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Partisan Priorities and the Health Care Debate:

Is There a Shift in Issue Ownership?

Noah Cramer
April 15, 2014
Gov 83.19

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I. Introduction
In Partisan Priorities: How Issue Ownership Drives and Distorts American Politics,
Patrick Egan argues that each of the two major American political parties owns particular issues.
That is to say, on a given issue, voters tend to trust one party over the other. For example
Democrats own education, the environment, and Social Security. Republicans, Egan argues,
own tax policy, national security, and crime. Egan concludes that issue ownership results from
a partys prioritization of an issue over timefor example, Republicans took ownership of tax
policy with a series of tax overhauls in the 1970s. That ownership is sustained by continued
Republican support for tax cuts (Egan 2013:12). Finally, Egan argues that issue ownership remains
remarkably resistant to changeonce a party owns an issue, it is not quick to relinquish it (Egan
Egan constructs his book around two historical accounts of issue ownershipa history of
Republican tax overhauls dating back to the 1970s and a history of Democratic pushes for health
care reform, culminating in the passage of the Patient Protection and Affordable Care Act
(colloquially Obamacare) in 2010.
But is Egans central assumption that the Democrats own health care still accurate? The
data set used by Egan to determine who owns which issue ends in 2010 (the year of Obamacares
passage). There is a good deal of evidence that suggests Republicans have since taken ownership
of the health care debate. First, though Egan argues that issue-owning parties tend to be able to
criticize opponents on owned-issues, Republicans have played the offensive on health care since
2010, criticizing the Affordable Care Act at nearly every turn. In 2009 and 2010 as the
congressional debates over Obamacare intensified, Democrats poll numbers plummeted despite

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signs of economic recovery (Saldin 2010:8). This is surprising given Egans analysis that, absent
economic struggles, presidential elections favor parties whose owned-issues are most salientif
Democrats own the health care issue and health care is the hottest topic of the day, Democrats,
in theory, would benefit (Egan 2013:85). Though other factors help explain the Democrats
midterm defeat, the negative effects of the health care debate are undeniable (Saldin 2010:8).
Perhaps even more strikingly, some recent polling data suggests that Republicans are now more
trusted on health care than Democrats (Rasmussen 2013), suggesting a full-fledged shift in issue
If Republicans have taken ownership health care, Egans thesis would imply that they have
made health care a priority, since Egan claims that parties take ownership of issues by prioritizing
those issues. Solid evidence supports this claim. The Republicans strategy for the 2014 midterms
has been described as going all in campaigning against Obamacare (Caldwell 2014) and Obama
himself has called derailing the Affordable Care Act the Republicans number one priority
(Kapur 2013).
A shift in either the ownership or the prioritization of health care policy would have
significant implications for Egans book. A shift in ownership might call into question Egans
claim that issue ownership remains stable over time. A shift would add a layer of complexity to
Egans argument that issue ownership fuels the creation of unpopular policy (Egan 2013:19),
implying that those unpopular policies have the power to destroy the issue ownership that begat
them in the first place. At the very least, a shift in issue ownership suggests that in a hurry to get
his book published, Egan neglected the significant political changes that were occurring around
him. A shift in partisan priorities not followed by a shift in issue ownership would be even more

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interesting, either providing a potential counter to Egans claim that issue ownership is determined
by issue prioritization or the Democratic Party will be handing over the keys to the health care
issue is in the near future.
This paper seeks to build on Egans analysis of issue ownership by aggregating the most
recent polling data on public faith in the two parties to successfully execute health care policy and
comparing it with earlier data. This paper ultimately finds evidence for a loss of trust in Democrats
ability to provide health care, but does not find evidence of a complete shift in issue ownership.
Following this analysis, I attempt to project the future of the health care issue by investigating
issue prioritization strategies. I find ample evidence of increased GOP focus on health care, but
not enough to project a future issue ownership shift or to distinguish it from what Egan terms
issue trespassingtransitory attempts to encroach on an issue-owning partys turf.
II. Is There a Shift?
To determine if a shift in issue ownership has taken place in the health care debate, I
attempted to create a data set parallel to Egans. I compiled opinion poll data using the same
database-- The Roper Center Public Opinion Archives-- and search terms as Egan (Egan 2013:73).
Like Egan, I included questions regarding partisan trust on Medicare and Medicaid in the data set.
While Egans data ranged from January, 1970 to July, 2011 (Egan 2013:73), I collected data from
three recent periods-- the entirety of 2003, the entirety of 2011, and the period from January 1,
2013 to April 14, 2014. Using these three time periods allowed me to avoid potentially
confounding variables including elections, spikes in Democratic popularity at the end of Bushs
presidency, and the 2009 financial crisis.

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I regressed the year the survey was conducted and the margin of support the Democrats
enjoyed over health care policy. I found that one year was associated with a 0.50 reduction in the
Democrats margin of support. This correlation was statistically significant.
Table 1-- Linear Regression


Standard Error




*Significant at P<0.05, n=78

Table 2-- Mean Margin of Democratic Trust on Health Care Over Time

Despite a clear loss of public faith in Democratic health care policy, it is important to note
that there has not been a total inversion in issue ownership. Voters still trust Democrats over
Republicans on health care by an average margin of 5%. Only one of 17 polls taken in 2013 and
2014 found that America trusted Republicans more than Democrats to administer health care

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III. The Future of the Health Care Issue

The loss of trust in the Democratic Partys health care policy could be temporary or could
imply that Democrats may soon lose ownership of health care. The trend against Democratic
ownership of health seems consistent with Egans model of Issue Trespassing, suggesting that
the Democrats health issues may be temporary. In issue trespassing, a party attempts to
neutralize the ownership advantage of the opposing party by increasing focus on a particular
issue (Egan 2013: 160). Egan finds that trespassing can lead to changes in issue-ownership but that
those changes tend to be short-lived. (Egan 2013:160). Egan cites multiple reasons for the
unsustainability of ownership shifts. These include inadequate prioritization of the trespassed issue
by the trespassing party and the issue-owning partys unwillingness to stop prioritizing the
contested issue (Egan 2013:160-165).
To determine if Republican gains in health care ownership will be lasting, it is worth
examining how those gains will be affected by the factors that have historically impeded shifts in
issue ownership. It seems likely that Republican focus on health care will be strong enough to flip
issue ownership. Health care policy has remained central to Republican electoral strategy
(Caldwell 2014). Furthermore, a 2014 Gallup Poll found that 79% of Democrats and 75% of
Republicans believe that action on health care is either extremely important or very important.
This near universal support for action makes health care the only issue in the top five priorities of
both parties (Wilke & Newport 2014). Though some may point out that bipartisan prioritization
of health care is an instance of what Egan calls Issue Convergence-- the prioritization of a
particularly salient issue by both parties-- it is important to remember that it is the Republican
backlash that has kept health care salient.

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However, it seems even less likely that Democrats will cease prioritizing health care. In
the Gallup Poll cited above, more Democrats than Republicans considered health care a top issue
(Wilke & Newport 2014). In lead up to the 2014 midterms, Democrats have taken to criticizing
Republican intransigence on health care, rather than running from the health care issue.
Democratic congressional candidates have warned that Republicans desire to repeal Medicare and
return to the days where insurance companies took advantage of customers (Hohmann 2014).
This strategy is best evidenced in a leaked Democratic Party memo which states, The best way to
push back on the attacks we know Republicans will launch over health care is to be on offense
about what your opponent would do to health care while highlighting your commitment to fixing
and improving the law (Hohmann 2014).
With neither party likely to cease prioritizing health care, we may be faced with a situation
not discussed by Egan-- a consensus issue (that is to say, an issue that nearly everyone desires
to see addressed, even if there is no consensus on how to address it. Egan argues that only
consensus issues can be owned.) without an owner. In this scenario, Republicans would continue
to garner trust over the health care issue while Democrats continue to lose it until neither party is
able to claim dominance on the issue.
IV. Recommendations for Future Research
Further research could better project the future of the health care debate and better explain
the processes of issue ownership by incorporating polling data from 2007 and 2009 into my data
set. This would show whether trust for Democrats on health care declined steeply after the election
of Obama in 2008, declined steeply after the passage of the Affordable Care Act in 2010, or has

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declined steadily at least since 2003. A steep decline after the passage of Obamacare might suggest
that Republican backlash and prioritization of policies to counteract Obamacare has caused a shift
in issue ownership. A steep decline after Obamas election, on the other hand, might suggest that
Obamacare is so unpopular that its presence in public discourse harms public trust for Democratic
politicians health care agendas. This result would run counter to Egans claim that the popularity
of specific policies does not affect issue ownership. Finally, if data shows that trust in Democrats
to perform on health issues has declined steadily since 2003, older data would be necessary to
determine at what point Democratic ownership of health care began to decline.

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Works Cited
Caldwell, Leigh Ann. "Republicans Hit a Nerve When It Comes to Obamacare." CNN. CNN, 7
Apr. 2014. Web. 14 Apr. 2014.
Egan, Patrick J. Partisan Priorities: How Issue Ownership Drives and Distorts American
Politics. New York: Cambridge UP, 2013. Print.
Hohmann, James. "Democrats' New 2014 Plan: Neutralize Obamacare." Politico. Politico, 17
Feb. 2014. Web. 15 Apr. 2014.
Kapur, Sahil. "Obama Torches GOP For 'Ideological Fixation' With Repealing Obamacare."
Talking Points Memo. Talking Points Memo, 9 Aug. 2013. Web. 14 Apr. 2014.
Rasmussen Reports. 43% Trust GOP More on Health Care, 39% Democrats. Rep. Rasmussen
Reports, 20 Nov. 2013. Web. 14 Apr. 2014.
Saldin, Robert P. "Healthcare Reform: A Prescription for the 2010 Republican Landslide?" The
Forum 8.4 (2010): 1-15. Web.
Wilke, Joy, and Frank Newport. "Democrats and Republicans Differ on Top Priorities for Gov't."
Gallup Politics. Gallup, 28 Jan. 2014. Web. 15 Apr. 2014.