Public opinion played a prominent role during the recent health care reform debate. Critics of reform pointed to poll results as evidence that a majority of Americans opposed sweeping changes. Supporters cited polls showing that people favored many specific aspects of the legislation. A closer examination of past and present polling shows that opinion tracked with historic patterns and was relatively stable, even if the contentious public debate suggested a volatile public mood in 2009 and 2010. Going forward, the public will begin reacting to reform implementation, primarily by judging it in terms of their perceptions of and experiences with what the new law does and does not do for people. These opinions could in turn influence implementation or future legislation.

s pe c i a l r e p o r t T h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 359;19 www.nejm* The top six responses are shown for each presidential election year. The issues are rank-ordered for all voters and for each party's voters separately. If there was a tie for sixth place, a seventh (or eighth) issue is also shown. When two or more issues were closely related, they were combined into one category in order to make the data more comparable over time. † Data are responses of voters as they left voting booths, reported by ABC News. 9Respondents could give up to two responses. ‡ Data are responses of voters as they left voting booths, reported by Voter Research and Surveys. 10

W hile much of the current political attention in the United States is focused on the hotly contested battle for control of Congress this fall, an equally competitive fight for the Presidency is looming, with the campaign effectively beginning the day after the November 7 midterm election, if not sooner. The extraordinary aspect about the 2008 election is that this will be the first presidential election in eighty years, since 1928, without a sitting President or Vice President running. In 1952, there was no President or Vice President on the general election ballot, but Alban Barkley, Harry Truman's Vice President, unsuccessfully sought the Democratic nomination. Without an incumbent or even semi-incumbent seeking either party's nomination, that makes both contests even more interesting and volatile than normal. THE REPUBLICAN RACE Each month, Democratic pollster Thomas Riehle and his Republican counterpart, Lance Tarrance, through their new corporate public affairs polling firm RT Strategies, conduct a national poll for the Cook Political Report. In their December survey, among Republican voters and independents who lean toward the Republican side and intend to vote in Republican caucuses or primaries, there was a tie for first place between Senator Charlie Cook, an independent, non-partisan,

One year after passage, the Patient Protection and Affordable Care Act (ACA) remains a divisive topic. Most publicly released polls on the law have focused on the views of Americans as a whole. But with much of the responsibility of implementation lying with the states, this essay explores whether opinion differs geographically. The analysis finds that views on the health reform law do differ by region, and these differences are most likely driven by the political leanings of a given area. While opinion nationally differs by age and race, this pattern does not hold when looking by region. Areas that have a larger share of uninsured and are slated to receive greater federal funding under the ACA also do not differ in their opinions. These data suggest that regional variations in attitudes about the ACA are based less on the demographic structure of a region and more on the political ideologies of residents in a given region. As implementation of the law continues, this analysis shows that national opinion data mask important regional variations in views of the ACA.

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