In the three years since the Affordable Care Act became law, it has become fodder for campaign ads and the subject of a high-profile Supreme Court challenge, while news analysts have endlessly debated and dissected it. None of that has had any effect on public opinion.
The Kaiser Health Tracking Poll, which has asked the question nearly every month since 2009, has found that the public’s views of the law, overall, have remained nearly static. About 40 percent of people don’t like the law. About 40 percent do. The remainder are unsure. Other polls show the same trend.
“Nothing has changed,” said Tresa Undem of PerryUndem Research and Communication, who has conducted polls and focus groups on the ACA.
All the advocacy and rhetoric hasn’t nudged approval higher. It also hasn’t had any major effect on public knowledge about what the law actually does and says. Recent surveys from Enroll America, an umbrella group for advocacy organizations and health providers, found that huge majorities of the populations that will benefit most from the law did not know it affected them. More than 80 percent of people who will be eligible for free health insurance through the Medicaid expansion, for example, had no idea they could get coverage.
The latest Kaiser poll, published Wednesday, said that awareness of individual provisions in the law has actually declined over time, not improved. Compared with April 2010, just after the law passed, fewer people know it will mean anyone can get insurance, regardless of their health history; that small businesses are eligible for tax credits; that the Medicaid program will expand; or that uninsured Americans will be able to get financial help buying health plans.
While politicians may be frustrated that their messages are not penetrating, pollsters say the trends in public opinion are not a huge surprise to them. For most members of the public, the law has registered as something big, abstract, and linked to government intervention in the health care system. Absent concrete experience, most people have decided what they think about the idea of health reform, and their opinions have remained entrenched. Think about the deep-blue state of Massachusetts, which enacted a similar health reform law in 2006. About two-thirds of people there approve of the state law, while only about half like the ACA.
That may start to change as next year rolls around and the law’s largest provisions begin to take effect. The minority of the U.S. population that lacks health insurance will start to see new options. Others may be overwhelmed by complex bureaucracies. Some people with cheap insurance may see their rates increase. People whose policies included limited benefits may suddenly become eligible for much more robust coverage. Those personal experiences are likely to shake up public perception rapidly.
“It goes from a hypothetical discussion of what may be to an actual experience of what they see,” said Robert Blendon, a professor at the Harvard School of Public Health.
Boosters of the law tend to think that implementation will lead to increased popularity. Blendon says that really will depend on the smoothness of the rollout. “I’m not sure what they see is going to make the bill more popular,” he said.