Support for the ACA Steady Overall, but Falling Among Uninsured

In posted over at Politico this afternoon, Jose Delreal notes that the overall numbers behind President Obama’s Affordable Care Act haven’t changed much as a result of the bill’s unfortunate rollout.

The Gallup survey has support for the ACA at 41 percent, virtually unchanged from 40 percent in November. Although a majority of Americans still disapprove of the health reform law, disapproval has dropped slightly from 55 percent in November to 51 percent in December.

It does not appear, however, that the troubled launch of HealthCare.gov has permanently changed opinions of the law. For comparison, disapproval for the ACA was 52 percent in July, before the website’s launch.

The article also notes that support for the ACA is quite unsurprisingly split along party lines, with 75% of Democrats supporting the law compared to only 10% of Republicans (I couldn’t find whether or not an “Independent” category was included on this poll, but it’s not that important to what I’m discussing here so I admittedly did not look very hard).

What’s interesting here is how the Gallup poll’s bird’s eye view, as presented by Politico, doesn’t seem to totally square with an article that came out over at Reason today. Peter Suderman looks at a Wall Street Journal /NBC News poll as well as a Harvard Institute of Politics poll and concludes that the Affordable Care Act has “lost the uninsured.”

A Wall Street Journal /NBC News poll released this week asked uninsured individuals whether or not they thought the law was a good idea. Just 24 percent said they thought it was. In contrast, half the uninsured polled said they thought it was a bad idea. As the Journal points out, that represents an 11 point drop in support for the law amongst the uninsured since September. The same poll also finds that 56 percent of the uninsured believe the law will have a negative effect on the U.S. health care system.

Let that sink in: What that means is that regardless of how bad the old system—the system that for whatever reason left them uninsured—was, a majority of people without health coverage now think that Obamacare makes it worse.

That’s how poorly the rollout of the health law is perceived to have gone. The exact group the law was designed to help have instead turned on the law. It’s never been particularly popular with the wider public, but now even those who were supposed to be beneficiaries are skeptical.

These polls paint a far more troubling picture of the status of the ACA among the public, since the success of the law depends very heavily on getting a large number of uninsured people to sign up. Specifically, it depends on the young, healthy uninsured, but Suderman points out that the Harvard poll found that “only 29 percent of uninsured young adults said they expected to enroll.” If this population does not buy into the ACA, it is almost certain that premiums will rise higher than the administration anticipated, and some of the support that the bill does enjoy will continue to erode further. If the figures posted here accurately reflect the sentiments of the young uninsured, then supporters of the ACA have cause for concern.

This is why I’m coming around to the view that, given its goals, the administration should have passed on the individual mandate and opted instead for strong auto-enroll measures (such as automatic insurance enrollment upon receipt of a driver’s license, or something along those lines) that allowed for individuals to actively opt out. To be clear, I am not personally endorsing such a system as my preferred method of delivering health care , but a non-normative look at things leads me to the conclusion that if the goal was simply to drive up the number of insured in America, the way to do it most efficiently would’ve been auto-enroll. Such an approach also would have probably engendered less opposition than the individual mandate, especially as it was (which is something like the GOP version of the ACA). It’s hard to believe that the 29 percent of young uninsured who expect to enroll under the ACA wouldn’t grow if it was on them to actively opt out of insurance rather than actively opt in.

Don Taylor thinks that subbing out the mandate for auto-enroll could be part of a deal on health care between the Democrats and Republicans, and I’m inclined to agree with him. I am also very interested to see what comes of this waning support of the law among young uninsured adults, whether it will turn around as benefits accrue, or whether it will cause the administration to backpedal a bit. I don’t know what’s going to happen, but I have a feeling that this is the beginning of what’s promising to be a very, very long story.

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