How Has Public Opinion on the ACA Shifted Over Time?

Next month marks 10 years since the passage of the Affordable Care Act (ACA), and since the landmark piece of healthcare legislation was signed on March 23, 2010, by President Barack Obama, it has both grown more popular while partisan beliefs about it have grown more entrenched, according to a new analysis published in Health Affairs.

And while certain pieces of the law would be difficult for opponents to wrench away—such as the extension of dependent coverage to age 26, protection from insurance denials of coverage based on health status, closure of the Medicare drug coverage “doughnut hole,” as well as Medicaid expansion—the public as a whole does not realize that the benefits would not exist without the ACA, popularly known as Obamacare.

The analysis, looking at how public opinion has shifted over time, was conducted by the Kaiser Family Foundation, which has conducted 102 surveys about 9 to 12 times a year since 2020, reaching over 130,000 respondents. The polls were all part of the Kaiser Family Foundation’s Health Tracking Poll.

Between 2016 and 2019, the share of people who felt that the ACA had helped them rose from 18% to 23%. The share who felt that the law was harmful to them and their family fell from 29% to 23%.

In the first poll, in April 2010, 46% of the public had a favorable opinion and 40% had an unfavorable opinion, with the share of Democrats feeling positive about the law equal to the share of Republicans feeling negative about the law (78% each).

However, after technical problems with the HealthCare.gov website in 2013, public opinion fell. Between October 2013 and October 2016, on average, 39.3% had a favorable view and 45.4% had an unfavorable one, although the share with a favorable view generally increased, and the share with an unfavorable view remained steady.

But the election of Donald Trump and efforts by Republicans to repeal the ACA have boosted the law’s popularity. Since November 2016, on average, 49.4% of the public has had a positive view of the law, compared with 41.6% who view it unfavorably.

Moreover, the share of the public with a positive view has outnumbered those with a negative view in every poll since May 2017. In November 2019, the percentage of those with a favorable view was even higher—52% compared with 41% who view it unfavorably.

The polls also ask how the ACA had a personal impact on respondents. Over time, respondents who said the law helped them or their family grew. Initially, people were more likely to say that the law hurt them rather than helped. But between June 2016 and September 2019, the share saying that the law had helped their family increased by 5 percentage points, while the share saying that it had hurt them fell by 6 percentage points.

Most of the increase in those who say they benefitted from the law came from Hispanics and lower- and middle-income people—some of the groups that experienced the largest coverage gains under the ACA

The authors also measured what they called the “average annual partisan gap in ACA favorability,” meaning the share of Democrats with a favorable view minus the share of Republicans with a favorable view. In 2010, the gap was 55.7 percentage points, dipping to a low of 48.9 percentage points in 2013, and stretching to a high of 64.1 percentage points last year. The authors said the growth is due more to an increase in Democrats with a positive view, since the views of Republicans have remained steady.

Regarding awareness of specific provisions of the law, the percent of people who were aware that the ACA provides financial help for lower- and moderate-income Americans to purchase insurance, provides an option for state Medicaid expansion, stops insurance coverage denials based on preexisting conditions, and Increases the Medicare payroll tax for upper-income Americans all fell.

Only the provision that young adults can stay on their parents plans until age 26 and the creation of health insurance exchanges saw an increase in awareness.

Negative messaging by Republicans and a focus on political disagreements over the law by the news media may have hampered awareness of the law’s benefits, the analysis found.

“With policy details taking a back seat to political controversy in news coverage, it’s not surprising that public awareness of these benefits has declined over time,” the authors wrote.

Reference

Brodie M, Hamel EC, Kirzinger A, Altman D. The past, present, and possible future of public opinion on the ACA [published February 19, 2020]. Health Aff (Millwood). doi: 10.1377/hlthaff.2019.01420.