As ACA Nears 5-Year Mark, Opinion Still Divided But Less So

Public opinion on the Affordable Care Act (ACA) remains divided as the fifth anniversary of its passage nears, but the opinion gap has narrowed a bit, according to a new tracking poll released Thursday by the Kaiser Family Foundation. To no surprise, results show opinions of those who identify as Republican or Democrat contrast sharply, with those who identify as independent remaining more mixed and malleable.

Results, gathered March 6-12, 2015, show that 41% of Americans have a favorable opinion of the ACA, while 43% have an unfavorable opinion, the closest margin the poll has found in more than 2 years. An April 2010 Kaiser poll taken after the ACA passed March 23, 2010, found that 46% had a favorable view of the law, while 40% had an unfavorable view.

Why People Feel the Way They Do

A characteristic of opinion on the ACA is that fully half of respondents have strongly held views: 22% hold a “very favorable” view while 28% have a “very unfavorable” view of the law. As Drew Altman, president and CEO at the Kaiser Family Foundation wrote in a column appearing yesterday in the Wall Street Journal’s “Washington Wire,” “The reason that views on the ACA don’t change very much is that opinion is split almost perfectly along deeply entrenched partisan lines.” Most Republicans (74%) dislike the law, and most Democrats (65%) support it; Republican support has been highly consistent, while Democratic support took a slight dip in October 2014 during the problems with HealthCare.gov, but has since recovered.

Most who support the law say they do for its intended purpose: they feel it will expanded coverage (61% of supporters). Other reasons are that the ACA will make healthcare more affordable (10% of supporters) and that it will make things better generally for the country or other people (7%). Opponents of the law say they opposed it because of cost considerations (26%), because they oppose the individual mandate (18%), or they oppose government overreach generally (10%).

“This Congress?”

Having survived an initial trip the Supreme Court of the United States, the ACA faces a new challenge in King v. Burwell, which was argued March 4, 2015. In that case, plaintiffs asserted that language in the law restricts premium subsidies for low- and middle-income consumers buying coverage off the exchanges only to those who live in states that set up their own exchanges. If the plaintiffs succeed, subsidies would be wiped out in 34 states, potentially creating chaos in those insurance markets.

The Kaiser poll found that only 22% of respondents knew something about the case, but when asked about scenarios that would cause consumer to lose subsidies, 65% said that Congress should correct the problem. A large majority (69%) of those living in affected states said their states should set up exchanges to keep people from losing insurance.

Whether Congress could actually make adjustments in the current political climate is another matter. When Justice Antonin Scalia, who clearly agreed with the plaintiffs, asked Solicitor General Donald Verrilli why Congress couldn’t just pass a law and fix the problem, Verrilli responded, “This Congress?” setting off waves of laughter in the court, some of it from members of Congress themselves.

Numbers in the poll bear out this sentiment. More than half (56%) say they are “not at all" confident that Democrats and Republicans could work together to address issues raised by the ruling, and 51% said they were “not at all” confident that Republicans in Congress could work with President Obama.

The current partisan divide will make adjustments to the ACA unlikely, despite the historic need for Congress to make technical adjustments to major legislation in the years after passage. This was done repeatedly after Congress passed Medicare 50 years ago, and that legislation was not without controversy. Altman writes that an opinion shift in is not expected unless the ACA were to somehow “morph” into a less volatile issue.

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