the crime bill.  That said, the effects of these three votes are probably not different from each other at a statistically significant level.  But note one difference between 1994 and 2012: the effect of any of these three bills was about 1-2 points (the crime bill’s was about 1 point).  So none of these were as potent as the ACA appeared to be.

Back to 2010.  Collins and Chait raise the question: if there is no ACA, does another bill serve the same function — that is, something that becomes a big enough albatross around the neck of Democrats to (perhaps) cost them the majority?  Or, to quote Chait again:

bq. But surely something would have occupied the “Washington liberals run amok spending your money during a crisis” political space.

I have two reactions to this.  First, it’s not easy-peasy to find such issues.  As Eric McGhee said to me via email: “If just any old issue would have worked, why don’t we see huge swings every year?”  I am not suggesting — nor is Eric — that Chait or Collins is claiming that “just any old issue would have worked.”  But we need to be clear that many, if not most, House elections aren’t affected by controversial roll call votes in this same way.

Second, and more importantly, what is this “something”?  What bill would have taken the ACA’s place?  Here are some possibilities:

1) The earlier health care vote, which Chait cites.  I think it’s hard to make as devastating a case against supporters of a bill when that bill was never was signed into law.  Unlike the 1993 budget or NAFTA or the ACA.  Maybe, as Chait says, Democrats who supported the first bill would have paid a price.  But as much of a price?

2) Cap and trade.  We investigated this bill in the piece.  It didn’t seem to affect the distance that voters saw between them and their representative.  It didn’t seem to affect vote choice at the individual level — except to make Democratic voters more supportive of their Democratic incumbent.  However, when we looked at the aggregate elections data, support for cap and trade was associated with a small electoral penalty (3 points).  So the question is whether this bill’s significance could have been inflated to that of the ACA.  Again, I think it’s harder to do that when the bill never became law.

3) TARP.  Clearly TARP was controversial.  But could this be pinned on Democrats?  It passed under Bush and got GOP votes.  I don’t think that attacking TARP would have been a strategy that the Republican Party could have embraced wholeheartedly.  Support for TARP already hurt some Republican supporters anyway (e.g., Bennett).

4) The stimulus.  This seems like the most promising alternative, especially since many voters didn’t think it worked and because it could be tied to existing concerns about the economy and the deficit.  On the other hand, I’m not as sure that it had quite the same resonance as the ACA.  Critiques of the stimulus amounted to garden-variety “wasteful government spending.”  I’m not sure that’s as, um, stimulating as “National Socialist Health Care: The Final Solution” and “death panels” and the like.

Perhaps there’s another bill I’m missing, or an angle on one of these existing bills that I’m missing.  But the point stands: if the argument is, “absent health care, something else would have served the same function,” then we should think about what that something else is and make the case for why it would have been equally as potent at the ballot box.

Although I’ve been more or less trying to rebut Collins and Chait, their critique and any others like it are perfectly fair and could even be correct.  Opinions will differ about what counterfactuals are or are not plausible.  We don’t want to throw up our hands and say we can learn nothing from these counterfactuals, but we also, as we try to be in the paper, want to be cautious.