The Washington PostDemocracy Dies in Darkness

Opinion How Americans learned to stop worrying and love the ACA — sort of

Democrats should give credit where credit is due — to President Trump. He has accomplished what they and President Barack Obama could not, namely make the Affordable Care Act popular, if not actually loved. The Kaiser Family Foundation poll reports:

Despite divided views about the Affordable Care Act, three-fourths of the public (75%) say President Trump and his administration should do what they can to make the law work, while one in five (19%), including 38 percent of Republicans, say the Administration should do what it can to make the law fail so they can replace it later, the latest Kaiser Health Tracking Poll finds.

Trump even convinced Republicans to hang onto Obamacare. “Fielded after the U.S. House cancelled its March 24 vote on a plan to repeal and replace the Affordable Care Act supported by President Trump and House Speaker Paul Ryan, the poll finds majorities of Democrats (89%) and independents (78%), and half of Republicans (51%) want the Trump Administration to make the law work, as do a majority of President Trump’s supporters (54%).” This is not to say the public is thrilled with Obamacare — support remains evenly divided. But the public, including most Republicans, no longer warm to a “repeal and replace” message, although that is precisely where House Republicans are stuck in an endless loop trying to appease the Freedom Caucus without losing everyone else.

Celeste Thompson travelled from Missoula, Mont. to join a small group of protesters demanding Republican Senators keep the Affordable Care Act or come up with a comparable plan to replace it. (Video: Jayne Orenstein/The Washington Post)

The most interesting finding may be that Republicans are sure to get blamed if the ACA fails: “When asked who is responsible for any problems with the Affordable Care Act going forward, six in 10 (61%) say that President Trump and Republicans in Congress would be responsible because they are in control of the federal government. Fewer (31%) say former President Obama and Democrats in Congress are responsible because they passed the law.” And finally, Trump has helped convince voters he’s not going to figure out how to give better care to Americans at a lower cost. “The poll finds 37 percent of the public expect President Trump to be able to deliver on that promise, down from about half (47%) in December. Most Republicans (80%) remain at least somewhat confident that President Trump can deliver on this promise.” Well, at least the public has figured out there is no magic deal and Trump has been selling snake oil.

Gallup’s polling is even more favorable to the ACA. “Fifty-five percent of Americans now support the Affordable Care Act (ACA), a major turnaround from five months ago when 42% approved and 53% disapproved.” This is the first Gallup poll showing majority support for Obamacare since 2012. Approval among Republicans is up, although by less than among Democrats. A plurality want to fix it (40 percent), 26 want to keep it as is and only 30 percent want to repeal and replace it.

Follow Jennifer Rubin's opinionsFollow

What does all this add up to? The public seems to have reached a remarkably level-headed conclusion: Obamacare is better than taking away whatever they got under the law, so let’s try to fix it. If it collapses, it’s the GOP’s fault. It is interesting how totally at odds with that sentiment are right-wing Republicans who want to re-argue the proposition that health-care coverage is a right. They don’t seem to grasp that getting rid of Obamacare is risky and scary, and that voters figured out Republicans have no superior plan. The entire premise on which House Speaker Paul D. Ryan (R-Wis.) has approached Obamacare is wildly out of sync with the public. Republicans seem blissfully unaware the “repeal and replace” moment has come and gone.

Right about now (or maybe in the election year) Democrats would be smart to put out a list of fixes they’d like to work on — improving rural health care, adopting ideas on Medicaid reform from governors, tightening rules so people cannot “game” the system by going in and out of coverage and, yes, some regulatory reforms that might encourage insurers to re-enter the exchanges. If Democrats coax Republicans into cooperating, we may see something better than the original ACA. If not, Republicans will have convinced the public they are out to lunch and fundamentally unserious about improving the health-care system.