What happened… By now, no one needs a detailed recap of the election itself. Although Senate Democrats may have done a little better than expected, the U.S. House of Representatives made a major swing to the right, as did statehouses across the country. This week’s Insider looks at the cause of that shift and tries to untangle the spin on the role of health insurance reform in the outcome. A second installment will look at ahead to the implications for implementation.

…and what the ACA has to do with it Although Republican leaders are already busy claiming that their electoral victory equals a voter mandate to repeal the ACA, the facts tell a different story.

Only 19 percent of voters said that health care was their main concern—and the majority of those voters voted for Democrats.  Furthermore, voters are split nearly between those who want to repeal the ACA, and those who want it to remain in place or go even farther. Taking this in, it’s hard to claim the election outcome was a call to repeal ACA.

It’s the Economy, Stupid

If health care wasn’t the driver, what was? Simply and clearly, the economy. Sixty-two percent of voters reported in exit polls that the economy was their number one issue and the majority of these voters (52 percent) cast their ballots for Republicans.

Despite the fact that the recession is officially over and the stock market has recovered the value it lost then, votes probably reflected the persistently bleak jobs picture.  The unemployment statistics since President Obama took office in January 2009 show that not only did the jobs numbers not get better; they got worse.

The “U6” rate calculated by the Bureau of Labor Statistics includes not only active job seekers (the number most commonly cited in unemployment data) but also counts discouraged workers and those who have a marginal attachment to the workforce and are looking for more work hours. The U6 now stands at 17 percent: that’s three percentage points higher than when President Obama took office and only one-tenth of a point off its high-water mark in 2010.

So the numbers suggest jobs was the biggest election factor, not views on health reform.

It’s also important to note that while the wave of GOP victories was widespread, it was far from evenly distributed.  Nearly 90 percent of House Democrats up for reelection this year who represented districts President Obama carried in 2008 were reelected.  The corresponding percentage for those in districts carried by Senator McCain was only 24 percent.  In other words, most of the Republican gains in the House came in districts that tended to vote Republican.  In a weak economy, Democratic House members in Republican-leaning districts were extremely vulnerable, regardless of their stand on health care.

Nonetheless, it would be a mistake to say that popular views of the ACA played no role in the outcome.  Without attributing causality, it’s noteworthy that Democrats in Obama-carried districts who voted against the ACA did worse than their counterparts who voted yes, while the hearty few who followed their conscience and voted yes on ACA while representing a McCain-carried district were almost all defeated.

Popular views of the ACA may also have played a role in the turnout and voting preferences of older adults.  Starting with the big lie about death panels in August 2009, there has been a deliberate, relentless and largely successful misinformation campaign aimed at older adults to turn them against the ACA.  Older voters are the age segment least supportive of the ACA.  They represented a larger share of the electorate this year than in 2010, and the majority voted for Republican candidates.  It’s not much of a stretch to suggest that their concerns about the ACA—however unfounded—helped bring them to the polls and affected their ballot choices.

And Democrats did not use the ACA to help motivate their core voters, even as they lost ground among older Americans.  Democratic messaging on the ACA focused heavily on the elimination of pre-existing condition exclusions—an issue that resonates particularly well with swing voters (who nonetheless trended Republican)—and pretty much ignored the importance of expanding coverage to more than 30 million Americans; an issue that plays better with core Democratic voters and particularly with younger voters, and racial and ethnic minorities, whose participation in the 2010 election fell sharply from 2008.

One notable (and perhaps too-late) exception? President Obama’s appearance on the Daily Show with Jon Stewart the week before the election, where he highlighted the coverage expansion as a key part of the ACA and made it part of his overall appeal to core Democratic voters.

The ACA, Medicare Advantage and the fall of Troy It’s more than a little ironic that senior voters turned away from the party most closely associated with the creation of Medicare (and Social Security) in favor of the party whose leadership has been very public about their intention to radically reshape, if not dismantle, the program.  Medicare beneficiaries made themselves willing, if unintentional, accomplices in undermining the program, and the Trojan Horse that made it all possible was the Medicare Advantage program.

The designers of Medicare Part D built in a formula that overpaid Medicare Advantage plans, thereby accomplishing two things at once.

First, the extra payments to the managed care plans enabled the plans to offer benefits that were richer than the statutory Medicare program.  The goal was to encourage beneficiaries to abandon traditional Medicare so that it would, in Newt Gingrich’s infamous phrase, “wither on the vine,” and make it easier to move from a guaranteed set of benefits to a voucher program.

Second, since the program increased Medicare costs overall, Medicare Part D would help precipitate a financing crisis that could be used as further ammunition for those who call for its restructuring.

The fortuitous (and surely unintended) twist on this strategy is the success ACA opponents have had in casting the elimination of those overpayments as a Medicare cut, cynically turning seniors against both the ACA and the party that has traditionally defended Medicare, and putting themselves in prime position to dismantle it–a long-held GOP goal.

So now what? With the election behind us, the next Insider will discuss what the new political landscape means for ACA implementation, and point to some silver linings among the clouds.

–Michael Miller, policy director