Americans' Views of the ACA: Quarter 1, 2015 Update

In recent focus groups conducted for Third Way by Hattaway Communications, voters overwhelmingly expressed weariness with continued Congressional debates over the health care law. Yet, despite their lack of desire for partisan pitches over health care, post-election surveys demonstrate that Americans don’t expect much change from Washington. Only 5% of Americans expect less Affordable Care Act (ACA) debate, 47% expect more, and 42% said it will be about the same.¹

Public opinion research shows that there is a hard core one-third of Americans who are unalterably opposed to the ACA. The rest are anywhere from positive to mildly opposed to the law, and most of them are weary of the debate, feel the ACA solves someone else’s problems, don’t have strong views on aspects like the employer mandate, but are accepting of fixes. They’d be happiest if the ACA never showed up in the newspaper, on the radio, or on TV for the next two years. This memo offers a quick round-up of five findings from the most recent publically available research around the ACA.

1. Americans remain divided in their views of the ACA.

Public opinion has remained relatively stable on the overall favorability of the law, with 41% having a favorable view of the ACA compared to 46% with an unfavorable view.² However, there are wide partisan differences—69% of Democrats have a favorable view and 79% of Republicans have an unfavorable one. Independents tilt slightly favorable at 46% to 40%. There has been a slight change in over-all views since mid-2014 when only 37% had a favorable view of the law. The biggest change is that unfavorable views have fallen from a high of 53% in summer 2014.

2. Individual provisions of the ACA receive more support than the overall law.

Americans support many individual provisions of the ACA, including marketplaces to buy coverage (78%), financial assistance for low- and moderate-income people (76%), Medicaid expansion (75%), and the employer mandate (60%). More than half of Republicans support all of these, except for the employer mandate. And all of these provisions receive 60% or more support from Independents and 78%-90% support from Democrats.³ There is also broad support for other sections of the ACA (e.g., contraception, 26 age limit for dependents, preexisting conditions)—although many voters are unaware that they are included in the health care law.

3. Most Americans do not think the ACA has impacted them personally, but confusion about the law persists.

The overwhelming belief is that the ACA is about other people’s problems. When asked about the impact on their own lives, only 16% of Americans say the health care law has helped them or their family directly, with another 24% saying it has hurt them. But an overwhelming 59% say the law has had no direct impact on their or their family’s lives.⁴ And when describing the ACA in their own words, 41% replied with some variation on it expanding access to health care and health insurance.⁵

Beyond their belief that this law is fundamentally about solving someone else’s problems, misconceptions persist—likely eroding overall support for the ACA. Forty-three percent think the law allows undocumented immigrants to receive government financial assistance to buy insurance. And 41% say it establishes a government panel to make decisions about end-of-life care for Medicare beneficiaries.⁶

4. Views of the employer and individual mandates are malleable.

Employer Mandate

Americans support the employer mandate, with 60% favorable to the provision and 38% unfavorable.⁷ However, these initial inclinations are soft. When those supportive of the mandate are told that some employers are moving employees from full to part time work to avoid paying the fine, net unfavorability rises to 68% (there is a 30 point shift from those initially favorable). On the flip side, when those initially unsupportive are told that most employers with 100+ employees already offer insurance and won’t have to pay the fine, net favorability rises to 76% (there is a 16 point shift from those initially unfavorable).

Individual Mandate

Americans oppose the individual mandate 64% to 35%.⁸ But here, again, public opinion can be swayed in both directions. Among those initially unfavorable, the following arguments shifted opinion in support of the individual mandate:

• Most Americans get coverage from employers or a public insurance program (net favorable is 62% to 33% still unfavorable);
• The fine would not be applied if it would consume too much income (59% net favorability to 35% still unfavorable);
• Without the requirement people will wait until they are sick to buy insurance, driving costs up for everyone else (54% net favorability to 40% still unfavorable); and,
• Without the requirement, insurance companies could still deny coverage to sick people (51% net favorability to 41% still unfavorable).

However, when told the amount of the fine ($300 or 2% of household income), opinions do not change very much among those initially unfavorable to the law (net 41% favorable to 54% unfavorable).

Overall unfavorability rose by 11 points to 75% when those who initially had a favorable view of the individual mandate were told that Americans would be required to buy health insurance even if they find it too expensive or did not want it and when told the amount of the fine.

5. Americans want Congress to fix and improve the health care law.

Recent surveys demonstrate that there is little appetite for a complete ACA repeal:

• December 2014 Kaiser Survey: 24% want to expand what the law does, 21% want to implement the law as is, 12% want to scale back what the law does, and 31% want to repeal the law entirely. Only 27% of Independents want to repeal the law.⁹
• January 2015 CBS Survey: 11% say keep it as is, 54% think changes are needed, and 32% want to repeal it entirely. More than half (54%) of Independents and 68% of Democrats say changes are needed, while 63% of Republicans want it repealed entirely.¹⁰

Nearly two-thirds (64%) of Americans want their Member of Congress to work to improve the law, with one-third saying it should be repealed and replaced.¹¹ Democrats are unified in their desire to work to improve the law (86%). Independents side with Democrats (65% improve the law to 32% repeal)—a mirror image of Republican views (33% improve to 65% repeal). These numbers reveal why many Republicans in Washington might still push repeal to satisfy their base, though doing so runs counter to the desires of most Americans.

Recommendations

1. Lower the heat on the Affordable Care Act.

For the vast majority of Americans, the debate over the ACA is over. The one-third still fighting for outright repeal of the law will continue to goad Democrats into the conversation. Rather than engage in inflammatory partisan rhetoric or backwards looking critiques over process, Democrats should be the adults in the room and only engage constructively.

2. Focus on specifics when discussing the ACA.

The ACA is too abstract for most Americans and misinformation lingers. To counter these problems, Democrats should highlight the positive provisions that majorities support. But acknowledge that problems exist and they will be fixed.

3. Pivot to improving the patient experience.

Moving forward, our goal is to make sure the health care system is working for all Americans. Democrats should concentrate on improving the patient experience. When patients stay healthy, or get better quicker, they need less care. And that reduces time and money wasted throughout the system. Redirecting the heath care conversation towards patient needs provides an alternative to what many Americans perceive to be stale debates. Throughout 2015, Third Way will release a series of 15 individual policies that aim to improve the patient experience. As an added benefit, each policy cuts waste in health care and has budgetary savings.