Diagnosis

04.02.14

After Four Years and Millions of Sign-Ups, Obamacare Is Still Unpopular

Democrats have said people would learn to love the law once they saw how it would help them. Polls show the public doesn’t agree so far.

“When people see what is in the bill, they will like it,” Nancy Pelosi said of the Affordable Care Act back in November. So far, she’s wrong.

Since the passage of the Affordable Care Act in 2010, Democrats have had a similar refrain. From the moment the bill was signed into a law, the reforms known as Obamacare have never been viewed positively by a majority of voters. Even on the eve of its passage, at least a plurality  said they opposed the law. But Democrats have long warned Republicans that eventually the public would come around. Sure, the law is unpopular now but just wait until peoples lives are really affected! Theyll love it!

They were right in one sense: the way people’s lives are concretely affected by the law will have a much greater impact on public opinion than any political messaging. The amount people spend on health care or the ability to see the doctor they want will be far more influential in generating support or opposition to the law than any speech or slogan. Yet as the enrollment window for health insurance plans on the exchanges came to a close this week, a look at the polling trends still shows significantly more Americans oppose the Affordable Care Act than support it, and that opposition to it is still higher today than it was on the day of the rollout of the exchanges. As initial opposition to the law based on fear of the unknown has given way to continuing opposition as implementation continues, and the notion that a fully implemented law would win plaudits from the public has not turned out to be the case.

In March, nine nonpartisan polls were released, most showing opposition to the law over 50 percent with support barely cracking the low 40s. The only poll that shows support and opposition statistically tied is the most recent ABC/Washington Post poll. At this point it looks like an outlier. (That poll also shows their uptick in support coming almost exclusively from Democrats. Independents and Republicans remain largely unpersuaded.)

It hasn’t been an easy few months for the Affordable Care Act, which has seen a steady stream of setbacks and controversies as it has become a reality. First, there was the horribly botched roll-out of healthcare.gov that was acknowledged by President Obama even as late as Tuesday. Then, “if you like your plan, you can keep your plan” was debunked by millions of plan cancellation letters across the nation, leading the line to be named the Politifact “Lie of the Year” for 2013. Even beyond the federal health exchange, in some states, the exchanges were an even greater embarrassment. In Oregon, for instance, things were so bad that residents have been given another month-long extension to apply.

And that’s just where we’re at so far. The ad-hoc delays to various components of the law make it hard to keep up with what is being implemented now and what penalties will hit folks further down the road. “If you like your doctor, you can keep your doctor” won’t necessarily be the case as networks shrink to keep costs down. If last fall’s round of cancellation letters wasn’t enough, another round is expected to go out this fall for letting small businesses know that they too can’t keep their plans.

The law’s supporters will point to the latest count coming out of the Obama administration that 7 million people have signed up for insurance plans through the exchanges. Yet there’s no official data on how many of those signups are the previously uninsured. The most recent estimate from McKinsey and Company is that only about one out of four signups are coming from someone previously without insurance, while the bulk are those who already had insurance. There’s also no telling yet if the newly enrolled are young and healthy enough for the insurance pools to work. Estimates suggested four out of ten Obamacare enrollees needed to be young and healthy in order for the exchanges to function well. If the final tally puts youth enrollment under 40 percent, premiums will have to go way up in 2015 to compensate for the older and likely sicker pool being covered.

Problems and unpopularity aside, there is even less support for fully repealing the Affordable Care Act. Some popular elements of the law such as the allowing of children as old as twenty-six to stay on their parents’ plan are pieces that have already been implemented for some time. The idea of going completely back to the old system holds little appeal, though full repeal remains a key legislative priority for Republicans in Congress.

For quite some time, the Affordable Care Act was opposed by most Americans in large part because they feared how it would affect their health care in the future. The future is now here. Implementation has occurred. And despite the optimism from the law’s supporters that once people experienced the law, they’d embrace it, the reality is that the law remains about as opposed as it was on Day One.

From here on out, how Americans feel about this law is likely to be based far less on what they hear on the news and far more on how it affects them personally. Both parties think that will benefit their own side, but only one will be right.