Polling the ACA

March 27th, 2012 at 8:24 am

Supporters of the Affordable Care Act will find this CBS/NYT poll result unsettling, but I don’t think it’s particularly surprising:

In the latest poll, 47 percent said they oppose the [health reform] law while 36 percent approve, with the rest having no opinion. The results are similar to previous surveys that have consistently found the law’s detractors outnumbering its supporters

My own views aside (more on those below), I’m not sure this result is as meaningful as you might think.  When you ask people about complicated legislation, and this one has many obscure moving parts (IPAB, exchanges, accountable care organizations), they often don’t much like it, in no small part because they very reasonably don’t want to endorse something they don’t know enough about.

Plus, there’s been so much distortionary noise around the ACA, unless you’re a health policy wonk, how are busy people supposed to filter out the noise?

In terms of public opinion, then, I think you get less insight from the poll question behind the headline—“do you approve or disapprove of the health care law that was enacted in 2010?”—than from specific, immediately understandable parts of the bill.

For example, 85% approve of the part that says insurers have to cover pre-existing conditions; 68% approve of the part that lets parents keep their kid on their health coverage plan until he or she is 26;  77% approve of closing the Medicare prescription drug coverage gap.  For public opinion polling, such percentages are stratospheric.

Of course, these are clear benefits of the legislation.  The individual mandate—the requirement that certain people either have insurance or they pay a penalty—doesn’t poll that well.

FWIW, OTEers know I’m a supporter of the ACA and am encouraged by stuff I’ve read suggesting its legality should be approved by the SCOTUS.  That’s not because I’m sure it will work, where “work” means providing coverage to the millions without and bringing cost growth and the share of expenditures on health in line with that of other advanced economies.  It’s because modern systems that do “work” in the above sense have similar features to the ACA—pooling across large, diverse populations (risk pooling dilutes costs), mandates (avoids adverse selection), explicit cost control mechanisms (cost targets, those “accountable care” provider groups noted above, IPAB—to name a few).

Given the extent of the uninsured in America along with the cost pressures on public budgets, the private economy, and families, we must see if these mechanisms work here.  If they fail, we’ll need to try new ones.   But no reform at all—the status quo–is not a viable option.  So let’s hope the court gets this right.

Full poll results here.

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7 comments in reply to "Polling the ACA"

  1. davesnyd says:

    OK; I’m about to vent and I’ll apologize up front for offending you (someone who was involved in the creation of the act and a member of the Administration) with some of the comments about why it polls poorly:

    * You talk about “distortionary noise”. I’ll call that the understatement of the year. It has been demagogued more thoroughly than any piece of legislation I’ve seen in my lifetime and insufficiently sold by the Administration.

    * Implementation was back-loaded to keep the ten year cost down. As a result, not enough people have seen the full benefits of the plan: near universal coverage.

    * And yes, it is too complex. Medicare for all or even a voucher system paid by payroll or VAT would have been simpler with no need for a mandate. The Administration made a tactical decision that putting forward the most Republican possible plan would undermine opposition to it. It would be nice to see some acknowledgement that Medicare for all would have provided less expensive and better coverage and that it was a mistake to do Romneycare nationally. Those who do not learn from history, etc.

    So, moving forward: the Administration needs to do a better job educating people about what has happened and what will happen; provide alternative paths (like Medicare for all), especially in case the mandate is overturned; and better engage “the base” in supporting the reform.

  2. Bud Meyers says:

    Robert Reich agreed with me…

    “The President and the Democrats could have avoided this dilemma in the first place if they’d insisted on Medicare for all. After all, Social Security and Medicare require every working American to “buy” them. The purchase happens automatically in the form of a deduction from everyone’s paychecks. But because Social Security and Medicare are government programs financed by payroll taxes they don’t feel like mandatory purchases.”


  3. Michael says:

    Obama made a deal to increase insurer profits, and he kept it. Americans don’t understand why the end result is so lousy, but they do smell something fishy.

  4. PeonInChief says:

    Wouldn’t it be entertaining if we ended up with single payer because the SCOTUS decided against the mandate?

    • Michael says:

      No way a country which considers Rick Santorum for the highest office in the land even flirts with single-payer.

  5. Michael says:

    So is anyone here under the delusion that the ACA addresses any of the serious problems with the US healthcare system? Private insurance is fundamentally evil, and the ACA expands private insurance, not restricts it. Combine this with Obama’s plan to raise the Medicare age…