As somebody born in the early 90's, I can say with certainty that the Affordable Care Act is the greatest law to pass in my lifetime, and yet it still receives stagnant approval ratings & a hugely tarnished public image. Indeed, I've been stewing on this topic for years, but in light of Gruber's recently uncovered gaffes - in addition to the Faux News outrage over them - I felt moved to compose the reasons for why the ACA remains broadly unpopular in spite of its objective successes. Head below the fold for my analysis.
First and foremost, the ACA's entrenched unpopularity stretches all the way back to its protracted drafting and eventual passage. In spite of the conservative rallying cry behind Gruber's latest gaffe about the law's supposed lack of legislative "transparency," no amount of GOP historical revisionism will change the fact that the ACA's long development in Congress was one of the most transparent legislative ordeals in Congressional history. Mind you, the law was debated in Congress for a year and a half before Obama finally signed it, and during that time there was round-the-clock reporting, Congressional interviews, and rampant punditry and analyses about how the eventual law was going to function. Don't forget, one of the most controversial parts of the ACA - the so-called "Cornhusker Kickback" - was jettisoned entirely from the final law precisely because the ceaseless transparency made it resolutely untenable to voters.
Now, yes, here's where I get to lay into the GOP for their nonsense. Indeed, a year and a half in Congress gave rise to all the lies that the GOP has been guilty of perpetuating: stuff like "death panels," "socialized medicine," a "government-takeover of health care," the "end of freedom as we know it," etc. Those lies are still unsubstantiated yet are still being told by GOP politicians, and they got their start during the lengthy push to get the ACA passed in the first place.
The second big issue is, sadly, an inherent one within the Democratic Party; namely, aside from a few firebrands like Sanders, Grayson, & Liz Warren, the Democrats in Congress are by and large total cowards. After they passed the law, they all virtually decided to run away from it in the face of constant GOP lies & attacks. There was a refusal to defend the ACA, a reluctance to even talk about it, and a White House that was doing little if anything to sell its landmark achievement.
Still, that ubiquitous reticence was exacerbated by the implementation timeline of the coverage expansion. Here, too, is another thing made painfully clear by Gruber's latest admission: the Democrats resorted to a fair amount of gimmickry in order to hit their ACA budget targets. In practical terms, this meant that the biggest coverage expansions didn't begin until last January - nearly four years after Obama signed the law - when, really, the administration could've gotten the bulk of the law up and running in two.
Still, though, even now that the law is objectively working & objectively doing precisely what it was DESIGNED to do - dramatically increase access to health insurance - why does it continue to enjoy stagnant public approval? It's all in the timeline.
Think about it, four years is a very long time for things to happen in the political world. Between March 2010 when Obama signed the ACA and January 2014 when it (mostly) came online, a ton of bad stuff was allowed to happen. In practical terms, there were two national elections (in 2010 & 2012), a Tea Party insurgency, a Supreme Court decision, and a genuine government shutdown, all of which were heavily influenced by predominantly negative ACA politicking. In a more general sense, however, the four year gap gave rise to a certifiable industry that fueled ubiquitous anti-ACA rhetoric & demagoguery. Sky-is-falling predictions about the law's effects were rampant, public opinion naturally soured, and anybody on the opposing side was either drowned out or too cowardly to speak up.
And that's a point that I really want to drive home here: Conservatives can't keep crowing about the ACA's continued unpopularity without also acknowledging the ubiquity of anti-ACA demagoguery over the past four years. Of course, it follows that if the message is that "the ACA is the root of all evil" and that that message is repeated ad nauseum for several years, then the general public (who has never been widely aware of the ACA at all because the administration hasn't sold it) will naturally develop an aversion towards the program.
Finally, yes, the rollout of HealthCare.Gov was botched & the "keep your plan" promise turned out to not be entirely accurate. Even the latter fiasco, however, was significantly overblown by the media & their GOP darlings; yes, some folks did have to update their plans as a consequence of new ACA regulations, but at the same time, the "keep your plan" promise did in fact turn out to be broadly true for most people even if it wasn't true for everybody. The thing is, after Obama got caught up in that mess, he proactively decided to quit making that promise, whereas the GOP continues to spew its lies about "death panels" and "socialized medicine."
Even now that HealthCare.Gov is essentially fixed, the impact of its lousy rollout still impacts how the law is perceived by much of the public, many of whom don't even realize the objective success of the ACA because (a) the conservative media won't tell them & (b) the rest of the media doesn't care. It's unfortunate, but that's where we are today.
Now that SCOTUS is going to put the ACA through another existential crisis, the latest conservative gambit is to rally behind Gruber's most recent gaffe in order to somehow mandate that the entire law is illegitimate in the first place, even though, it was publicly debated for a year and a half, passed by both chambers of Congress, signed by a democratically elected (and reelected!) president, and upheld by a Republican Supreme Court in 2012. But all of that doesn't matter because Jon Gruber said some stupid things several years ago. Frankly, it's hogwash.
It's important to remember, however, that even though the ACA is broadly unpopular amongst the public, repealing it is even more unpopular. Moreover, the public actually supports the things that ACA does when those things are described to them in the first place. Surely, the benefits of the law need to be connected to the public writ large, just as the consequences of repealing the ACA need to be driven home across the nation to all of its beneficiaries.