Three years after its passage, a majority of Americans still oppose The Patient Protection and Affordable Care Act (ACA), often referred to (derisively) as “Obamacare,” according to a new CNN/ORC international poll. According to the poll, which was conducted May 17-18, 54% of Americans “generally oppose” the ACA, 43% of Americans “generally favor” the ACA, and only 3% of Americans express “no opinion” of the ACA.
These results are unsurprising. In fact, public opinion of the ACA has remained remarkably consistent since it was enacted in 2010. A CNN/ORC poll conducted March 19-21, 2010, for example, found that 59% opposed the ACA whereas 39% supported it. One year later, in the same CNN/ORC poll conducted March 11-13, 2011, the results were virtually unchanged: 59% oppose, 37% support.
At a glance, then, it would appear that pubic opinion supports the Republican approach to dismantling the ACA and “replacing” it with something else. Feeding off the lack of public support for the law, congressional Republicans have voted to repeal it a remarkable 37 times. The most recent effort to repeal the ACA occurred on May 16, in which the house voted 229 in favor of repeal to 195 in opposition. Two of the most conservative Democrats in the house – Mike McIntyre of North Carolina and Jim Matheson of Utah – joined the Republicans in voting for repeal.
The repeal votes are purely symbolic and have no chance of passage in the Democratic-controlled Senate. Many Republicans recognize this. During his senatorial campaign, for example, Sen. Ted Cruz (R-TX) proclaimed, “We must and will repeal every syllable of every word of ObamaCare.” But fully aware of the futility of this effort, Cruz later admitted that “We know to a metaphysical certainty that that bill is not going to pass any time soon.”
Even so, it is clear that the Republican party sees a political advantage in voting to repeal the ACA, keeping up the pressure as the Obama administration gears up for its full implementation.
As with many political issues in Washington, however, misperceptions abound about the law. This is particularly true of the ACA, which has been wielded by Republicans (to great effect) as a political cudgel since 2010. As a result, the American public has been increasingly disillusioned by a debate in Washington divorced from facts, empirical data and reasoned analysis.
Indeed, six months after the law’s passage in 2010, most Americans still didn’t know what was in it. For example, roughly a quarter falsely believed that the ACA created so-called “death panels” of bureaucrats making decisions about people’s healthcare. And while support for the ACA has modestly improved since 2010, the American public remains uninformed about the overhaul.
According to a recent poll from the Kaiser Family Foundation, an astonishing 42% of Americans do not even know that the ACA is federal law. Included in that 42%: 23% are “unsure” of the ACA’s status; 12% believe the law has been repealed by Congress; and 7% think the Supreme Court overturned it. About half of the public (49%), moreover, say they still do not have enough information about the ACA to understand how it will impact their family.
Given the general ignorance regarding the ACA, it is difficult to interpret polling on the law as a reliable metric of public opinion, let alone an indicator as to whether it is good or bad policy. This salient point raises interesting questions about “public opinion” in general, specifically regarding its usefulness in political debate. If anything, “public opinion” on most federal legislation is a far better indicator of the effectiveness of Republican or Democratic messaging than it is an indicator of the relative strengths and weaknesses of differing approaches to our most pressing problems.
Aside from general ignorance, and compounding the problem, however, is the fact that accurately measuring “public opinion” about the ACA, whatever that means, has been incredibly challenging. In 2012, for example, a Reuters/Ipsos poll showed that while 56 percent of Americans opposed the ACA, most backed its key provisions. Absent the controversy of the individual mandate, the Reuters/Ipsos poll found that strong majorities of Americans favor most of what is actually in the health care law: 61% favored allowing young adults to stay on their parents’ insurance plans until age 26; 72% agreed that companies with more than 50 workers should be required to provide health insurance for their employees; and 82% favored banning insurance companies from denying coverage to people with pre-existing conditions.
Even the CNN/ORC poll referenced at the top of this article is more complicated than it appears. Recall that the CNN/ORC poll found that 54% of Americans “generally oppose” the ACA and 43% of Americans “generally favor” the ACA. This result led many media outlets (mostly, but not entirely, conservative) to proclaim that a “majority of Americans oppose ObamaCare.”
But if you look beyond the lead and dig deeper into the data, these headlines turn out to be incredibly misleading. Indeed, if you break down the 54% of Americans who “generally oppose” the ACA, you find that while 35% oppose the health care law because it is “too liberal,” 16% oppose the ACA because it is “not liberal enough.” So while a sizable percentage of Americans (35%) would presumably support the Republican position that Congress should work towards its full repeal, it’s hard to imagine that the 16% of Americans who oppose the ACA because it is “not liberal enough” would be supportive of a Republican proposal. In fact, while the Republican party has been thoroughly dedicated to repealing the ACA, it has shown little, if any, interest in replacing it.
The ACA is an important step towards expanding access to vital health services, improving the quality of care Americans receive, and controlling rising health care costs. Because of the ACA, millions more Americans will have access to health care who did not before, including those with pre-existing medical conditions. Because of the ACA, millions of new community health centers will be constructed, and hundreds of health centers will be renovated. Because of the ACA, seniors will benefit from lower premiums and the federal deficit will be reduced by hundreds of billions of dollars. In fact, health care spending has recently slowed due to structural changes in how health care is delivered and financed, and many experts believe the ACA is a contributing factor.
But considering the complexity of our health care system, there will be challenges as the ACA is fully implemented. Some of the ACA’s provisions will prove effective, and their success should be built upon. But some of the ACA’s provisions will manifestly fail at achieving their stated goals, and such provisions should be repealed. What is important that we meet these challenges head on and continue to move forward.
As President Obama recently acknowledged, “In a country as wealthy as ours, nobody should go bankrupt if they get sick.” It is unclear whether that sentiment is shared on the other side of the aisle.