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View related content: Politics and Public Opinion
It’s hardly news that the Affordable Care Act (ACA) is unpopular. The President’s ratings are seriously underwater on handling the issue. But does the current state of popular opinion mean people will embrace a Republican alternative if GOP members can coalesce around a single approach? Or that they will be receptive to different Republican alternatives? Answering this question requires understanding contradictory currents in public opinion
Let’s look first at the polls on the ACA itself. As we approach the enrollment deadline, all major national polls show that more people are opposed to the law than support it. In nearly all major polls, around 60 percent disapprove of President Obama’s handling of the issue.
We know that very few people actually read the legislation before it passed, so most people formed their impressions from news they happened to see or from conversations with friends and neighbors. They consulted their values, which pulled them in different directions. Value-based judgments don’t always point in a clear direction but they tend to stick in the polls. Some pundits tell us that as Americans become better informed about the ACA, they will support it more strongly. We’re skeptical because opinions about the health care law aren’t based wholly on the accumulation of more factual information. Here are five different considerations people bring to thinking about the ACA:
1. Most people who have health care (about 80 percent of Americans) are highly satisfied with the care they have. A new Gallup poll shows that 72 percent of the insured say they are satisfied with “how the health care system is working” for them. People with insurance like their doctors, they are satisfied with the quality of care they receive, and they are reasonably satisfied with cost. For a subject as fraught as health care decision-making is for ordinary mortals, then, any effort to make significant alterations to a fairly satisfactory system was bound to be greeted with skepticism. It hasn’t gone away.
2. One particular provision, the mandate, was unpopular at the outset and is unpopular today. Students of public opinion know that Americans don’t like being told what they have to do by the government in Washington. Whether the decision is to smoke or wear seat belts or even to take your own life, people like to make decisions themselves. The mandate goes strongly against that grain, and its low favorability ratings show that.
3. Americans don’t like radical change. That explains both many Americans’ opposition to the ACA and also many Americans’ unwillingness to support full repeal. Support for outright repeal hovers around 40 percent. That’s a big number, but most people want a more measured approach.
4. While most people don’t have a clue about how we can best help the uninsured, working to cover more people has long been a goal almost all support. Americans rarely offer specific legislative advice, but they are generous and compassionate, and the long-standing support in polls for providing help for those who can’t afford health care has been and continues to be strong.
5. Another related consideration that comes into play here concerns public perceptions of the two parties. The belief that the Republicans don’t care enough about everyone is long-standing and therefore hard to shake for the GOP. That may be why virtually all recent polls show that more people trust the Democrats rather than the GOP to handle health care. Whether there is a single GOP response to the ACA or many, Americans who aren’t GOP supporters will be skeptical.
Public opinion currents pull people in different directions. At this point, neither the cheerleaders for the ACA nor their strong opponents are navigating the currents of public opinion successfully.
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