Five years later, still not repealed
As it turns out, stripping some 8.2 million people of their health insurance isn't a popular idea.
A recently released poll conducted by Perry Undem on behalf of Vox Media indicates that people oppose the objective of the King v. Burwell case by a 2-to-1 margin: 31 percent of those surveyed support kicking millions of people off the health insurance plans they thought they could afford, while 63 percent think doing so would be a bad idea. The remaining 6 percent refused to answer, presumably because they didn't understand the question.
While it's still astonishing that even a third of the country believes that taking away health insurance from millions of lower- and middle-income people is a good idea, the unpopularity of doing so should be yet another nail in the coffin of the King case. It would be bad enough to ignore both congressional intent and legal precedent in a crusade to justify a purely political ruling. It's even worse when such a decision would directly remove health insurance from over 8 million people and potentially collapse insurance markets in a few dozen states. But perhaps the worst thing for Chief Justice John Roberts is that the general public really doesn't want to see it happen.
But there's a significant downside to the fairly comprehensive Vox poll on attitudes toward the Affordable Care Act: the conservative propaganda machine has been successful in convincing people that the law has not worked, even though it has. More on that below the fold.
At first glance, the topline numbers don't seem that positive for the law: 26 percent say they have a favorable opinion of the law, 36 percent have an unfavorable view, and the rest are neutral or unsure. Most say that their views on the law haven't changed; but among those who have, opinions of the law have changed for the worse by a 58-42 margin. Given those numbers, one might expect there to be significant momentum in polling for repealing the law, but there's not:
29.Which comes closest to your point of view about the law?
The health care law is a start but I want to see it changed so that it works better for more Americans: 58
The health care law doesn’t work and should be repealed: 38
Refused: 4
Similarly, only 31 percent of respondents want Congress to repeal and replace the Affordable Care Act, while 50 percent either want the law kept as is or want it kept on the books and improved. These figures might seem contradictory, but a further exploration suggests why: people understand what the law is designed to do, but have false impressions about possible negative consequences, as well as its efficiency compared to expectations.
In most cases, fairly strong majorities are aware about the positive benefits of the law for consumers: 64 percent believe, correctly, that pre-existing condition coverage is mandatory because of the law. Similarly, majorities believe that the law is responsible for more people getting health insurance coverage, allowing younger people to stay on their parents' plans until age 26, subsidies for lower-income people, and especially the individual mandate to require health insurance.
But the constant drumbeat of negativity from conservative circles has led to the continuation of mistaken impressions: for instance, 49 percent of those surveyed believe that insurance costs are going up because of the law, even though the Affordable Care Act is actually slowing the growth of premiums. Similarly, 42 percent of people think that their taxes have gone up because of the law, even though nowhere near 42 percent of people will be subject to either the individual mandate penalty or the supplemental Medicare tax that helps fund subsidies on the exchanges. Meanwhile, only 16 percent claim to have gotten health insurance because of the law, and that puts it in a bit of a pickle from a polling standpoint—ultimately, people believe that they are paying more for a law that helps others.
Altruism isn't known to be a strong suit for the American electorate, but it would be easier if people knew that the law was actually working as intended. The Affordable Care Act has met or exceeded its enrollment goals in each of its two annual sign-up periods, and the cost of subsidies has come in under budget, according to the Congressional Budget Office. But despite that, only 13 percent of people believe that the law met its enrollment goals compared with 44 percent who don't. Even worse, only 5 percent believe that the law is costing less than estimated, while 42 percent believe it is costing more.
There's bad news and good news in these numbers. The bad news is that the false narrative of the right wing has succeeded in convincing people that the law is expensive for them and is not working as intended. The good news is that overall, people recognize the positive attributes of the law, and want it to work better than than the negative impressions they have of it right now. Cumulatively, that represents an aspirational desire for a functioning law that helps people get insurance.
Fortunately, that's exactly what the facts indicate that we have—and maybe someday we can cut through the clutter and get that message to sink in.