The latest Kaiser Health Tracking Poll is out, and among other things it shows an uptick in the number of Americans who say they disapprove of the Affordable Care Act, from 45 percent in June to 53 percent in July. This is a curious finding, given all the good news we’ve had in recent months about the law’s performance. At the same time, we’ve had a blizzard of anti-Obamacare ads around the country, nonstop Republican rhetoric against the law, and the lawsuit against the president over a part of it — all of which has probably helped stoke general disapproval of the ACA.
Yet while Republicans have succeeded in getting a majority of people to say they disapprove of the law, they’ve failed to amass support for their goal of repealing it. In the same Kaiser poll, 60 percent still say that the law should be improved and not repealed, which is in line with previous polls on the subject.
Indeed, we’ve now reached the point where opinions on the ACA are a mirror of opinions on government in general.
Since the 1960s, political scientists have characterized the American public as “symbolic conservatives” but “operational liberals.” When you ask them abstract questions, like whether they prefer “small government” to “big government” or whether they favor “less regulation” over “more regulation,” a majority give the conservative answer. But when you ask them about the specific things government does, a majority will say that government should do and spend more on almost everything — education, medical research, Social Security, environmental protection, and on and on (the two exceptions tend to be foreign aid and welfare). This is why Republicans tend to talk in broad terms about government, while Democrats tend to talk in more specific terms about programs.
When it comes to the Affordable Care Act, we may be locked into a similar situation for the foreseeable future: A majority of Americans disapprove of this thing called “Obamacare,” but similar (or even larger) majorities are happy about almost everything the ACA does. They’re symbolic Obamacare opponents, but operational Obamacare supporters.
This is how it has been pretty much since the law was passed, but we can now be pretty sure that no matter how well things actually go with the law, it won’t change. And things have been going extraordinarily well with the law. Here’s a list of some of the developments just in the last few months:
- In contrast to the predictions of “rate shock” as the cost of coverage skyrockets, premiums in 2015 will rise only modestly, in some states less than they did before the law. In California, where 3.4 million people gained insurance in the last year, premiums are slated to rise only 4.2 percent. The CBO estimates that over the next decade, premiums on exchange plans will rise an average of 6 percent a year.
- Gallup’s survey shows the rate of uninsured falling to 13.4 percent in the second quarter of 2014, the lowest level since they began tracking in 2008.
- HHS reports that an additional 6 million Americans have enrolled in Medicaid and CHIP since the fall of 2013, over 1 million in April alone.
- A Harvard study estimates that over 10 million Americans were newly insured because of the law.
- A Commonwealth Fund survey shows that of people who previously had insurance but got new insurance through an exchange or Medicaid, 77 percent are satisfied with their coverage, compared to only 16 percent who aren’t satisfied.
- In preparation for the exchanges’ second year, more insurers are asking to join all over the country.
- The Medicare trustees report extends the projected solvency of the Medicare trust fund four years past its previous projection, to 2030.
- In April, the CBO estimates that over the next ten years the law will cost $104 billion less than it previously estimated, because lower premiums translate to less spent on subsidies.
- Surveys show hospitals in states that expanded Medicaid seeing an increase in Medicaid patients and a reduction in self pay and charity cases, where the hospital has to pick up the cost for patients who can’t afford to pay.
- HHS announces that because the ACA closes the “donut hole” in prescription drug coverage, 8 million beneficiaries have saved an average of $1,400 on medications since 2010.
In a world where everyone understood the law’s provisions and had a good grasp of the relationship between policy and individual outcomes, the ACA would be spectacularly popular. But that isn’t the world we live in. When someone gets a letter from their insurer saying that their premiums won’t be going up next year, they don’t say, “Thanks, Obamacare!” To the average person, these developments range from the vaguely understood to the completely invisible. Which is why you can have a situation like in Kentucky, where vigorous implementation of the ACA has been absolutely transformative in reducing the state’s uninsured population, but Mitch McConnell still finds it politically beneficial to attack the law that has done so much good in his state.
Given the law’s complexity, the complexity of health insurance itself, and the fact that unlike something like Medicare no one has an Obamacare card in their pocket, this may not be all that surprising. But both sides have reason to be politically disappointed with the place public opinion has come to rest. Democrats hoped that once the benefits of the law became clear, it would grow tremendously popular. That hasn’t happened. Republicans hoped that they could convince the public to favor the law’s repeal with an unrelenting and lavishly funded assault. That hasn’t happened either. And neither is likely to change.