Affordable Care Act and Political Speculation | MIT Center for Civic Media

Affordable Care Act and Political Speculation

In expectation of the Supreme Court's ruling on the Affordable Care Act, I've been looking at predictions, public poll stats and listening to commentary full of speculation. These have been hard to miss, reading the news in the last week. In this blog post, I look at a few methods for speculation – public opinion polls, opinion pieces, and InTrade.

Especially in an election year, I expect to see many more types of polls speculating about which candidate is favored and around what issues. The barrage of polling data leads me to a few questions about speculation. What is the relationship between these speculation methods and political outcomes? Is there any relationship between public opinion polling results and Supreme Court decisions? How do politicians and lawmakers interact with polling data? And, how do non-politicians interact with polling data – in what ways do polls of public opinion influence public opinion or civic action? In short, why should I, as a member of the public, care about public opinion polls?

What's at stake
The Affordable Care Act was signed into law in 2010. The provisions of the law greatly impact the numbers of US citizens who will be insured and also the health insurance industry and how it can design and sell health insurance. Among the 2000 page law, are key reforms including:

  • Minimum coverage provision, now most commonly called the individual mandate requires individuals to have healthcare insurance or to pay a fee to offset healthcare costs for uninsured individuals (to take effect in 2014)
  • Coverage for people with pre-existing conditions – requirement that insurance companies insure individuals with pre-existing conditions (already in effect)
  • Parents can continue to cover their children until age 26, extended from 19 or the age at which children finish schooling (already in effect)
  • Expanded Medicaid coverage supported in part by federal matching funds to states (to take effect in 2014)
  • Health insurance exchanges – for individuals who are not covered through employers, exchanges are supposed to help individuals and small businesses find affordable insurance (to take effect in 2014)
  • Tax credits to help individuals making between 100% and 400% of the poverty line to pay for insurance costs (to take effect in 2014)

For more complete information about the provisions of the Affordable Care Act, includes a timeline tool showing various provisions and when they take effect from 2010 through 2015 (

The Supreme Court heard arguments on four questions

  • Can the court hear this case? In 2011, United States Court of Appeals for the Fourth Circuit, in Richmond, Va. ruled that it could not hear this case until tax penalties of not having health insurance come into effect in 2015.
  • Is the minimum coverage provision (the individual mandate) constitutional?
  • Which other parts of the Affordable Care Act will need to be struck if the individual mandate is struck? In part, the individual mandate is a measure to make universal healthcare economically feasible – it supports insurance companies that have to insure people with prior considitions and higher healthcare costs by including people who can pay but will not use money for their own healthcare. Asking this question is asking what other dependencies exist within the law. Exmaples of states that previously attempted to insure all citizens with prior conditions show that this leads to collapse in health insurance industry.
  • Is the expansion of Medicaid a violation of states rights?

Deeper discussion about what's at stake for individuals and health insurance providers: What's at Stake for Your Insurance as Supreme Court Weighs Health Reform? Julie Appleby of Kaiser Health News; June 22, 2012; and Self-Interest Meets Mandate. Eduardo Porter; June 19 2012;

Speculation, what's to come and what's missing from speculation
Some political speculation feels like filler. Like the words that newscasters speak to fill airtime between events or insights, it's free of information about events or insights. This article is a good example of this – this article comments on speculation about the outcome, but doesn't touch the reasons why readers might care about the outcomes, the effects of the ruling on healthcare and health in the US. Does the existence of this article indicate that we think speculation itself is newsworthy? Or did everyone else notice that this was going to be filler and knew to skip reading it (if this is you, please share your methods with me)?

How much more useful are polls? According to this Jun 24 2012, Reuters poll, 56% of polled are against the Affordable Care Act, but 44% support the individual components of the law. How will these numbers effect SCOTUS? How do they effect politicians in their public support or opposition to the law? How and why should members of the public care about public opinion polls?

InTrade, superspeculation
InTrade, frequently referred to as a source of public opinion data is a sort of composite speculation tool. About 10,000 InTraders place bets on outcomes of yes or no questions, basing bets on other polling data and related information. Current information for two related InTrade bets speculate that the Supreme Court will rule the individual mandate is unconstitutional.

Where's history?
Speculation being forward looking, might be blind to unexpected shifts and ignores history. The history of political support for the individual mandate is particularly interesting. Political opinion on the individual mandate has moved 180 degrees. The idea of the individual mandate began as a conservative proposal in the 1990s, supported by Republicans as an alternative to healthcare reform as proposed by Hilary Clinton. By 2008, John Edwards, proposed an individual mandate as he campaigned for the Democratic presidential nomination. Support in 2010 for the Affordable Care Act was strictly partisan, passing the Senate with a 60 yes votes (58 Democrat and 2 Independent) and 39 No votes (all Republican), and opposition to the individual mandate is partisan now.

“Americans are strongly divided along partisan lines. Among Republicans, 86 percent oppose and 14 percent favor the law and Democrats back it by a 3-to-1 margin, 75 percent to 25 percent, the Reuters/Ipsos poll showed.” (

And, predictions are that the Supreme Court is likely to be divided 5-4 along party lines. Could polls in the 90s have presaged this?

What stories do polls tell? What important stories do they not tell? What medium best tells the story of asynchronous bipartisan support? And should I bother paying attention to polls as we await this decision?

Related references:
Health Care Reform and the Supreme Court (Affordable Care Act). NYTIMES Supreme Court Blog.

Supreme Court of the US Blog.

Congressional voting records on health reforms.

Reuters Poll: Most Americans oppose health law but like provisions

Of course the Supreme Court is political. Ezra Klein, June 21, 2012;

Conservatives Sowed Idea of Health Care Mandate, Only to Spurn It Later. Michael Cooper. Feb 14, 2012, New York Times.