Majority Support Provisions Of Affordable Care Act

A Kaiser Health Tracking Poll shows the same trend that has been present in most polls on health care reform–most people support the specific measures in the act  (with one notable exception) but are misinformed about what is contained in the Affordable Care Act:

  • After taking a negative turn in October, the public’s overall views on the ACA returned to a more mixed status this month.  Still, Americans remain somewhat more likely to have an unfavorable view of the law (44%) than a favorable one (37%).
  • The survey also finds that individual elements of the law are viewed favorably by a majority of the public.  The law’s most popular element, viewed favorably by more than eight in ten (84%) and “very” favorably by six in ten, is the requirement that health plans provide easy-to-understand benefit summaries.  Also extremely popular are provisions that would award tax credits for small businesses (80% favorable, including 45% very favorable) and provide subsidies to help some individuals buy coverage (75% favorable, including 44% very favorable), as well as the provision that would gradually close the Medicare doughnut hole (74% favorable, including 46% very favorable) and the  “guaranteed issue” requirement  that prohibits health plans from denying coverage based on pre-existing conditions (67% favorable, including 47% “very” favorable).
  • Despite strongly partisan reaction to the law overall, many of its provisions are popular among Democrats, Republicans, and independents alike.  The elements of the law with the highest levels of bipartisan support include requiring plans to publish easy-to-understand summaries (88% of Democrats, 87% of independents, and 76% of Republicans favorable), tax credits to small businesses (88%, 77%, and 73%, respectively), and allowing individuals to appeal their health plans’ decisions to an independent reviewer (82%, 70%, and 70%, respectively).
  • Far and away the least popular element of the health reform law is the individual mandate, the requirement that individuals obtain health insurance or pay a fine. More than six in ten (63%) Americans view this provision unfavorably, including more than four in ten (43%) who have a “very” unfavorable view.
  • More than a year and half after health reform was enacted, there is much about the law that the public still does not know, including some of its more popular elements. For example, about four in ten (42%) are unaware of the law’s most popular provision, requiring health plans to produce straightforward benefits summaries.  The least well-known provisions — eliminating cost-sharing for preventive services and the medical loss ratio requirement, which fewer than four in ten recognize as being included in the law — are each favored by at least six in ten people, including a third who see each as “very” favorable.
  • Substantial shares also incorrectly believe the law does two specific things that it does not.  For instance, more than half (56%) think the law includes a new government-run insurance plan to be offered along with private plans (while another 13% don’t know if the law does this). And a third (35%) think the law allows a government panel to make decisions about end-of-life care for people on Medicare (with another 12% saying they don’t know). Those numbers have changed little in the past year.

While most people do support the actual provisions of the Affordable Care Act, general polling on opinions on health care reform often provide negative results for three reasons: 1) Many people are unaware of the benefits which are in the act (and which they support), 2) Many people believe items which are not in the act are contained in it, and 3) many oppose the individual mandate.

As I’ve pointed out many times before, the individual mandate is an old Republican idea which the Democrats foolishly adopted, as opposed to utilizing other possible measures to deal with the free rider problem. Most of the current Republican candidates are on record as having supported the mandate in the past. This not only includes Mitt Romney, who has taken both sides on virtually every issue during his career, but has also included current front-runner Newt Gingrich as can be seen in this video:

Gawker summarizes:

At a forum in 2005, alongside then-Sen. Hillary Clinton (D-NY) and former Sen. John Breaux (D-LA), Gingrich explained the tradeoffs that both the right and the left would have to make in health care: For the right, some transfer of wealth is involved in providing health care for the working poor, the disabled, and other groups. And for the left, individuals should still have control over their health care, rather than total government management.

“I mean, I am very opposed to a single-payer system – but I’m actually in favor of a 300 million-payer system. Because one of my conclusions in the last six years, and founding the Center for Health Transformation, and looking at the whole system is, unless you have a hundred percent coverage, you can’t have the right preventive care, and you can’t have a rational system, because the cost-shifts are so irrational, and create second-order problems.”

This led Gingrich to a few conclusions of how to implement such a system: Convert Medicaid into a health insurance voucher system as it applies to the working poor (on the rationale that the creation of food-stamps do not involve the government running its own grocery stores); Create very large risk pools for individuals to purchase insurance (i.e., exchanges); and minimize insurance companies from cherry-picking customers.

“I know I risk not sounding as right-wing as I should, to fit the billing,” Newt said at one point, which did indeed trigger some audience laughs.

Gingrich then invoked the example of welfare reform in the 1990’s – perhaps his single biggest accomplishment from when he was Speaker – and how it got people off of the welfare rolls.

But my point to conservatives is, it’s a model of responsibility. If I see somebody who’s earning over $50,000 a year, who has made the calculated decision not to buy health insurance, I’m looking at somebody who is absolutely as irresponsible as anybody who was ever on welfare. Because what they’ve said is, a) I’m gambling that I won’t get sick, and b) I’m gambling that if I do get sick, I can cheat all my neighbors.

Now when you talk to hospitals, a very significant part of their non-collectables are people who have money, but have calculated that it’s not worth the cost to collect it.

And so I’m actually in favor of finding a way to say, if you’re above whatever – whatever the appropriate income level is, you oughtta have either health insurance, or you oughtta post a bond. But we have no right, we have no right in this society, to have a free-rider approach if you’re well off economically, to say we’ll cheat our neighbors.

As Media Matters has previously pointed out, as late as 2008 Gingrich was still advancing the mandated insurance/bond approach for people above a determined income level.

It was a major mistake for Barack Obama to reverse his campaign position of opposing the mandate, adopting an old Republican position, and underestimating the degree to which Americans oppose being told what to do by government. If not for this mistake, I believe that support for health care reform in general, as well as for Obama’s reelection, would be much higher than they are now.

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