Political Animal


November 30, 2011 2:20 PM The nature of the opposition to health reform

By Steve Benen

The latest Kaiser Family Foundation report on Americans’ attitudes towards health care reform included some pretty interesting tidbits.

We learned, for example, that while those with unfavorable attitudes towards the Affordable Care Act outnumber supporters, most Americans want the law left intact or expanded, not repealed. That’s probably not what Republicans hoped to see.

Also, KFF found that Americans tend to strongly support the provisions within the health care reform law, though they’re still unclear about what is — and isn’t — in the act.

But this was the survey result that stood out for me:

Unfavorable views of the health reform law may be a proxy for more general disillusionment with the state of the country and Washington politics. A plurality (44 percent) of those who view the law unfavorably say their negative view is more about their general feelings about the direction of the country and what’s going on in Washington right now, while just a quarter say it’s based on what they know about the law.

Here’s the accompanying chart on this:

I’ve long wondered whether this is true, and I find this result oddly reassuring.

If the unemployment rate was 5% and President Obama enjoyed a 67% approval rating, it’s pretty damn likely support for the Affordable Care Act would be much higher than it is. Republicans would have us believe the law’s unpopularity is the result of overreach — the ACA is too liberal; it’s too much government, etc.

But there’s ample evidence to the contrary. Americans aren’t satisfied with much of anything coming out of Washington lately, and so attitudes towards the health care reform law are caught up in a general sense of discontent.

If/when conditions economic conditions improve, and the public gets a better sense of what the Affordable Care Act does (and doesn’t) offer the public, it still stands to reason the right will find it increasingly difficult to undo the entirety of the law.

Steve Benen is a contributing writer to the Washington Monthly, joining the publication in August, 2008 as chief blogger for the Washington Monthly blog, Political Animal.


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  • Burr Deming on November 30, 2011 2:26 PM:

    My bet is the public will give it another favorable look when it hits us that the only real alternative is the Republican proposal.

  • Gummo on November 30, 2011 2:28 PM:

    most Americans want the law left intact or expanded, not repealed

    You mean exactly like the dirty effing hippies were screaming during the whole debate when the Democrats were happily whittling the damn thing down to a nub to appease Big Pharma (the industry, not Limbaugh), Republicans and know-nothing teabaggers?

    Gee, what a surprise.

  • Anonymous on November 30, 2011 2:28 PM:

    I find this result oddly reassuring.

    Just shy of half of the public bases their opinion on an important policy matter on a nonspecific, generalized dissatisfaction and not on the facts...and you're reassured?

    Maybe I'm being too much of a pessimist, but I take it as a sign that the republic is doomed.

  • Anonymous on November 30, 2011 2:29 PM:

    also, many polls show that if you break up the law into pieces, they are very popular:

    closing doughnut holes, including preexisting conditions into private insurances, prohibiting dropping coverage when patients get sick, giving tax credit to businesses who provide employ-based insurances, providing free preventative cares, coverage over 26 years and young people through parents'.

  • c u n d gulag on November 30, 2011 2:35 PM:

    The Republic IS DOOMED!

    We all know it.

    Most of the commenters here are part of Steve B's 12-step program to wean us off total pessimism, and give us at least some hope and optimism.

    Without him and the other commenters here, I know that very soon, I'd be washing down a couple of M-80's with gasoline, and then firing up my last cigarette.

    They can list my cause of death as "Explosive Diarrhea."

  • Bruce K on November 30, 2011 2:42 PM:

    None of this is in any way reassuring. It's fantasy to think otherwise, because the economic conditions are improving in such fits and starts that the general distress underlying these numbers is not easing, and probably won't in the near term. Yes, if pigs could fly, Obama's numbers might look better..but will they evolve wings before November 2012?

  • E L on November 30, 2011 3:27 PM:

    The right, by end through through its new darling, Newt, would try to repeal ACA if the polls showed the favorability 90-10%.

  • square1 on November 30, 2011 3:37 PM:

    The problem with ACA isn't what it is. The problem is the discrepancy between what it is and what it was billed to be.

    Before Obama was inaugurated, our health care crisis could be broken down into roughly 4 components:

    1. The crisis of skyrocketing health care costs and insurance premiums. 2. The crisis of the uninsured. 3. The crisis of bad-faith insurance denials. 4. The crisis of rising Medicare costs.

    Far and away, #1 was the most important. Not only because it affected the most people, but because if you solved #1 it would partially solve the other 3.

    Unfortunately, the administration largely ignored the basic cost issue, preferring to focus on the issue of universal coverage. But universal coverage was largely a symptom of the larger cost problem. Leaving aside, denials of coverage for pre-existing conditions, the primary reason people are uninsured is because they can't afford the damn premiums.

    Bizarrely, the entire HCR debate got dragged down into budgetary issues and CBO scores. If you were an American who was complaining about your employer-provided insurance premiums being too high, no doubt you were left scratching your head and wondering what the fuck the cost of your health insurance had to do with the federal budget over 10 years.

    And ironically, the one area where health insurance costs do significantly affect the budget -- the real problem of rising Medicare costs -- was left largely unsolved.

    For certain Americans (e.g. those with pre-existing conditions) ACA was a great bill.

    But for the vast majority of Americans, the big drama over HCR back in 2009 and 2010 probably seems like a big ado about nothing: They still largely are tied to employer-provided insurance, they still see their insurance premiums rising steadily, and they still are being told that Medicare is a bomb waiting to blow up the budget.

  • some guy on November 30, 2011 3:57 PM:

    Far and away the least popular element of the health reform law is the individual mandate, the requirement that individuals obtain health insurance or pay a fine. More than six in ten (63%) Americans view this provision unfavorably, including more than four in ten (43%) who have a "very" unfavorable view.

    pretty big elephant in the room.

  • square1 on November 30, 2011 4:28 PM:

    If the unemployment rate was 5% and President Obama enjoyed a 67% approval rating, itís pretty damn likely support for the Affordable Care Act would be much higher than it is.

    I have two responses to this. The first is that I don't know why Steve Benen finds this reassuring. Even if true, the unemployment rate isn't at 5% and isn't like to return to that level for several years, certainly not before the election next year.

    Second, this confirms what I have been saying for some time, but which has not been discussed very much. Namely, President Obama made a massive strategic error by expending such a large portion of his political capital on passing legislation that wouldn't significantly improve the economy and wouldn't even show significant tangible effects to most voters for several years.

    Had Obama stayed focused on jobs and short-term economic growth in 2009 and 2010, as well as meaningful reform of Wall Street, including criminal prosecutions, then we would likely be much closer to 5% unemployment right now and people would feel more positive about health care reform as a concept. Maybe HCR would have been passed in 2012 instead of 2010, but the bill could have been more popular and, frankly, much better.

  • chi res on November 30, 2011 5:37 PM:

    And ironically, the one area where health insurance costs do significantly affect the budget -- the real problem of rising Medicare costs -- was left largely unsolved.

    The provisions of the ACA that are intended to help lower the costs of health insurance haven't even been implemented, but so many are already completely convinced that they won't work.

    What's your pick for the seventh race?

  • Doug on November 30, 2011 8:06 PM:

    square1, the problem with your reasoning is that you're supporting an argument on what should have been done THEN, with data not known AT THAT TIME.
    Lord knows you try, but you can't have it both ways. The stimulus was perfectly in tune with the KNOWN economic needs of 2009. The ACTUAL economic conditions of 2008-09, job losses a third or more greater than earlier reported and an economy shrinking at more than twice the then-known rate, weren't known until the summer of 2011. If you wish to remark on WHY those numbers were so far off in 2009, go for it. That's something I'd like to know, too.
    "Had Obama stayed focused on jobs and short-term economic growth in 2009 and 2010..." the results would have been even worse. We wouldn't have the ACA to use as a base for national health care. Nor would we have had ANY more spending for "jobs and economic growth". Why should we? We were in the process of spending $800-900 billion on a stimulus, why we would need more before THAT was even spent?
    That last is exactly what every "Blue Dog" would have asked, immediately prior to voting against any further spending. Nothing could have passed in the House without the support of at least half of the Blue Dog caucus and there easily were 25 or more Blue Dogs who wouldn't have supported further spending.
    By the way, maybe the reason for there not being much of a discussion about President Obama's "strategic error" is simply because it wasn't?

  • Anonymous on November 30, 2011 10:12 PM:


    your comment just summed up selfish nature of people who are unhappy with this bill.

    1 you don't think this bill is not that good even though it will gives more than 20% of Americans insurances. Those are not small numbers. you could be one with preexisting condition since anything could be doomed so.
    i respect Obama greatly for passing a bill that helps the most needy/powerless of the society knowing that this is going to be unpopular with many other citizens.

    2 you would want to believe that Obama couldn't pass a major medical cost containment bill simply because he was working with corrupt insurance companies.
    but medical cost containment is actually hard and needs to be dealt gradually with means testing with cooperations with private medical professionals and facilities.

    Paul Ryan alternative is an aggressive way to cut cost but only to government.
    but if you want to reduce the cost, you actually have to reduce pays of good doctors, hospitals, nurses, not just evil insurance companies.
    people would never have gone for that for the fear of reducing quality medical care. Doctors already refusing to take medicare patients as it is.

    also stop quoting cliche criticism about "jobs bill should have been priority" crap. Obama passed recovery bill of 2009 and smaller job bill of 2010.

    who are you to tell 49 million uninsured people that they are not priority to the country compared to 14 million unemployed people?

  • square1 on December 01, 2011 1:06 AM:

    Sorry, Doug. You are simply wrong.

    Not only was it pointed out, at the time, that the stimulus was too small, but it was pointed out that it was too heavily weighted towards tax cuts and non-immediate spending. The Condi-esque whine that "nobody could have predicted" that the stimulus wouldn't fully work is flat out nonsense. The White House chose to simply ignore the critics.

    You make the preposterous suggestion that we had to wait until the Summer of 2011 -- a period of over 2 years -- before there were economic metrics that told us that the stimulus was insufficient. Please. We had sustained unemployment above 9% during this time. The American people knew the economic problems weren't solved. Too bad you couldn't figure it out. You must work on Wall Street or in D.C.

    Furthermore, you completely ignore all the non-legislative powers that the President had at his disposal to fix the economy. Including properly administering the HAMP program, which has been a complete disaster. And you ignore what the administration could have done on prosecuting securities fraud on Wall Street.

    Bottom line, Obama should have focused more on economic and financial issues in the first two years. Had he done so, the Democrats likely would have kept the House, the economy would be better now, and we could have passed a better HCR bill later.

  • square1 on December 01, 2011 1:23 AM:


    You appear to have a reading comprehension problem. It isn't about what I want. I was explaining why ACA isn't more popular.

    Is it good that there will now be fewer uninsured people who had pre-existing conditions? Generally, yes. And I'm sure many of those people will be thankful and support ACA. The problem is that that is a minority of Americans.

    For most people, ACA hasn't even done anything yet. Certainly their insurance premiums haven't gone down. Nor is there any reason that they will ever go down.

    1 you don't think this bill is not that good even though it will gives more than 20% of Americans insurances.

    It doesn't "give them" insurance. In large part it simply mandates that they purchase insurance. That doesn't really help people who are uninsured because they cannot afford the insurance. Will there be some subsidies? Yes. But, as we all know, as insurance premiums will continue to rise, but the subsidies won't.

    What the fuck do you plan on telling people they should do when they can't afford insurance premiums and Republicans in Congress refuse to increase the subsidies?

    Candidate Obama opposed universal coverage by individual mandate on the campaign trail. He pointed out that it is like trying to solve homelessness by simply passing a law that says that people must buy houses. He was right then. He is wrong now.

    2 you would want to believe that Obama couldn't pass a major medical cost containment bill simply because he was working with corrupt insurance companies.

    First off, insurance companies aren't corrupt. Politicians are corrupt. Second, yes, that is exactly what I believe. I believe that because, as soon as the President was sworn in, he immediately met secretly with industry lobbyists and cut secret deals.

    There is nothing "hard" about cost containment. The only "hard" part is telling some of the people who have been getting fat and rich off of the waste in the system that they will no longer be making billions of dollars. That is "hard" when they are campaign contributors.

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