The Electoral Consequences of Roll Call Voting: Health Care and the 2018 Election

Austin Bussing

Will Patton

Jason M. Roberts

Sarah A. Treul 

University of North Carolina at Chapel Hill


Members of Congress are often faced with two conflicting choices: casting a vote to satisfy their constituents or casting a vote to satisfy the leaders in their party. While the goals of the party and constituents are often the same, there are some issues, such as health care, on which representatives may receive mixed messages. The repeal of the Affordable Care Act (ACA), also known as “Obamacare,” has been an important electoral talking point amongst members of the Republican Party since the passage of the law, and Republicans seemed to have finally had their chance, with GOP control of the House, Senate, and White House at the beginning of the 115th Congress.  There was just one problem, however. A repeal would result in hundreds of thousands of Americans (many residing in the districts that Republicans represented) losing their health insurance coverage. Suddenly, GOP members found themselves in a difficult position when a vote to repeal the ACA was scheduled. Would they decide to follow through with repeal and fulfill a partisan promise, or would they listen to angry constituents who threatened to vote them out if they took away their health insurance?

Our recent article in Political Behavior explores the question of how members of Congress were able to navigate the conflicting demands of constituents and party leadership by focusing on these Republican efforts to repeal and replace the Affordable Care Act. It has been well-documented that a voter’s identification as a Republican or Democrat is the strongest predictor of their vote choice, which seems to suggest that voters who elected their Republican representatives may continue to do so, regardless of their vote on repeal, so long as it meant having a Republican represent them in Congress. This seems to suggest, however, that members could be free from punishment by their constituents for casting a “bad” vote. It was clear, given the vocal opposition that many members received at public events, including town halls, that this was not entirely the case.

Our article shines light on how members of Congress gather and process information about constituent opinion in their districts. We utilized data on the number of town hall events held by Republican House members leading up to the repeal vote in order to test for an association between these events and the members’ votes on the repeal measure. In theory, these town hall events should represent opportunities for members to more clearly understand their constituents’ opinions on the repeal of the ACA. In addition to examining the effect of town halls on members’ votes for the ACA repeal, we also test for downstream effects of Republican members’ repeal votes on their performance in the 2018 midterm elections.

Overall, our findings show that Republican members of Congress were held responsible, at least in the 2018 midterms, for their votes to repeal the ACA, as members who voted for repeal were more likely to lose their seat in 2018. This relationship held when controlling for a number of other important variables, including each districts’ vote percentage for Hillary Clinton in the 2016 presidential election and the presence of a quality Democratic challenger. Districts of Republican members who voted for the ACA repeal also saw more Democrats running for the seat, suggesting that these members who favored repeal may have appeared vulnerable to the opposing party. Furthermore, in an individual-level analysis using survey responses to policy-relevant questions, we show that voters who agreed with their member’s vote on the ACA repeal were statistically more likely to vote to reelect their member– even controlling for partisanship and the respondent’s vote choice in the 2016 presidential election. These results demonstrate that, even in an era of highly partisan electoral behavior, members of Congress are still held responsible for their vote choices on important issues.

Interestingly, we do not find results in the expected direction in our analyses of data on the number of town hall events held by Republican House members. Because the ACA repeal was the dominant topic of discussion at these events, and because much of the constituent opinion expressed at these town halls was decidedly against repeal, we expected the number of town halls held to be negatively associated with member support for repeal. This was not the relationship we found– in fact, Republican members who held more town halls were actually marginally more likely to support a repeal bill that Speaker Paul Ryan (R-WI) ultimately pulled from the House floor. Anecdotal evidence from the statements of a number of Republican members, including Speaker Ryan himself, suggests that Republicans were skeptical about the constituent feedback received at these types of events. Some Republicans, such as Jason Chaffetz (R-UT) expressed the belief that many people showing up at these town hall events were not actually constituents. These types of statements illustrate both the inherent difficulty of gauging constituent opinion on salient and divisive policy issues and the resistance of members to abandon partisan behavior in Congress. Despite this, the results presented in our paper demonstrate that the close monitoring of constituency policy preferences is a worthwhile endeavor for members of Congress, as shared partisanship cannot always insulate representatives from the repercussions of voting against their constituents’ interests.

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