Why public opinion on ObamaCare should worry us all

It’s policymaking 101: When a policy delivers benefits to people, support for the policy grows. Political scientists call situations like these “policy feedback loops,” and they are a big part of the story of how Social Security and Medicare became so entrenched in American life. But what happens if hyper-partisanship stops the loop? Consider the Affordable Care Act (ACA). Over the past four years, some 20 million people have gained health coverage and the already-insured have received new protections. But public opinion of the ACA has remained mixed.

{mosads}The numbers are stark. Monthly tracking polls show that 49 percent hold unfavorable views of the ACA versus just 38 percent holding favorable views. These assessments fly in the face of the ACA’s accomplishments. The law slashed the uninsured rate among non-elderly adults (ages 18 to 64) by a stunning 43 percentage points since 2013. Twenty million Americans gained health insurance coverage, including 8.9 million whites, 3 million blacks and 4 million Hispanics. Seniors got help affording prescription drugs. Insurance companies may no longer drop from coverage those who become ill, or refuse to cover people with pre-existing conditions. Why didn’t these benefits improve the public’s assessment of the law?

To track public opinion on the ACA over time, we began following 1,200 Americans in 2010. We have re-interviewed those same individuals every two years, asking them the same questions. Unlike the snapshots offered by traditional polls, this approach, like a moving picture, enables us to track how individuals’ views change or remain the same over time.

The benefits mattered, to a point. Our respondents updated their views of the law, especially as individuals and their families experienced tangible effects of specific provisions. Asked about the ACA’s requirement that insurers cover young adults on their parents’ insurance until they are 26 years old, the percentage of respondents who perceived “some” or a “great” impact of this provision on themselves and their families (as opposed to “no” or “little” impact) increased by 13 points between 2010 and 2014. Those perceiving a personal impact from the law’s prescription drug benefit for senior citizens grew by 7 percentage points, and those aware that tax credits or other subsidies helped pay for health insurance increased by the same amount.

Overall, Americans are increasingly likely to view the ACA as expanding their family’s access to health insurance and medical care. The percentage of people who perceive some or great impact on access has swelled by 19 points, while the percentage who perceive little or no access has diminished by 18 points.

These changes transcend partisan identity. Among Democrats and Republicans, the experience of gaining health coverage between 2010 and 2014 more than doubled the likelihood that individuals would credit the ACA with widening access, compared to those who already had insurance in 2010.

The law’s actual effects are also weakening opposition to it among those who were most adamantly against it in 2010. Since then, the ranks of those urging repeal shrank by 9 percentage points. And, no surprise, the experience of gaining health insurance over these years more than doubled the likelihood of moderating one’s opinion.

So why have overall assessments of the ACA remained so divided and largely negative? The culprit, we found, is the political environment. Prevailing attitudes of distrust in government, strong partisanship and ingrained attitudes — not features of the law itself — are perpetuating the public’s negative opinion. The ACA remains highly politicized, to say the least. Republicans in the House have voted to delay, defund or repeal the law some 60 times, and its very nickname — ObamaCare — primes us to think of the ACA through a political lens.

Conservatives consider the law the very embodiment of government overreach. On the other hand, many liberals support a single-payer system and pass the ACA off as a sellout to powerful interests. When it comes to assessing the law, Americans are caught in an echo chamber in which the din of party elites and activists drowns out their positive personal experiences. And that is troubling.

There is broad support from both the public and experts for using government action to address America’s pressing challenges, from student loan debt to climate change. Solving these problems, like reforming healthcare, will take time, and in a democracy, reforms will need to gain supporters by bringing real benefits to citizens. But if hyper-partisanship has broken the policy feedback process, the likelihood of government getting down to the practical business of solving these problems is low indeed.

Jacobs is the Walter F. and Joan Mondale Professor of Political Science at the University of Minnesota. Mettler is the Clinton Rossiter Professor of Political Science at Cornell University.