Americans' attitudes on Obamacare have long been paradoxical. Polls have generally shown lackluster support for the overall law while at the same time finding wide support for many of its individual provisions. That dynamic has been a chief challenge for Republicans hoping to repeal the law, and the House GOP's newly unveiled proposal to replace the Affordable Care Act offers the clearest look yet at which popular (and unpopular) provisions will be kept or repealed.
How does the new American Health Care Act stack up? A comparison of the law's changes to the latest high-quality polling on those portions of the ACA shows the Republicans' plan keeps several of the law's most popular provisions, but also scales back or repeals several others that enjoy majority support. As widely expected, the law also repeals the individual mandate to buy insurance (or pay a fine), the least popular part of the ACA and a rallying point for opponents of the law.
Popular parts the GOP plan keeps
The House Republicans’ replacement plan preserves four parts of the ACA that at least 60 percent of adults favored keeping in a January Associated Press-NORC poll. The survey found 77 percent supported the ACA’s requirement that private insurance companies offer preventive health services at no out-of-pocket cost, while 60 percent supported requiring plans to cover the full cost of birth control, both of which are included in House Republicans’ plan.
The plan also includes the signature ACA rule prohibiting insurance companies from denying coverage or charging more to people with preexisting medical conditions, which was supported by 69 percent of adults in the AP-NORC poll. More than 70 percent supported allowing adult children up to age 26 to stay on their parents’ health plans, which the GOP plan keeps.
Popular parts the GOP plan changes
The House Republicans’ plan includes major changes to two parts of the ACA that were critical to the large increase in insurance coverage — the Medicaid expansion and financial subsidies to help low- and middle-income people buy insurance.
The GOP plan swaps the ACA’s income-based subsidies for tax credits determined by age and income; an analysis by the Kaiser Family Foundation suggests that would increase financial aid for people with middle and moderately high incomes and reduce aid for people with lower incomes. A McClatchy-Marist poll last month found that 72 percent of adults said lawmakers should keep financial help for lower-income people; in November, a Kaiser Family Foundation poll found 80 percent favorably viewed the law’s subsidies for those with lower and middle incomes.
Two-thirds of Americans (66 percent) in the AP-NORC poll supported expanding Medicaid to more low-income, uninsured adults, which allowed states to expand the pool of those covered and have the federal government pick up 90 percent of the costs. The House GOP proposal would restrict that expansion starting in 2020, maintaining the high level of funding for participants who joined before that point but not afterward. The plan also provides $10 billion over five years to the 19 states that did not expand Medicaid, which could be used to pay hospitals or other providers that treat many poor patients.
The bill would also cap the amount of federal Medicaid funding a state receives per person, a shift from current guaranteed benefits that would put more pressure on states to fund care for lower-income residents. While this issue is fairly complex, a February Kaiser Family Foundation poll found roughly 32 percent of the public supported such a change, while 63 percent preferred maintaining federally guaranteed benefits.
Popular and unpopular provisions the GOP plan repeals
The House GOP plan would repeal two popular parts of the ACA affecting large companies and higher-income Americans, as well as eliminate its least popular component.
The plan cuts a tax on investment and traditional income for families with higher incomes, which was included in the ACA to help fund Medicare. The January AP-NORC poll found that 53 percent of adults supported the ACA provision while 28 percent opposed it; a November Kaiser poll found 69 percent had a favorable view of the provision.
The new proposal also cuts two key mandates for individuals and employers, which differ widely in popularity. As noted, the GOP plan cuts the individual requirement to have insurance (33 percent supported the mandate in the AP-NORC poll). But the plan also cuts the requirement that employers with at least 50 workers offer health insurance (in the poll, 62 percent supported the requirement and 22 percent opposed it).
The proposal may please 'repeal' opponents
Besides the individual mandate, there isn’t a clear connection between the changes proposed by House Republicans and their popularity with the public at large. But the changes do reflect the preferences of Americans who oppose Obamacare overall, suggesting that GOP lawmakers are protecting parts of the law supported by their base.
The chart below, by AP-NORC, shows that pattern, particularly the orange bars, which show results among those who want the ACA repealed. At least six in 10 “repeal” supporters favored eliminating out-of-pocket costs for certain services, allowing children up to age 26 to stay on their parents’ plan and protecting people with preexisting provisions. All three are included in the House GOP plan.
Meanwhile, about half “repeal” opponents support fining large employers who do not provide insurance, covering birth control, expanding Medicaid, increasing Medicare taxes on those with higher incomes and keeping the individual mandate. Only one of those five was included in the House plan.
The House GOP proposal’s elimination or scaling back of several popular features of the ACA gives ammunition to Democrats seeking to defend the law. There also some parts of the proposal that polls have not gauged recently, including eliminating taxes on medical devices and, yes, indoor tanning. But as with Obamacare itself, it is difficult to predict how the popularity of individual provisions will affect the popularity of Republicans’ changes.
The coming weeks will be key in assessing Americans’ reactions to Republican repeal proposals. After President Trump was elected and before House Republicans released their health-care plan, support for Obamacare had enjoyed a rise in support to narrow pluralities or majorities in public polls. Few have supported keeping the law as-is or repealing it entirely, though a large majority support at least some changes.
Emily Guskin contributed to this report.