Results from polls on the views of the public about the Affordable Care Act have varied somewhat between the various survey organizations, so a new study published in the New England Journal of Medicine looked at the average of 27 recent polls. This average showed that as of June and July 2017, the public remained split in its assessment of ACA, but more people approved than disapproved of the law (49 percent vs. 44 percent). Approval of the ACA increased 5 percentage points between 2012 and during the 2017 House and Senate debates. While this is a thin margin, there is consistently significantly greater support for the government’s role in providing safety health care coverage as well as specific key aspects of ACA, including expansion of Medicaid coverage.
The researchers concluded that two underlying public values were particularly important in how Americans view ACA replacement or repeal: support for universal coverage and the preferred role for the federal government in health care. When it came to the question of whether the federal government should ensure that all Americans have health care coverage, 6 in 10 respondents (60 percent) said that it should be the responsibility of the federal government. The percentage of the general public who said that they believed it was the responsibility of the federal government increased from 42 percent in 2013 to 60 percent in June 2017.
The views of the public about a general principle often differ from their views about specific policy proposals. When the researchers looked at specific aspects of ACA replacement proposals, some different patterns of public opinion emerged. The replacement proposals in both the House and the Senate tended to focus on these changes:
Reducing the Number of Medicaid Recipients and Spending
A majority of the public preferred to keep the number of people covered by Medicaid the same as it is now (72 percent), whereas 22 percent wanted to reduce the number receiving Medicaid to what it was before ACA, reducing government spending and taxes. An average of polls showed that 31 percent of the public favored reducing federal funding for Medicaid. In addition, less than 4 in 10 respondents (37 percent) favored giving states less federal money for Medicaid but increasing their flexibility in whom to cover and how to spend the money.
Reducing the Number of People Receiving Subsidies to Purchase Health Insurance
A majority of the general public did not favor changing the law so that it either provided financial assistance for the purchase of health insurance to fewer persons or reduced the number of people to be covered by Medicaid. When asked about the extent of coverage to be provided by a replacement plan, 57 percent of the public as a whole preferred to provide financial assistance to purchase insurance to the same number of people as ACA does now, whereas approximately one third preferred to provide assistance to somewhat fewer people (22 percent) or a lot fewer people (12 percent) but save taxpayer money.
Ending the Individual Mandate
On the issue of removing the requirement under ACA that people obtain health insurance coverage or pay a penalty, the overall public was divided. A total of 48 percent favored removing this requirement, whereas 50 percent were opposed. In late 2016, before the start of the congressional debate, only 35 percent of the public had a favorable opinion of the individual mandate.
Allowing Insurers to Offer Health Plans Covering Fewer Benefits
Approximately one third of the public (35 percent) believed that insurers should be allowed to offer health plans that cover fewer benefits than currently required.
Allowing Insurers to Charge More for People with Preexisting Conditions
On the issue of ending federal health insurance regulatory protections for people who have preexisting medical conditions, less than one fourth of the public believed that insurers should be allowed to charge more for people with preexisting conditions (24 percent).