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A Magazine of Ideas

Top 10 Takeaways: Public Opinion on the Affordable Care Act

Tuesday, October 1, 2013

With the ACA's exchanges going live today, let's take a look at public opinion on the law.

What are Americans saying about the Affordable Care Act (ACA) as the start date for the exchanges arrives and Congress continues to debate delaying and defunding it? How have views of the law changed over time? At least a dozen pollsters have asked about the bill (and then the law) since the debate over it began early in the Obama administration. We have tracked their efforts since the beginning of the battle over Obamacare; here is where things stand today:

1. Views on the law: Most Americans don’t like it. In every poll conducted by eight major national pollsters this year, opposition to the Affordable Care Act outweighs support.1 In the September 2013 CBS News/New York Times poll, for example, 39 percent of respondents approve of the law and 51 percent disapprove. In the mid-September Kaiser Family Foundation poll, 39 percent have a favorable view of it and 43 percent an unfavorable one. The late September CNN/Opinion Research Corporation poll found 38 percent in favor and 57 percent opposed.

2. Intensity: Opponents have it. Only a few pollsters ask people whether they feel strongly about their views of the law. But as those polls make clear, some Americans are adamant about it. Take the latest Kaiser poll, which shows that 20 percent of respondents have a very favorable view of the ACA but 30 percent have a very unfavorable one. Throughout 2013, in this poll and others, the intensity of feelings has been stronger on the negative side. 

In every poll conducted by eight major national pollsters this year, opposition to the Affordable Care Act outweighs support.

3. President Obama’s handling of health care: Thumbs down. Since the passage of the Affordable Care Act, major pollsters have asked more than 125 questions about how the president is handling the issue of health care. Disapproval almost always outweighs approval. Only about a dozen of these questions have the president breaking even or winning the issue. The latest poll from ABC News and the Washington Post shows 42 percent of those polled approving and 52 percent disapproving. The responses in the latest CBS News/New York Times poll are similar (40 percent to 54 percent, respectively) as they are in the CNN/Opinion Research Corporation responses (42 percent and 55 percent, respectively). The president’s overall job approval ratings are better than his ratings on handling health care.

4. Democrats versus Republicans on health care: The Democrats are losing ground. Pollsters don’t ask questions about which party would do a better job handling health care very often. When they do, Democrats almost always lead the Republicans, though in some recent polls the margin is close. Pew has asked the question eight times since February 2010, when 45 percent of respondents said the Democrats would do a better job and 32 percent the GOP. But their latest poll from September has the parties evenly matched at 39 percent for the Democrats and 40 percent for the Republicans. In the new NBC News/Wall Street Journal poll, 37 percent said Democrats would do a better job dealing with health care and 29 percent the GOP. Many people thought neither party would do a good job or there wouldn’t be much difference either way. The Democrats’ advantage in this poll has slipped. It was 16 points in February of this year. Now it is eight points, the lowest level since the bill’s passage in March 2010.

5. Expand it? A consistent 20 percent says yes. Several pollsters ask people whether the law should be expanded or if it goes far enough. About 20 percent in most of these polls say it should be expanded. Take the Fox News poll of registered voters. In their latest four-part question from June, 17 percent of respondents wanted to expand the law and another 19 percent wanted to keep it as it is. In October 2012, the first time Fox asked this question, those responses were 20 percent and 15 percent, respectively. In the new September Kaiser poll, 17 percent said the law doesn’t go far enough

6. Repeal it? In whole or part, around four in ten. In nine Fox News surveys of registered voters since October 2010, between 27 percent and 39 percent have wanted to repeal the law entirely. When given a full set of options about whether to expand it, keep it as it is, or repeal it, other pollsters put the “repeal entirely” response at around 20 percent, with an additional 15 to 20 percent saying parts of it should be repealed. At the other end of the spectrum, as noted above, around 20 percent want to expand it.

Many people have real doubts the law will help those it was intended to help.

7. Defund it? Americans say “no.” In the September 2013 CBS News/New York Times poll, 56 percent said they would like Congress to “uphold the law and make it work as well as possible,” while 38 percent wanted it to “try to stop the law from being put into place by cutting off funding to implement it.” On 10 occasions since January 2011, Kaiser has asked people about defunding. Their latest results were similar to the CBS results: 56 percent disapproved of cutting off funding, while 37 percent approved.

8. Will you and your family be better off? Not really. On nearly 50 occasions since February 2009, the Kaiser Family Foundation has been asking people a three-part question about whether they and their families would be better or worse off under the health reform law or whether the law wouldn’t make much difference to them. Between 35 and 40 percent of respondents usually say things won’t change much. Of the remainder, more usually say they will be worse off than better off. In their new mid-September poll, 24 percent said better off, 32 percent worse, and 37 percent said it wouldn’t make too much difference.

9. Will the country be better off? Deep divisions. When it comes to the nation as a whole, 45 percent of those polled in April 2010 said the country would be better off under the law, 35 percent worse off, and 11 percent said there wouldn’t be much difference. Now, those responses are 37, 39, and 16 percent, respectively.

10: The uninsured: Losing ground under reform? In April 2010, 67 percent of those polled told Kaiser interviewers that the uninsured would be better off under the ACA. That response has dropped nearly 20 percentage points in the latest Kaiser poll, to 48 percent. As for the worse off responses, in April 2010, 15 percent said the uninsured would be worse off. That is now 26 percent, while 18 percent say there would be no difference. Sad but true: many people have real doubts the law will help those it was intended to help. 

Full wording of the questions and trends mentioned in this report can be found here.

Karlyn Bowman is a senior fellow and Andrew Rugg is a research assistant at the American Enterprise Institute.

FURTHER READING: Bowman and Rugg blog about public opinion in their weekly “What You May Have Missed in the Polls” series and recently collaborated on “5 Years After the Crash, What do Americans Think of Wall Street, Banks, and Free Enterprise?” Joseph Antos explains the ACA in his four-part series, starting with “Obamacare: Destined to Flop? Part I,” while James Pethokoukis explains “Obamacare: Wrong in Practice, Wrong in Theory.” Christopher J. Conover contributes “‘Not One Dime’: Health Care Law Projected to Add $6.2 Trillion to U.S. Deficit.” Neil McCray and Joe Antos share “HHS Report on ACA Exchange Premiums: Putting the Best Face on a Bad Situation.”


1 In our AEI Special Poll Report on health care, we have examined the polls and trends from ABC News/Washington Post, the Pew Research Center, Gallup, CBS News/New York Times, Fox News, AP/GfK/Roper, the Kaiser Family Foundation, NBC News/Wall Street Journal, and Quinnipiac University.

Image by Dianna Ingram / Bergman Group