Earlier this year, the Kaiser Family Foundation conducted a poll that showed that almost 54 percent of the American public had a favorable opinion of the Affordable Care Act, commonly known as Obamacare. That is the highest favorability rating the law has received since it passed in 2010 and suggests that a majority of the public now support keeping the program in place. That is a far cry from the 34 percent favorability rating the poll gave the law in October of 2011.
There are many reasons why Obamacare has risen in public opinion, including wider adoption, improving insurance markets and growing participation among insurers. Many analysts however point to a psychological cause more than an economic one as being the primary motivation; now that more of the public has benefited from the program, they are more willing to defend it. When the program was new and untried, the public was hesitant to support it if it meant sacrificing their old medical arrangement.
Now that more of the public has become accustomed to Obamacare, they fear losing it. In 2017, when the Republican-controlled Congress attempted to repeal and replace the ACA on numerous occasions, many beneficiaries of the Affordable Care Act felt threatened. This helped strengthen the relationship between millions of newly insured Americans and the Obamacare system.
In 2010, when a Democrat-controlled Congress passed the Affordable Care Act under the leadership of President Barack Obama, there were almost 47 million uninsured Americans. By 2017, this number had fallen to 28 million, primarily due to subsidized private health plans, expanded Medicaid enrollment and longer coverage periods for children. There has been some fluctuation in these figures as new changes to the health care system have been implemented, but there is no doubt that millions more are now covered due to the Affordable Care Act.
The most important change that the ACA enacted was allowing 28 states to expand the eligibility criteria for Medicaid enrollment in return for greater federal funding assistance. Prior to the ACA, Medicaid was primarily limited to those households with income less than the federal poverty level. However, under the ACA, many states raised eligibility criteria to 138 percent of the federal poverty level, which helped insure 15 million more Americans.
Another key benefit of Obamacare was that it allowed children younger than 26 to remain on their parents’ plans. This helped cover more than 5.7 million young Americans since the law was passed in 2010.
The benefit that is most often publicized is the ability to obtain a health insurance policy from the newly created insurance exchanges at a discounted rate. Individuals and families can now buy health coverage off of the exchanges and get up to hundreds of dollars in monthly subsidies if they meet certain eligibility requirements. The most important qualification is income that is between 100 percent and 400 percent of the federal poverty level.
Obamacare also introduced some very popular changes to the health insurance industry—as well as some very unpopular ones. Among the most popular is the prohibition of discrimination against people with a prior health condition. This component of the law barred insurers from denying coverage or raising prices on sick applicants.
The new law also imposed some new restrictions on what must be covered in all health insurance policies. This included mandatory preventive care services like immunizations, certain cancer screenings, and annual checkups that were performed at no charge. Additionally, the ACA also mandated that all covered women have free access to contraceptive and pregnancy care.
One of the most unpopular elements of the Affordable Care Act, however, was the individual mandate. The individual mandate required all Americans above the federal poverty level have health insurance for most of the year or pay a financial penalty. This component of the law was challenged in the courts, eventually giving rise to a Supreme Court decision that confirmed the legality of the individual mandate.
Why Obamacare’s Popularity Is Trending Up
Although the Affordable Care Act appears to have improved the lives of millions of Americans, it took some to time to achieve the current level of public support. Before it was even signed into law, many critics saw Obamacare as a threat to the U.S. health care system. Many analysts believed that too many newly insured would overburden a fragile system that had limited resources. Others pointed to the enormous costs that a new entitlement program would place on the federal government, perhaps tipping it into insolvency.
A poor rollout of the program did not help endear it to the skeptical public. The main internet website Healthcare.gov had numerous technical problems that made it difficult for people to enroll. The rollout was handled poorly in general due to management by unqualified program personnel which created fodder for critics and frustration even among supporters. The upwelling of resistance eroded public support almost from day one.
The botched implementation was later compounded by rising health plan costs in years to follow. Initial projections underestimated how many sick people would enroll in Obamacare plans and how much it would cost to cover their claims. Furthermore, policy administrators overestimated how many healthy would enroll. This created cost overruns for insurers who either raised rates or dropped out of the Obamacare exchanges entirely.
In the past few years, however, many of these problems have been addressed. Many of the unhealthiest enrollees have gotten the most important and costliest treatments, allowing coverage costs to normalize. The lower cost of insuring Obamacare enrollees has helped raise profits among participating insurers which could lure more insurers into the market. Lower costs and greater competition are expected to help lower premiums in many local insurance markets in 2019.
This surging popularity for the Affordable Care Act is part of the reason why Republicans failed to repeal it last year. This burgeoning support is also why a majority of the public is in favor of maintaining the program and developing solutions for ongoing problems.