Obamacare’s most popular provisions are its least well known

March 22, 2013

This poll from the Kaiser Family Foundation tells you almost everything you need to know about the politics of Obamacare:

It is, by now, so well known as to be almost a cliche: Obamacare is unpopular even though most of its major provisions are highly popular. But this Kaiser poll adds to our understanding. What you're seeing in those long blue lines at the bottom is that Obamacare's least popular elements -- the individual mandate, the employer penalty -- are also its best known. And some of its most popular elements -- closing the Medicare Part D "donut hole," creating insurance exchanges, extending tax credits to small businesses -- are its least well known.

In fact, the situation is even a bit worse than that. Many of Obamacare's more popular elements are actually becoming less well known with time:

Part of this is because media coverage focuses on what's going wrong rather than what's going right or what hasn't happened yet. That doesn't represent a conspiracy or a bias. It's natural to the news business, where controversial, hard questions are more interesting than settled, smooth processes. But the fact is that Washington Post readers have heard a lot about the states that aren't setting up exchanges and the small businesses that aren't happy with the law. There's less being written about the states where the exchanges are looking good.

Part of that is because the health-care law has failed at certain early tasks. For instance, take our article on unhappy small businesses. It included this tidbit, which helps explain why the popular small-business tax credits haven't had more of an effect:

Hoping to help small firms combat the rising costs, policymakers included a health-care tax credit for small businesses in the Affordable Care Act. Through the end of this year, the provision was meant to provide a tax break of up to 35 percent of health-care costs for tax-eligible small employers and 25 percent for tax-exempt groups such as charities. Next year, the credits are slated to rise to 50 percent and 35 percent, respectively.

But many have complained that an onerous application process has deterred business owners from claiming the credit, and the Government Accountability Office reported in May that only 170,300 of the nation’s 1.4 million eligible firms claimed the break in 2010.

And then there is, of course, the ceaseless efforts Republicans have made to attack the law publicly, impede it procedurally and defund it legislatively. Implementation of a law of this size would always be difficult. But it will be far harder with Republican governors refusing to help and Republican legislators viewing each and every tough problem as an opportunity to chip away at the legislation.

The argument of Obamacare's advocates has always been that it will become more popular in 2014, when it begins rolling out its benefits. And that remains likely. But pressing against that prediction is the fact that it will also become less popular as implementation leads to lots of stories about where the law is failing and what it could be doing better. My guess is the law's top-line polling will change a bit, but the bigger change will be that the intensity of its supporters will come to match that of its detractors. All of a sudden, a lot of people will have something to lose if Obamacare is ever repealed.

Both the opportunity and the traps for Obamacare can be seen in that Kaiser poll. Much that it is doing and will do is enormously popular. But those popular policies, even when the full law rolls out, directly affect only a fraction of Americans, and much of the media and political attention is likely to be on the difficulties and embarrassing stories sure to emerge as part of the process.

The question is whether it matters. Obamacare can have a hard implementation in 2014, but President Obama isn't going to repeal it or even lose reelection over it (though congressional Democrats might). And by 2015, it will be insuring tens of millions of people, the health-care industry will have adapted and many businesses and ordinary Americans will be using the exchanges. At that point, no one is going to repeal it.

So for Democrats, the question is clear: How do they make the implementation process as smooth as possible and draw attention to the benefits of the law? But the question for Republicans is also clear: Obamacare's stumbles aren't going to lead to repeal, but they might create an opening to pass targeted reforms of the law. So what will those be? If Republicans succeed in generating enough political anger that Democrats decide to reopen Obamacare, what is it they'll want to do to the law? Repealing the medical-device tax can't be the sum total of their ambitions.

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Brad Plumer | March 22, 2013