The Agenda

Obamacare Approval Hasn’t Changed Much in Four Years — Except It’s Collapsed Among the Uninsured

The Kaiser Foundation has a cool interactive infographic tool to examine the polling they’ve done on the Affordable Care Act since it was passed, four years ago. You can click through the tool to see how approval and disapproval ratings have changed across different demographic categories and over the years. For the most part, opinion hasn’t changed much — it’s ticked up slightly over the last four or five months for most demographic groups, during the law’s troubled rollout, but not by a huge amount (a finding Gallup’s replicated). The one striking finding: Disapproval of the law among the uninsured population has risen substantially over the past few months (click on the image to enlarge).

That may look like a relatively temporary uptick, but it’s much more substantial than what’s happened in any other demo. A caveat: Kaiser’s sample size for the uninsured isn’t that big, so this has a substantial margin of error. Nonetheless, several straight months of the rate’s rising when you’d think it’d be falling seems reliable.

Assuming the finding holds up, why might it be happening? For one, they’re more likely to be interacting with the law: Navigators are trying to reach them; some of them have probably been on the individual market at times, which only a limited percentage of Americans are, and are now seeing themselves priced out of coverage; others are perhaps just disappointed with what the law has to offer, or that its plans aren’t free, period. Some of them could be people who would have been eligible for Medicaid if their state had expanded it, and now see people making a little more money getting heavily subsidized insurance while they’re left out in the cold. As Jason Sorens points out on Twitter, it’s possible that we’re seeing a selection effect — people who like the ACA and for whom it works well are now leaving the ranks of the uninsured. We’ll have to see if this trend holds up.

Some Republican strategists and conservatives have argued that as Obamacare is implemented, its costs are going to be so great that Americans will turn against it in droves. But besides a slight boost to disapproval from the bad PR around the rollout of the exchanges, that doesn’t seem to be panning out in polling, so far. The implementation of the law has not fundamentally changed whether people have favorable or unfavorable views of it, except, it seems, among those whom it was specifically targeted to help (which are just a slice of the electorate and probably don’t vote in strong numbers). That’s interesting, though it’s important to note it’s not an indictment of the law, per se: Whether individuals targeted by a given public policy actually support that policy or not is not dispositive.

More data after the jump.

Disapproval overall, as you can see, has steadily outweighed approval, and has risen a bit since last fall:

It’s risen a bit among political independents, too (it’s stayed relatively steady with Republicans and Democrats)

And it’s not changed dramatically among senior citizens or those aged 18–64:

People do seem to be following the rollout of the law closely, though, according to Kaiser’s February poll: While there’s some social-desirability bias here, Americans say they’re following it and even more esoteric aspects of the law (e.g., the Congressional Budget Office’s estimate of its effects on employment) with the same level of attention they gave to the Winter Olympics. (In other words, some surprising share of Americans’ media-consumption habits are a little like Reihan’s.)

The February survey also found that the uninsured and those on the individual insurance market say they’d prefer cheaper plans with narrower doctor networks than paying more for access to more doctors. The narrower provider networks offered by the plans on the exchanges have been controversial, though people perhaps don’t realize the cost savings they’re getting by selecting such plans because other changes the ACA has made to insurance have made their insurance much more expensive, period.

Patrick Brennan was a senior communications official at the Department of Health and Human Services during the Trump administration and is former opinion editor of National Review Online.


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