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November 01, 2013 11:10 AM A Level Deeper on Obamacare and Public Opinion

By Ed Kilgore

Greg Sargent is right to draw attention this morning to the latest Kaiser Family Foundation survey on the future of the Affordable Care Act, which takes us a solid level deeper than the usual “support” or “oppose” surveys. Taken at a time when hysteria over health.gov’s problems was beginning to dominate the news, the survey asks which of four options respondents favor: expanding the law, keeping it as is, replacing it with an (undefined) Republican alternative, or repealing it altogether. And even though the same survey shows generally negative assessments of Obamacare implementation (only 26% of Democrats give the federal government “good” or “excellent” marks), the overall landscape of opinion remains favorable to Obamacare as it is or as it might be if expanded.

Overall, 22% want to see Obamacare expanded, 25% like it as is, 24% want to repeal and not replace it, and 13% favor a Republican alternative. Only 29% of self-identified Republicans favor a “repeal and replace” strategy, which helps explain why congressional GOPers haven’t been terribly active in promoting more than the bare bones of an alternative. Meanwhile, among self-identified Democrats, more favor an expanded Obamacare (40%) than the one we actually have (39%).

At a time when Republicans are stressing the terrible, terrible loss of existing insurance policies under Obamacare, it’s interesting that in this survey at least, support for the status quo ante amounts to only 24%, as opposed to 60% favoring some alternative. Perhaps the current furor over canceled policies is boosting support for the old system a bit, but it’s clear the reasons the public support health reform to begin with haven’t gone away. And at some point—say before the 2014 elections—Republicans as a party are going to have to decide whether they want to defend the unpopular Good Old System or go whole-hog with an “alternative” that at this point has very little public support.

Democrats need to stare at their own numbers here—not in order to lurch to the abandon-Obamacare-and-take-up-single-payer position urged by a few lefty pundits, but to argue that “fixing” Obamacare means strengthening it, perhaps by finding ways around state obstruction of the Medicaid expansion, perhaps by bringing back some version of the public option. The bottom line is that there is still a hunger for reform, and little support for conservative alternatives (indeed, I suspect it might actually shrink if people were more aware of the atavistic nature of such alternatives, which would kill off employer-based coverage without reforming the individual insurance market into which most Americans would be driven). So progressives need to get out of their defensive crouch on health reform.

Ed Kilgore is a contributing writer to the Washington Monthly. He is managing editor for The Democratic Strategist and a senior fellow at the Progressive Policy Institute. Find him on Twitter: @ed_kilgore.

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