ACA and Public Opinion

VII. Key Issues: Regulation & Reform >> C. Health Reform >> Affordable Care Act (ACA) >> ACA Repeal >> ACA and Public Opinion (last updated 6.24.18)

Overview

A strong proponent of the ACA, Jacob Hacker, professor of political science at Yale University, warned in 2010: “Reformers won the war in 2010, but they lost the battle for public opinion. Americans were convinced that reform was needed but not that government could do it. Reformers cannot afford to lose the second battle for public opinion.”
Yet by Spring 2016, six years after the ACA’s passage:

• The Pew Research Center national survey (April 12-19, 2016) found that 44 percent of respondents approved of the law, while 54 percent disapproved.
• The RealClearPolitics polling average as of May 2016 found that 48.8 percent were opposed to the law, while 39.2 percent favored it, reflecting a difference of 9.6 percentage points.
• The RealClearPolitics polling average in late 2015 saw a majority of Americans opposing the law (50.0%), outnumbering those who favor the law (42.6%) by more than 7 percentage points.
• As of mid-2014, the RealClearPolitics polling average showed a majority of Americans favor repeal (51.0%), outnumbering opponents of repeal (43.8%) by more than 7 percentage points.
• The Kaiser Family Foundation’s November 2015 poll found that 45 percent of Americans say they had an unfavorable opinion of the law, with just 38 percent saying they had a favorable opinion. By April 2016, the disapproval number had grown to 49 percent.
• In May, 2016, Gallup reported that “the slight majority, 51%, favor repealing the act.” A separate May poll found that “the percentage of Americans who say Obamacare has helped them and their families has risen and, at 22%, is now at its highest since 2012. The percentage who say the law has hurt them is up 10 percentage points, now at 26%.” The poll found 49% disapproval of the ACA and 47% approval.

Heritage’s Robert Moffitt has argued (4.28.14) that “the course of the current national debate is following a familiar pattern, mirrored clearly in previous national health care debates, such as the triumphant passage and bipartisan repeal of the Medicare Catastrophic Coverage Act of 1988 and the quiet collapse of the Clinton Health Security Act on the Senate floor in the fall of 1994. In each case, public hostility to the health care legislation was stimulated by the mass disruptions, or threatened disruption, of existing health care coverage; the rapid and excessive cost increases that were initially ignored or unanticipated; and the metastasizing federal bureaucracy, issuing or threatening to issue costly, cumbersome, and intrusive rules and regulations to control Americans’ health care decisions.”

In February 2017, the New York Times reported that long-held pattern of opposition to the ACA had begun to shift. In a variety of recent polls, with questions asked in different ways, more Americans said they favored Obamacare than opposed it: “The growing interest in government action fits a historical pattern. A body of political science research suggests that the public’s preference for increased government action tends to move in opposition to the ideology of the party in power.”

Still other polls found increased dissatisfaction among actual ACA enrollees and Americans’ desires for new health reform policies.

Public Opinion Polls

Poll Summaries

• RealClearPolitics: Obama and Democrats’ Health Care Plan. 
  • The RealClearPolitics polling average as of May 2016 found that 48.8 percent were opposed to the law, while 39.2 percent favored it, reflecting a difference of 9.6 percentage points.
  • The RealClearPolitics polling average for 11.19.15 showed a majority of Americans oppose the law (50.0%), outnumbering those who favor the law (42.6%) by more than 7 percentage points.
  • Of 33 polls conducted in 2015, only 3 showed more people favoring the law than opposing it. The link includes a chart going back to late November 2009 showing how this average has changed over time.
  • Against/Opposed. The highest average percentage opposed was 57.5% (12.7.13, when the rollout of ACA Exchanges was going badly); the lowest average percentage opposed was 46.9% (7.16.12, right after the Supreme Court upheld the law in NFIB vs. Sebelius).
  • For/Favorable. The highest average percentage in favor was 44.2% (7.15.15); the lowest percentage in favor was 36.4% (12.7.13).
  • Difference. For the entire period shown on the chart, ACA opponents have outnumbered those in favor; this differential peaked at 19 percentage points (12.7.13) and has been as low as 4.7% (8.10.12).
• RealClearPolitics, Repeal of Health Care Law: Favor/Oppose. As of mid-2014, the RealClearPolitics polling average showed a majority of Americans favor repeal (51.0%), outnumbering opponents of repeal (43.8%) by more than 7 percentage points (this average has not been calculated since then). The margin between proponents of repeal and opponents had  grown rather steadily for more than a year.
• HuffPost Pollster. Health Care Plan: Favor/Oppose. This scatterplot shows a large number of polls conducted between 2009 and early 2011. The average of these polls shows that those in favor outnumbered those opposed until roughly July 2010 after which the situation was reversed. Those opposed outnumbered those in favor by as much as 10 percentage points during this period.

Regularly Conducted Major Polls

• Kaiser Family Foundation. Health Tracking Poll is conducted monthly.  
  • November 2017 results. “The public are divided in their view of the ACA with similar shares of the public holding favorable views (50 percent) as unfavorable views (46 percent). These attitudes are largely partisan with eight in ten Republicans (81 percent) reporting an unfavorable opinion of the law and eight in ten Democrats (80 percent) reporting a favorable opinion.”
  •  April 2017  results. “The public is divided in its view of the ACA with equal shares (46 percent) expressing a favorable view as an unfavorable view.”
  • December 2016 results: 46 percent view the law unfavorably, while 43 percent rated the ACA as favorable.
  • July 2016 results: “Overall attitudes toward the law remained largely unchanged over the past month. The most recent survey finds 40 percent of Americans reporting favorable opinions of the health care law and 46 percent reporting unfavorable opinions.”
  • April 2016 results: Those with an unfavorable view of the ACA grew to 49 percent; 38 percent had a favorable view.
  • November 2015 results: “While views of the health care law have been narrowly divided for much of the year, this month more say they have an unfavorable view of the law than a favorable one (45 percent versus 38 percent, a statistically significant difference). About a third of the public (35 percent), including 40 percent of the uninsured, says they are closely following news coverage of the ACA’s third open enrollment period. The uninsured report valuing insurance, with large majorities saying it is personally important to have (86 percent) and that it is something they need (69 percent), and just over half (55 percent) intend on getting coverage in the next few months. When asked to say in their own words why they are uninsured, the most common response is that insurance is too expensive and they can’t afford it (33 percent).
• Gallup. Gallup conducts polls regarding opinion about the ACA roughly every 2 months. 
  • On 11.27.17, Gallup reported that 50% of Americans now approve of the law, “a modest decrease from the record highs of 55% in April and 53% in July. Despite this slight decline, the current approval rating for the law remains higher than all pre-2017 Gallup readings on the question.”
  • On 9.8.16, Gallup reported that support for the healthcare law continued to be more negative than positive, with 44% of Americans supportive of the law and 51% opposing it. 18% say the law has helped their families; 29% say it has hurt them.
  • The 5.16.16 results: “The slight majority, 51%, favor repealing the act.” 
  • In a 5.13.16 poll, Gallup found that “the percentage of Americans who say Obamacare has helped them and their families has risen and, at 22%, is now at its highest since 2012. The percentage who say the law has hurt them is up 10 percentage points, now at 26%. The bulk of Americans continue to say the law has ‘had no effect,’ and that percentage is down significantly, from 70% in 2012 to 50% today.” This poll found 49% disapproval of the ACA and 47% approval.
  • The 11.13.15 poll showed: “A slight majority of Americans (52%) say they disapprove of 2010 healthcare law known as the Affordable Care Act or ‘Obamacare.’ Disapproval of the law, which has generated public opposition from its outset, is up four percentage points since July. Approval of the ACA now stands at 44%, down slightly from 47% this summer.”  
  • The October 2014 Gallup survey found more than a quarter of Americans, 27 percent, said ObamaCare has been harmful, while 16 percent said it has helped. “Forty-six percent say the law will make things worse in the long run, while 36% say it will make things better and 15% say it will not make much difference.” The percentage of Americans surveyed who said the law had no effect on them had dropped from 70 percent in early 2014 to 54 percent.
• The New York Times reported (2.1.17) that “Obamacare [Is] More Popular Than Ever, Now That It May Be Repealed,” citing the following recurrent polls:
  • Fox News. In March 2015, 38% had a favorable view of the health care law also known as Obamacare, vs. 58% unfavorable; by August 2015, the favorable/unfavorable ratio was 41%/54%; in the poll conducted by telephone Jan. 15-18, 2017, the ratio had risen to 50% favorable vs. 46% unfavorable (includes graph).
  • Morning Consult. Morning Consult polls taken before and after Mr. Trump’s inauguration show approval of Obamacare has increased the most among urban voters (+10.5%), Hispanic voters (+12.5%) and people who say the country is on the “wrong track” (+12%).
  • NBC News/Wall Street Journal. The NBC News/Wall Street Journal poll has been asking whether Barack Obama’s health care plan was a good or bad idea since 2009. Its poll in January 2017 indicated for the first time that more people viewed the health law as a good idea than as a bad one.
  • Pew Research Center. The Pew Research Center has found that, for the first time since 2007, a majority of Americans believe it should be the federal government’s responsibility to make sure Americans have health insurance. From 2000-2007 roughly 60% of Americans had agreed and only 35-40% said no to this idea. However, there was steady erosion of support for this idea so that prior to passage of the ACA in March 2010, more people opposed the idea than supported it. By late 2013, opposition was at its peak (>50%) while support was below 45%. By the first week in January 2017, 60% agreed and only 38% said no to this proposition (includes graph).
• American Action Network (2.6.17). “At American Action Network (AAN), we commissioned a survey last month to find out what Americans think about improving our broken healthcare system.
  • Nearly seven in 10 Americans support repealing ObamaCare with a realistic, modest transition period during which people can keep current coverage. Even a plurality of Democrats agreed with this proposal, by a 48 to 43 margin.
  • Specifically, nearly nine in 10 Americans support a price transparency requirement for doctors and hospitals, as well as allowing small businesses to pool together to negotiate lower health insurance prices.
  • More than eight in 10 Americans support allowing health insurance companies to sell plans across state lines for more choice and lower costs.
  • Americans want an ObamaCare replacement plan that provides health policy ownership and portability. Nearly eight in 10 Americans favor a health plan that can be taken from job to job and into retirement years.
  • Americans want patient-centered healthcare. Nearly 75 percent of respondents support a plan that empowers patients and doctors to choose the plans and medical treatments that are right for them.” Bliss, Corry. (The Hill, 2.6.17)
• Black Book Research (2.27.17). Obamacare Satisfaction Plunges as Insurers Focus on Cutting Costs and Less on Enrollee Approval. “34,800 consumers who were continually enrolled in Obamacare plans between January 2015 and February 2017 were polled since open enrollment began in November 2016. The strongest dissatisfaction was traced to 2017 marketplace plans with enduring member services failures including:
  • Declining customer service support (96% of all Obamacare plans)
  • Premium price increases (90%)
  • Narrowing provider networks or excluding their former providers (80%)
  • Curtailed benefits (77%) and
  • Lack of competitors in the markets to choose from (61%).

Member service interaction dramatically dropped in satisfaction, noting live call center support was substandard to over 92% of Obamacare members comparing year to year results.
Length of member problem resolution has extended to an average polled 31.4 days from 12.5 days on average in 2016.
48% of Obamacare enrollees complain of web site downtime stretching weeks and wait times with call centers spreading over an hour since November 1, 2016.
Obamacare insurers with little market competition in states with high enrollments are disappointing their members the most.
This year, only 22% of the 44,200 private Obamacare enrollees polled placed their health plan satisfaction as good, very good or excellent.”

• Pew Research Center. According to polling conducted 11.29-12.4.17, overall support for the health care law has grown since last year. “Currently, 56% of the public approves of the law while 38% disapproves… The law drew majority approval for the first time in February, when 54% expressed support for it.”

Analysis

Items are in reverse chronological order.

• Why So Many People Hate Obamacare. “Some 40% of Americans had an unfavorable view of the law in April 2010, while 46% had a favorable opinion, according to a Kaiser Family Foundation poll. Since then, the public’s perception has generally been more dour. In November, 45% of people had a negative view, versus 43% with a positive one… Some people hate Obamacare philosophically. They rail against the law because they don’t think the government should force people to buy health insurance and penalize them if they don’t. Also, they view Medicaid expansion and subsidies for low- and moderate-income enrollees as yet another entitlement program that uses hard-working taxpayers’ money to help lazy, undeserving people. Others say there’s nothing affordable about the Affordable Care Act. They blast the program for having high premiums and deductibles that get worse every year. They are also angry that they couldn’t keep the insurance plan or doctors that they had.” (CNN Money, 1.6.17)
• What’s the Real Reason Americans Hate Obamacare? “Professors Lawrence Jacobs and Suzanne Mettler recently coauthored a befuddled sounding op-ed, in which they fret over the continued unpopularity of the Affordable Care Act, better known as ObamaCare. When a policy delivers benefits, they argue, it should be popular. So why do people continue to hate ObamaCare?” (Conservative Review, 6.23.16) 
• Why Public Opinion on ObamaCare Should Worry Us All. “So why have overall assessments of the ACA remained so divided and largely negative? The culprit, we found, is the political environment. Prevailing attitudes of distrust in government, strong partisanship and ingrained attitudes — not features of the law itself — are perpetuating the public’s negative opinion. The ACA remains highly politicized, to say the least. Republicans in the House have voted to delay, defund or repeal the law some 60 times, and its very nickname — ObamaCare — primes us to think of the ACA through a political lens. Conservatives consider the law the very embodiment of government overreach. On the other hand, many liberals support a single-payer system and pass the ACA off as a sellout to powerful interests. When it comes to assessing the law, Americans are caught in an echo chamber in which the din of party elites and activists drowns out their positive personal experiences.” (The Hill, 6.21.16)
• Obamacare Poll: Most Enrollees Hate Their Plans. “A new survey conducted by the Kaiser Family Foundation shows that a majority are dissatisfied with their plans: ‘Just over half (54 percent) now rate the value of their coverage as only fair or poor.’ Moreover, the percentage of Obamacare enrollees unhappy with their premiums and deductibles has been going up: ‘Nearly half now say they are dissatisfied with their plan’s annual deductible… and four in ten are dissatisfied with their monthly premium.’… When the ‘reform’ law was first implemented, in 2014, the percentage of enrollees who rated their coverage ‘only fair’ or ‘poor’ was 39 percent… The Kaiser survey comes on the heels of a Gallup poll showing that, despite the ongoing propaganda campaign to which the public has been subjected by the Obama administration, a majority of Americans now want the law repealed. ‘Americans are split on the idea of maintaining the ACA.… The slight majority, 51%, favor repealing the act.’ The media shamelessly ignored this finding but, as John Merline writes at Investor’s Business Daily, its significance is hard to overstate. ‘Six years after it became law, most Americans want Obamacare repealed, including a quarter of Democrats.’” Catron, David. (The Spectator, 5.23.16)
• 9 Reasons Why Many Liberals Absolutely Hate Obamacare. “According to recent polls, Americans are against Obamacare by an average margin of about 10 percent, and even many liberals that fought so hard to get Obamacare passed are now abandoning ship.
  • The launch of Obamacare has been such a colossal technical failure that many liberals are now completely ashamed to be associated with it.  At this point, it is nearly impossible to sign up for a health insurance policy on Healthcare.gov.  According to USA Today, the first person to successfully enroll in Obamacare in the state of Delaware had to spend seven hours on the phone and in front of the computer to accomplish that feat.
  •  In some areas of the country, people are only able to purchase health insurance from a single company on the Obamacare health insurance exchanges.
  • Obamacare is causing health insurance premiums to skyrocket, and many liberals are absolutely shocked when this happens to them.  In fact, one liberal blogger was horrified to learn that Obamacare is going to nearly double his monthly health insurance premiums.
  • Obama promised us that if we liked our current health insurance plans that we could keep them. Unfortunately, that was a lie. All over the country, existing health insurance plans are being canceled thanks to Obamacare.
  • Large numbers of employers are no longer offering health insurance to their employees thanks to Obamacare.
  • Lots of liberals are actually losing their good paying jobs because of Obamacare. For example, thousands of Connecticut doctors were just fired by UnitedHealthCare.
  • Many liberals are absolutely mortified by the fact that it cost more than 93 million dollars to build Healthcare.gov.
  • Many people that believe that they have successfully enrolled in Obamacare are not actually enrolled at all.  There are major problems in transmitting enrollment data from Healthcare.gov to the health insurance companies. This is how it was explained in the Washington Post.
  • Obamacare is extremely complicated.  In fact, according to CNSNews.com, the regulations for Obamacare are now over 11 million words long.” (The Sleuth Journal, 10.19.13)
• EBRI (November 2010). Public Opinion of New Health Care Reform Is Limited and Varies by Plan Type, Political Party.

News

• The Kaiser Health Policy News Index is designed to help journalists and policymakers understand which health policy-related news stories Americans are paying attention to, and what the public understands about health policy issues covered in the news.
• ObamaCare Watch, Public Opposition contains news of public opinion regarding PPACA.

ACA and Elections