How one senator's vote on healthcare caused his approval rating to plummet overnight

Countries & Cities · Published 15 October 2026 Swipe more like this →

In short: Ben Nelson was once Nebraska's most popular senator, boasting a 78 percent approval rating. That changed in late 2009 when he became the decisive 60th vote needed to pass the Affordable Care Act. The backlash was immediate, slashing his support to 42 percent and reshaping his political legacy.

Ben Nelson, a Democrat from Nebraska, served as governor from 1991 to 1999 and as a U.S. senator from 2001 to 2013. Throughout his Senate career, he was widely regarded as the most conservative member of his party, frequently breaking with Democratic leadership. His political survival in a heavily Republican state relied on this moderate-to-conservative positioning, which included opposing a public health insurance option and maintaining a strong anti-abortion stance.

The defining moment of his Senate tenure occurred during the 2009 debate over the Patient Protection and Affordable Care Act. To overcome a Republican filibuster, Democrats required 60 votes. Nelson provided the final vote for cloture, but only after securing specific concessions. These included a provision for permanent federal reimbursement of Nebraska's Medicaid expansion costs—a move critics derided as the 'Cornhusker Kickback.' Nelson maintained the provision was a placeholder intended to address unfunded federal mandates for all states.

The political fallout was severe. Within a short period, his approval rating dropped from 78 percent to 42 percent. Although he later requested the removal of the Medicaid reimbursement provision and voted against the final reconciliation version of the bill, the damage to his standing was significant. By 2010, polling suggested he would lose a hypothetical race against Republican governor Dave Heineman by a wide margin. Nelson did not seek a third term in 2012, and as of 2026, he remains the last Democrat to hold statewide office in Nebraska.

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