Obamacare has grown more popular, but just barely. In the fall of 2018, favorable outnumbered unfavorable responses to the ACA by 47 to 42 percent, but those who hated it still outnumbered those who loved it—and that imbalance has held true from the beginning in 2010. On Election Day in 2010 and 2012, just a third viewed the program favorably, rising to just 40 percent in 2014 and 2016—all elections for which the Tea Party GOP was able to mobilize its base by promising to repeal and replace Obamacare. Only in 2018 did support rise to nearly half of the country.8
By contrast, Medicaid was wildly popular, viewed favorably by 58 to 19 percent, despite the GOP’s efforts to shift control to the states and cut it dramatically.9
Support for the Affordable Care Act was dragged down by the white working class, who form 37 percent of registered voters, but also by unmarried women and millennials who were supposed to be the beneficiaries of expanded access to health care.10 Only 20 percent of the white working class was favorable to the program through its first two years and that crept up to just a quarter by 2014. By the end of 2018, only a third viewed the ACA favorably, while 46 percent gave it the lowest possible rating.
White unmarried women who rallied to support Democrats in overwhelming numbers in the 2018 off-year election only became dependable supporters when the program was under attack from President Trump. These are single women on their own who support expansive government and who should benefit from expanding the health care safety net, yet just a third dependably supported it in the program’s first five years.11 Even in this last election with health care on the ballot, just 50 percent embraced it.
African Americans were strong supporters from the outset, but that had much more to do with the GOP labeling it “Obamacare” and Republicans’ effort to destroy his legacy.
So, what is going on?
It is not a great mystery. I did focus groups with white working-class independents and Democrats who voted for Trump in Macomb County, Michigan, and Donald Trump’s promise to fix the health care system was the greatest hope for his presidency. They believed passionately that Obamacare had made health care less affordable. They spoke of “price hikes” and reduced coverage and fees “punishing people that can’t afford it.” Nearly every person in our groups struggled with how to afford their plans, copays, and medications. One complained the cost of health care was “cutting into a lot of peoples’ income that’s not growing nearly as fast as premiums.” Another felt “taken advantage of” by the price hikes. Others complained of paying “outrageous” sums for coverage on the exchanges.
And the groups I did with unmarried women, African Americans, and Hispanics a year into Trump’s presidency sound eerily similar. They were not getting the relief they expected and costs were unbearable.
The battle over the Affordable Care Act was transformative. Health care costs became the biggest factor impacting voters’ going off a cliff financially or having some security. And it was politicized in ways I have not seen before. Voters now believed that the party you voted for would determine whether your health care costs would be “unaffordable.” And perhaps most important, a big majority wanted government to play a bigger, not smaller, role in health care.
In the 2018 election, health care was issue number one and those voters voted for the Democrats by 75 to 23 percent. Going into the presidential election year, Democrats are more trusted than the Republicans on this issue by 60 to 40 percent.12
Uttering the three words “prescription drug companies” in the working-class and college groups in December 2018 produced a reaction as personal and emotional as anything I have witnessed in my years of research. In one of the Macomb County groups, the male participants, one after the other, said: “killers,” “the devil,” “bad news,” “drives up health care costs,” “very costly.” The women in Oak Creek, Wisconsin, again one after the other, said: “worst of the worst,” “all money,” “greedy to the tenth power.”13
In one group in Oak Creek, the first participant said, “rapist.” And the moderator responded, “That’s a strong word.” He pushed back, “That’s the way I feel.” Another said, “criminals.”14 The moderator reacted, “Another strong word. Tell me about that.” This time the participant elaborated: “I feel they are poisoning people legally. I think they are killing people, legally, and they are getting away with it.”
In Seattle, the first participant said, “criminal.” And the moderator: “I’m sorry, what did you say?” Participant: “I mean, I have to pay for my own drugs the last twenty years with an individual plan that has a large deductible, so to me it’s just ridiculous. I pay $1,000 for an antibiotic for my daughter just because I’m a small business owner and don’t have insurance. It’s just kind of crazy.” The results can be ruinous: “When I look to the future and the medical costs that I know I’m going to have to pay every year,” said one Seattle woman with a husband recovering from brain cancer, “I sometimes can’t get out of bed in the morning.”
What people see are powerful companies that get doctors to push their product, spend massively on advertising to create demand, and get government to promote their interests. And consumers are left to live with the very high price. The reaction to prescription drug companies underscores how skeptical America has become of big corporations whose greed and power look just corrupt.
CEOS
CEOs of big corporations are the villain in the American story—and getting them to behave in the interest of their employees, company, and the country will be central to the Democrats’ case for change.
This strong anti-corporate streak emerged from a long history of chief executives shifting production, outsourcing, and weakening unions while failing to invest in the company’s competitiveness and enriching shareholders and CEOs. The anger with CEOs is fundamental and longstanding.
When I interviewed Macomb voters in the summer of 2008, their worry about candidate Barack Obama was not that he would govern for his own people, but whether he would tackle the powerful CEOs of American companies who have championed NAFTA and other trade agreements that accelerated the outsourcing of our jobs.
Globalization and technology had left all employees worried that their jobs would be disaggregated and outsourced abroad and put further downward pressure on wages. CEOs and the leaders of American business had broken a compact that had left fewer able to reach the middle class. Companies shed factory workers, who were first on the chopping block, but now outsourcing put a broader range of jobs at risk, including those of many college graduates.
And people believe CEOs and big industry used their influence over government to get a tax structure, trade agreements, and a regulatory regime that allowed them to get ever richer and make the country more and more unequal.
This is not nuanced. People are focused like a laser on CEOs, as you can see in what happened when I started testing the fairly neutral term “CEOs of large businesses.” In the graph below you can see the working-class contempt in the two-to-one negative responses to the term. But CEOs had also lost the confidence of college graduates. Negative reactions had always outweighed the positive. Just 10 percent view these deans of American capitalism with awe.
The leaders of American companies had lost millennials more than any generation and group, and they are the future. Their attitudes have been shaped by America’s post-crisis policies. In 2014, negative reactions to CEOs outnumbered positive by thirty-two points: in 2018, by twenty-eight points (19 percent warm and 47 percent cool). One third of millennials give CEOs the intensely negative rating. The New America is intensely anti-corporate.
In December 2018, I measured reactions to “CEOs of large corporations” for Public Citizen, and the anti-corporate pushback was as strong as I have ever seen. People told us that CEOs are overpaid, greedy, and “a lot of them are just out for themselves, not for the good of the company and their employees” (Macomb woman). They are “wealthy,” “untrustworthy,” “out of touch,” and “don’t care,” according to those
in the working-class groups. In Seattle, people said “overpaid” but also “entitled” and “sheltered” and having “no accountability.” They especially distrust the way that corporations are able to bend the system to their will so that they can earn more profits while hurting consumers.
They know that through lobbyists and big campaign donors, “they are buying their laws, basically” (Macomb man). That is what CEOs and labor unions are able to do, according to the college men in Seattle:
[Money and politics] reinforces and perpetuates this system that gives them more power and influences the access to campaigns and the important people running campaigns. And then there’s all this shadow money that gets thrown around that is really difficult to trace, but it’s almost always by self-serving corporations.
CEOs work for themselves at the expense of the country, and they use their growing wealth to influence campaigns and politicians to get government to help them enrich themselves further, without regard to what happens to other citizens.
That America was angry with corporate behavior and the CEOs who led the biggest companies was utterly absent from anything Democrats have had to say during the last decade. It is why Donald Trump was able to attack Hillary Clinton for taking corporate cash for speeches and being in the pocket of Wall Street. It is why so many Trump voters even now say a “President Hillary Clinton” would mean the rich are still calling the shots:
“She—politicians are owned by big businesses. Obama was too, they are all, they are in it for profit. I think she would not have been looking out for us, she would have been looking out for the wealthy.”—moderate GOP woman, Oakland County
The Democrats’ top leaders weren’t seen as pushing back on corporate power or wanting government to be a check on business or the new class of oligarchs.
How were the American people left with this impression?
HILLARY CLINTON’S CAMPAIGN
Hillary Clinton fully identified with President Obama’s vision of the economy and opportunity and faith in America’s upward trajectory. She viewed his campaign and government as successful, and thus, stocked her campaign with his campaign consultants and those who had worked in his White House.
She believed America was dynamic, growing, making progress, and now needed an economy that truly left no one behind. Inequality had worsened, but the answer was “building ladders of opportunity,” which President Obama had described in his State of the Union speech before his own reelection, in his campaign speeches for Clinton, and in his private handwritten letter to President Trump.
President Obama’s America was not a country in pain, but one where those left behind were looking for a seasoned leader to make progress. And Clinton was only reluctantly willing to pull off this narrative. She lived in a cosmopolitan and professional America not very worked up about the state of the country, even if many of the groups in the Clinton coalition were struggling and angry.
Obama’s refrain was so out of touch with what was happening to most Americans and the working class more broadly. In our research, “ladders of opportunity” fell far short of what real people were looking for. Incomes went down after the financial crisis, pensions lost value, and many lost their housing wealth, yet people faced dramatically rising costs for things that mattered: health care, education, housing, and childcare, which Edward Luce writes about so forcefully. People faced “vanishing” geographic and social “mobility.” Billionaires spent massively to influence politicians and parked their money in the big cities, whose dynamism drew in the best talent from the smaller towns and rural areas.
Clinton’s default position was Obama’s refrain about America, but she invited real discussion of these issues and got close to embracing the need for change in some of her economic speeches, her convention address, and in the debates. But when the going got tough, she empowered those most wedded to Obama’s vision.
My vantage point included regular meetings and exchanges with John Podesta, intended campaign chair with a long history of advising previous Democratic presidents. Early on, he pressed me for help on pushing back against Bernie Sanders’s Wall Street attack and asked my reaction to Hillary’s emerging stump speech. Later, I worked directly with Hillary Clinton on how to best close the primaries and was asked to react to the economic and convention speeches. And Podesta asked to email Clinton’s campaign manager Robby Mook directly when he could not get him to change course at the campaign’s close.
From 2015, I pushed Podesta, the other principals, and Hillary Clinton to show their discontent with the state of the economy and politics and to put forward bold economic policies, like those proposed by Joe Stiglitz and the Roosevelt Institute. Clinton was always comfortable with the policies, but her default was “build on the progress,” which meant minimally disrupting the status quo.
And from the beginning, I called on her to decry the special-interest, big-money influence that was keeping government from working for the middle class. On that, I got nowhere.
But I got the opportunity to keep offering this input only because John Podesta, the speechwriters, and most of her campaign advisers agreed with me.
Early on, I chided the campaign privately for starting every economic talk with dutiful praise for President Obama’s handling of the economy, and, later, for saying, “America is already great.” “The New American majority,” I wrote, “is looking for a president who will address the building problems”—and “not a third term of Obama.”
Podesta invited me to critique Clinton’s comments at an Iowa town hall that he thought was “getting there,” but I was dumbfounded. “What is your core message?” I asked. You want to “build on the progress that we’ve made” and Republicans will “rip away the progress and turn us backwards.” With some help from AutoCorrect, I said, “I think the overall message is tone-death [deaf] on what is happening in the country.” Clinton “has left the change voters to Sanders.”
I warned that Sanders was gaining by embracing the “level the playing field” message that I had developed with the Roosevelt Institute, which began: “Families and small businesses are struggling, yet CEOs and billionaires are using their lobbyists to rewrite the rules so government works for them.” And Sanders gained on economic change by committing to “stop any new trade deals that undermine American jobs and income.”
Sanders’s surprising strength and the harm caused by his big money and Wall Street attacks led John Podesta and I to huddle on how Hillary could find her footing on reform. Clinton’s instinctive response was to go silent and attack Sanders on guns and health care. I warned in my note on reporting a survey for the campaign reform group Every Voice: “Billionaires, corporations, and special interests buying their government is a voting issue.”15
My survey for Every Voice in December 2015 showed a big majority and highest level of support yet for “a plan to overhaul campaign spending by getting rid of big donations and allowing only small donations to candidates, matched by taxpayer funds.” You heard it right. That is with taxpayer funds, which is some measure of where voters have moved on this issue.
Hillary Clinton supported these and other bold reforms, but she was reluctant to speak out on them because of her financial support from Wall Street. I tested what would happen if Clinton were to publicize her reforms and say, “We must end secret money, unaccountable money that is corrupting our political system. On my first day in office, I’ll sign an executive order to require federal contractors to disclose the money they are spending to influence politics.” She committed to appoint Supreme Court justices who “value the right to vote over the right of billionaires to buy elections.”
The research showed Hillary Clinton could not afford to be silent on reform. When voters heard her reform message first before her being attacked by her opponents as corrupt, a majority rallied to her reform message anyway. But when voters heard the attacks first, her message fell short of a majority and intense support fell eight points. She had to be opportunistic on refo
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“LEVEL THE PLAYING FIELD” LEVELED “LADDERS OF OPPORTUNITY”
In the spring of 2016, both parties faced fateful choices, but also extraordinary opportunities to break out and offer disruptive changes to the current course of the country.
Based on the work of Joseph Stiglitz, the Roosevelt Institute developed a policy agenda to “level the playing field” and “rewrite the rules of the economy” to favor the middle class, rather than the top 1 percent. I helped evolve that agenda into a narrative and message that would be compelling in the upcoming election. It contrasted with candidate Hillary Clinton’s developing message that centered on building “ladders of opportunity” for every American and building on the accomplishments of President Obama.17
But it was a turning point for Republicans. Donald Trump was leading the primary field and had made trade, immigration, and nationalist economics central to his conservative vision. Ted Cruz was his main competitor, and he lambasted government spending and trade deals that promoted crony capitalism.
I put this big cross-party vision battle to a test first in a large-scale, experimental web survey and then in a national phone survey.
Donald Trump’s simulated “nationalist” message declared our political leaders were too incompetent, spineless, or corrupt to stand up to special interests and other countries to put American workers first. It was pitted against a Reaganesque message that asserted big government and crony capitalism stunt the economy, which requires smaller government, lower taxes, and fewer regulations to thrive. It was soon very clear Republicans led by a leader with an economic nationalist message could put the Democratic candidate at risk.
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