The health care plan House Republicans put forward to replace the Affordable Care Act is just a starting point for negotiations. And we don’t have any polling yet on the plan (the American Health Care Act) specifically. But pollsters have tested many of its key components, and we have good data on how Americans feel about replacing Obamacare in general. These surveys suggest that although some parts of the AHCA will likely be popular, it’ll face a bumpy road in the court of public opinion.
First, Obamacare has never been so popular (though it’s still not that popular). The Huffington Post/Pollster.com aggregate, for example, has 48 percent of Americans viewing the law favorably versus 43 percent unfavorably. There is support for tinkering with the law, but not really for changing it completely. In a January 2017 Fox News poll, 34 percent of voters wanted a partial repeal of the law, 28 percent wanted it to be expanded, 13 percent wanted to leave it as is and just 23 percent wanted it repealed entirely.
So Republicans are starting the Obamacare replacement debate in a small hole.
They’re also entering that debate at a bit of a disadvantage in terms of credibility — Republicans face a trust deficit on health care, though not an overwhelming one. Throughout 2016, multiple pollsters asked Americans which party they had more confidence in to handle health care policy. In pretty much every instance, Democrats were preferred over Republicans. An October GWU Battleground poll was typical in finding that 50 percent of likely voters had more confidence in the Democrats than Republicans on health care, while 45 percent had more confidence in Republicans. This small edge reflects a longer-term advantage: Americans have been more trusting of Democrats than Republicans on health care since at least the beginning of the decade.
That’s the playing field: By small margins, Americans like Obamacare and trust Democrats on health care generally.
Of course, much of the coming health care debate will be over individual parts of the GOP plan. The AHCA retains some of the most popular parts of Obamacare, including allowing children to remain on their parents’ plan until the age of 26 and banning discrimination against people with pre-existing conditions. In other cases, though, the AHCA changes things. Some of these changes will probably prove to be more popular than what’s in the ACA. In the others, not so much. Let’s look at some of the individual components that will probably receive the most press.
Dropping the individual mandate
Politically, this is probably the AHCA’s biggest advantage over Obamacare. Requiring people to buy insurance (or pay a tax) proved to be quite unpopular. In a November 2016 Kaiser survey, only 35 percent of Americans had a favorable view of this provision compared with 63 percent who had an unfavorable view. Even 43 percent of Democrats had an unfavorable view of the mandate. Of course, the ACA’s individual mandate is key to making the law work. The AHCA instead allows insurance companies to charge a 30 percent surcharge for any new enrollee who has not had insurance for at least 63 days. It’s basically a penalty if you let your insurance lapse and want to get insurance again. Will that be viewed as a mandate-lite, with the money going to insurance companies rather than to the government? The answer to that question could have big political ramifications. Keep in mind: 78 percent of Republicans were against the mandate.
The ACA expanded the Medicaid rolls in 31 states and the District of Columbia. It’s been one of the most popular components of the law. Most Americans (61 percent) thought Medicaid was working well in the February Kaiser poll. Even some Republican governors are promising to fight any GOP plan that nixes the Medicaid expansion. The AHCA doesn’t eliminate Medicaid, but it does change the way it’s funded1 so that each state is sent a fixed amount of money per enrollee. Kaiser didn’t test support for this exact plan, but it tested a similar policy. Compared to the current system where the federal government matches whatever spending the states do on Medicaid, this per-enrollee funding plan is unpopular. Just 31 percent of Americans are for the new system compared to 66 percent who were for the old system.
Cutting Planned Parenthood funding
While there’s no provision in the AHCA that explicitly mentions Planned Parenthood, the bill would essentially kill funding to it that Obamacare provided. There hasn’t been a recent poll that asks about Planned Parenthood and the Obamacare specifically, but there have been surveys that ask about federal funding for Planned Parenthood. Only 31 percent of voters supported cutting off funding in the January 2017 Quinnipiac poll. When this 31 percent were told that abortions provided by Planned Parenthood would not be funded (and they are not under the ACA), just 12 percent of Americans overall supported cutting off funding to Planned Parenthood.
Delaying the Cadillac tax
The Cadillac tax charges employers and insurers extra for super-generous health care plans. Under the ACA, this tax would have been implemented in 2020. Now, it’s delayed until 2025. Republicans may like the delay part, but they probably won’t like that it still exists. Back in 2015, 60 percent of Americans were opposed to the Cadillac tax. An even higher 85 percent of Republicans were opposed, according to a Kaiser survey. Republicans probably need to vote in near unanimity in Congress for the AHCA (or something like it) to pass.
Federal subsidies for the poor are cut, but wealthy people probably will pay less
Some lower- and middle-income Americans who don’t get insurance through their employers currently receive subsidies to help pay for insurance. The AHCA raises the ceiling on how much money a person can make and still qualify for subsidies. But those subsidies look like they will shrink for lower-income people under the House GOP’s plan. (So, there’s less assistance, but more people can qualify for that assistance.) There’s no polling that tells us how much money Americans think should go to lower- or middle-income people to help with health care, but surveys do indicate that such subsidies remain popular. A March 2017 Monmouth College poll found that 84 percent of Americans were in favor of them.
Meanwhile, wealthier people will likely get more of a break under the AHCA than they do under Obamacare, as the AHCA lowers the Medicare payroll tax. The November 2016 Kaiser poll found that 69 percent of Americans liked that tax. Perhaps surprisingly, even 63 percent of Republicans did.
The bottom line is that health care is a tough nut to crack for any party. The ACA remained quite unpopular for most of its existence, and it’s not clear the Republican substitute will prove to be any more popular. That doesn’t mean the Republican bill won’t pass. It just means that it won’t be a cakewalk among Americans; Republicans and the Trump administration will need to do a better job selling their plan than Obama and the Democrats did of selling theirs.