We asked five groups of voters whether Congress should expand the [Affordable Care Act], leave it alone, shrink it, or repeal it altogether.
“Change it so it does more” was the most popular option among African-American women (at 50%); millennials (41%); white suburban women (47%) and #NeverHillary independents (47%).
President Trump got low marks from the same populations: Majorities of each said they disapproved of how he has approached health care.
Rural voters were the exception on both counts. They were split on Trump, and a plurality supported repealing the ACA.

If you look more closely at the poll results, you see that among all voters, 16 percent want to keep Obamacare as it is, 43 percent want to change it so it does more, 4 percent want it to do less, and 34 percent want to repeal and replace it (although no specifics are described, so it’s not clear whether the replacement would be more or less generous). In short, about 60 percent consider the ACA to be the bare minimum they’d accept.

It is striking, however, that only 9 percent in the poll say they buy health care individually. Put differently, less than 10 percent access what the political class normally calls “Obamacare” — plans offered through the exchanges. Fifty percent of respondents say they receive health insurance through their employer, a market that was not as dramatically changed as the individual health-care market. So why are voters so enthusiastic about the ACA? There are a few possibilities.

First, keep in mind that many of the benefits derived from Obamacare (e.g., protection for preexisting conditions, coverage for children up to age 26) do affect group coverage plans. Voters know that and don’t want to give it up. As we discuss below, of all the issues relevant to health care and all the changes Obamacare made, the preexisting condition protection may be the most significant and most popular.

On July 28, 2017, Sen. John McCain (R-Ariz.) cast a vote on the floor of the Senate against repealing the Affordable Care Act's individual mandate. (Peter Stevenson/The Washington Post)

Second, the key may be in the 43 percent who want Obamacare expanded — an informal way of saying the government needs to do more in the health-care arena. That may reflect fears about rising health-care costs (deductibles and co-pays) employees pay, concern from those who still aren’t covered by Medicaid expansion and/or dissatisfaction with the range of health-care providers covered “in network” on group employer plans.

Alternatively, support for the ACA may simply be another way of reflecting support or opposition to Trump. Among those who want to keep the ACA the way it is or expand it, only 24 percent favor Trump. Among those who want to repeal it, 67 percent support Trump.

Meanwhile, Republicans should be concerned that health care is becoming among the most important, if not the most important issue, for voters. Drew Altman of the Kaiser Family Foundation writes:

The importance of health care as a national priority is sometimes overstated — but our recent polling shows it really could be a decisive issue in the midterms. That’s because it has been surging as an issue for Democrats, and in an election many see as a referendum on President Trump, it may now be as important a factor as Trump is. …
The surprising number from our tracking polls: 33% of Democrats pick health care as the top factor in their vote in the upcoming elections, while 30% pick Trump. For the general public, 25% pick health care, about the same percentage as pick Trump (26%).  . . . In fact, health care actually ranks higher now for Democrats than it did for Republicans in the anti-ACA elections of 2010 and 2014, when it ranked third on their list of issue priorities.

Republicans have managed to snag themselves on the worst possible issue: Possible elimination of the protection for preexisting conditions. “Two issues — protections for people with pre-existing conditions and drug prices — have unique bipartisan traction, which can matter in swing states and races,” reports Altman. If you want to motivate voters regardless of party, you’d be hard pressed to come up with a more incendiary issue than taking away protection for preexisting conditions — as a lawsuit from red states now threatens and which the GOP Congress and president will not oppose.

At least in this election cycle, politicians are speaking in code (Medicare for all! Repeal and replace!), so they don’t have to spell out precisely what they have in mind. In turn, voters — as we’d expect based on human nature — don’t want to lose what they have but want something “better.” That might entail everything from bigger government subsidies for drugs to permanent, across-the-board expansion of Medicaid.

It won’t happen in the midterms, but in the 2020 election, politicians will be pushed to spell out what they’d do instead of the existing system. Voters likely aren’t going to care about the fine print, but these poll numbers should put Republicans on notice: Voters are asking government to do more, not less, so talk of “markets” and “freedom not to buy insurance” won’t sound like political winners right now. And they really don’t trust the GOP, which they see as the party antagonistic to government help with health insurance woes. In the health-care debate, we see more evidence that few Americans want “small government” — and certainly not when it comes to health care.