The US healthcare paradox: we like the Affordable Care Act but fear Obamacare | Harry J Enten

No wonder Republicans can campaign against the ACA when a plurality of Americans still believes it includes ‘death panels’

President Obama’s healthcare law is hated and loved by some so much that they are willing to shut down the government over it. I’m not sure I’ve ever seen so much passion over an issue about which so few (myself included) know as much as we should.

I wrote about this divide when Obamacare was in front of the US supreme court. Americans were opposed to “Obamacare”, or the Affordable Care Act, yet they were in favor of many of its provisions. Not surprisingly, Americans lacked knowledge of what exactly the law did.

So, as the political fight has intensified, on the eve of implementation of one of the ACA’s key provisions, the creation of new health insurance pools, how much has changed? Does the noisy debate on the ACA mean Americans are better-informed than before about Obamacare? Here are five ways Americans’ opinions about Obamacare have and have not evolved over the past year.

1. Americans have grown more negative in their views

The HuffPollster chart tells the story fairly well. It includes polls that ask about Obamacare and the Affordable Care Act (ACA).

Last June, the split was about 47% opposed to, and 40% in favor of, Obamacare. That gap narrowed, after the supreme court upheld the law’s constitutionality. The difference between those for and against the law dropped to only 2pt by the election.

Since the election, however, US public opinion has changed drastically: 52% of Americans now oppose Obamacare – that’s tied at the record high. A little less than 38% are in favor of it, according to the HuffPollster aggregate.

2. The Obamacare v the Affordable Care Act difference still exists, though may be overblown

A few weeks ago, a CNBC poll purported to show major differences when asked about the law in different manners: 46% were against Obamacare, while only 37% were opposed to the ACA. Importantly, support for the healthcare law also dropped from 29% to 22%. What’s happening is that Americans have heard a lot about “Obamacare”, but not much about the ACA. The key is the difference between those who favor and those who oppose for each question, which is about 15pt.

Most of the polls that show the best numbers for Obamacare (that is, the margin of opposition at 10pt or less) don’t mention Obama’s name. These include the Kaiser and ABC/Washington Post surveys. A Fox News poll found the gap was slightly wider, with the margin between favorable and unfavorable towards Obamacare at 26pt, and just 16pt for the ACA. Some, such as the UConn/Hartford Courant poll, use similar wording and find the largest gaps.

The bottom line is that many Americans oppose Obamacare no matter the wording. But Obama’s name probably makes them even less likely to like it.

3. There is a percentage of Americans who oppose the law for not going far enough, though this, too, is likely overblown

Democrats like to point out that even as a majority opposes Obamacare, a certain percentage of Americans think it’s because the law is “not liberal enough”. A new CNN poll puts that percentage at 11%. When you add those who favor Obamacare to those who regard it as “not liberal enough”, you have a near-majority.

The problem with this finding is that I don’t believe that Americans necessarily know what “too liberal” means in this context. My evidence for that is that the group with the highest percentage of those who say they are against the law because it is “too liberal” are, in fact, Republicans.

The actual percentage who don’t like Obamacare because it’s not liberal enough is probably closer to 7%, if not lower. That’s the percentage Kaiser found when they asked if Obamacare went “far enough” in changing the healthcare system. I caution, however, that some of that may be those who want radical conservative change – such as yearning for government to get completely out of healthcare.

4. Americans continue to like the individual provisions, except for the individual mandate

While only 37% of Americans viewed the ACA favorably in a March 2013 Kaiser poll, most liked what the healthcare bill is scheduled to do. Over 55%, and up to 88%, of Americans regard the following facets of Obamacare at least somewhat favorably: tax credits to small businesses to buy insurance, closing the Medicare “doughnut hole”, creating insurance exchanges, giving rebates to customers of insurance customers that spend too much on administrative costs, and the employer mandate. Even Republicans like all of them except the Medicaid expansion, increase in Medicare tax, employer mandate, and individual mandate.

Indeed, the only requirement of Obamacare most people didn’t like was the mandate for all people to join it.

5. Americans still don’t seem to know what Obamacare means for them

Given the discordance between Americans’ feelings on the individual parts of Obamacare and the law as a whole, it’s not that surprising that a striking 41% of Americans don’t feel they have enough information about the ACA, per the UConn/Hartford survey. Only 19% say they are very familiar with the law.

The individual provision questions strike the same chord. More than a third of people are unaware of the health insurance exchanges, subsidy assistance to individuals, or the Medicaid expansion. The latter two provisions of the law have actually seen a decrease in the percentage of people who knew these policies were in the bill, since it first passed. The only part of Obamacare that Americans seem to know really well is the individual mandate, which has also seen the largest percentage-point increase in awareness.

More worryingly, more people than not thought that Obamacare includes a public option, undocumented immigrant insurance, “death panels”, and cuts to Medicare. The Affordable Care Act contains none of these.

The fact is most of Obamacare is liked by the public. The issue is that the provision that is not liked is the best-known.

Conclusion: Americans are confused on Obamacare

There are lots of confused and confusing data here, and it’s difficult to say anything definitive about how Americans feel about the healthcare law signed by President Obama in 2010. As I found more than a year ago, they don’t like the law overall, even while they approve many of its measures.

Some Democrats may say that this points in their favor, but the same dynamic of a differential between the backing people will give for a broad proposition as opposed to their support for individual policies could be said to operate in the case of gun control. Thus two Colorado state senators were recently recalled over a gun control law whose individual provisions many said they liked.

Overall, Americans clearly don’t know enough about Obamacare. Of course, they know just as little about the Affordable Care Act – but to the extent that they are less hostile to a law that doesn’t bear President Obama’s name, it does appear that the embrace of the term “Obamacare” by Democrats and the White House was a tactic that has not worked out.

Harry J Enten

GOP governors are reading the polls on whether to support Medicaid expansion | Harry J Enten

GOP governors are divided over what to do about Medicaid expansion, but their actions thus far line up with poll data

Republican governors across the US are split on whether to accept additional federal funding to expand Medicaid. Some such as New Jersey Governor Chris Christie and Florida Governor Rick Scott have said yes in order to get more federal dollars, while Indiana Governor Mike Pence and Wisconsin Governor Scott Walker have declined. Why? From a public opinion standpoint, Republicans face a catch-22: the majority of Americans want the expansion, but the Republican base doesn’t.

Per a January Kaiser poll, 52% of Americans believe the Medicaid expansion should go into effect vs. the 42% who think Medicaid should be kept the way it is. That’s far more popular than the 2010 Patient Protection and Affordable Care Act at large, which 52% of Americans want to try to change or stop to ensure it has “less impact on taxpayers, employers, and health care providers”.

When we expand it to the state level, the polling picture looks similar. The percentage of adults who believe Medicaid should be expanded after being told the state would have to pay 10% of the cost after three years is 54% in Arkansas, 62% in Florida, 51% in Kansas, and 55% in Texas. Perhaps most impressive is Iowa where more adults believe that the state should opt-in on the expansion even after being presented with Republican Governor Terry Branstad’s arguments against it.

The issue for Republican governors is that the Republican base just doesn’t agree. In the national Kaiser poll, only 16% of Republicans believe expanding Medicaid should be a “top” priority, and a mere 23% of Republicans believe that Medicaid expansion should be done at all.

The same holds on the state level. In Florida support from Republicans is 25 points lower than it is for the public at large. In the blue state of New Jersey, only two-fifth’s of Republicans like Medicaid expansion. In the swing state of Iowa, nearly four-fifth’s of GOP voters agree with Governor Branstad’s arguments against the exchange.

The result of these competing factions is a bunch of Republican governors don’t know what to do. Republicans know that the majority of the public thinks they are too extreme and unwilling to compromise. The last thing they need to do for their re-election efforts is to oppose a program that seems to be popular with the residents of their states. That’s especially the case governors with low approval ratings in purple states like Rick Scott.

At the same time, Republican governors know that conservative voters have shown very little restraint in taking out Republicans who don’t toe the party line. Former Florida Governor Charlie Crist hugged President Obama, which was the picture in the opening ad for the insurgent run for senate of Marco Rubio. Long-time Indiana Senator Dick Lugar was apparently too nice to Obama, so he received a successful primary challenge in 2012.

The same pattern seems to be occurring to Chris Christie in New Jersey and Rick Scott in Florida. Conservatives refused to invite Christie to CPAC, despite the fact that he is arguably the most conservative elected New Jersey governor in an incalculable number of years. A CPAC insider said Christie’s future role in the national Republican Party is “limited”. Christie’s exclusion is no doubt because of a number of factors such as gun control and his post-Sandy Obama love, but few would doubt that the Medicaid expansion played a roll.

Meanwhile members of Governor Scott’s own cabinet have called his move on medicaid “surrender”. Florida Attorney General Pam Bondi opposed the move and has been polled as a potential primary challenge to Scott. That’s right, there’s some chatter that Rick Scott ,who is one of the most conservative governors in the nation, might face a primary challenge.

To add to the intra-party squabbles, the normally Republican and high donation giver Hospital Associations are fearful of losing money if the Medicaid expansion is not taken by governors. They have lobbied hard. No doubt Rick Scott, a former hospital executive, was at least partially swayed by them. Most other conservative groups are, like most Republicans, against the Medicaid growth.

So what is a Republican governor to do from a re-election angle? If you’re in a deep red state, oppose the expansion. It’s doubtful that a deep red state will support a Democratic governor over this one issue. You’ll only increase the chance of a primary challenge. If you’re in a purple or blue one and potentially vulnerable for re-election, support it. You’ll get money help from the Hospital Associations to help in the primary and general elections. You also don’t want to be seen in the same lens of a national party that is already facing quite low approval ratings.

Harry J Enten

How the fate of gun control is tied to presidential popularity | Harry J Enten

Polling shows that Obama’s approval rating is closely correlated with opinion on gun control. That suggests trouble ahead

Want to know how people feel about President Obama’s gun control plan?

Simply ask whether they approve or disapprove of how the president and his administration are doing their job. The two questions are nearly perfectly linked, and that could have major consequences for the future of gun control legislation.

The latest ABC/Washington Post polls prove the strong relationship. Many individual gun proposals are highly popular. In fact, seven tested gun measures, including background checks and bans on assault weapons and semi-automatic handguns, have majority support ranging from 51% to 88%.

When you attach Obama’s name by calling it “Barack Obama’s proposals”, the Post discovered that 53% of Americans favor the proposals – nearly identical to Obama’s approval rating of 55% in a separate Post poll last week. Gallup found the same, with 53% in favor of Obama’s gun control plan, compared to his monthly approval rating of 52%.

Drill down to specific demographics and the link between approval of the gun plan and approval of Obama’s administration becomes even clearer. Neither the Post nor Gallup asked about the plan or Obama’s approval in the same poll. The Post did, however, enquire about Joe Biden’s favorability. Biden’s net favorable of +11 percentage points is very close to Obama’s net approval rating of +14pt from the prior poll, meaning that the two are closely correlated.

[Note: we test Biden because we are examining small sub-samples and the sampling error on margins (for example, for favorable minus unfavorable) of less than 350 people is about 10pt or greater, which makes comparing different poll sub-samples difficult. By restricting ourselves to the same sample of people, as we can with Biden's favorables and the gun package, we can compare the answers among the exact same group of respondents.]

Among the 24 subgroups tested, the correlation between a subgroup’s opinion towards Joe Biden and Obama’s gun plan is 0.98 – nearly perfect. Moreoever, 95% of the differences in subgroup net favorables on Obama’s gun plan are predicted by their respective opinions of Biden. You rarely see two variables this closely linked. That’s even higher than the strong explanatory power that evangelical voting had in forecasting the Republican primary.

The median difference between a group’s opinion towards Biden versus Obama’s gun package is 2pt, which matches the 1pt difference between favorability for Biden and Obama’s gun control package overall. That’s ridiculously small. It means that if a respondent liked Biden, who substitutes for the administration, then the person liked the gun plan. Among independent voters, Biden’s net favorable is +5pt, and the net favorable impression of Obama’s plan is +7pt. Republican responders register -51pt net favorables for both. Among region, the median difference is only 3pt. Biden, for example, had a net favorable of +12pt in the south, while Obama’s gun plan had a favorable of +10pt. In the battleground of the midwest, Biden stood at +4pt and Obama’s gun plan was at +5pt net favorable.

So much for the correlation, but what does it mean for the future of gun control legislation?

In short, it means the gun control debate is likely heading in the direction of healthcare. In that political fight, as with this one, individual proposals polled well, but attaching Obama’s name to a proposal polarized opinion.

The key difference this time is that the net approval for Obama and his administration is about 14pt higher than it was when the healthcare bill passed in March 2010. That’s at least part of the reason why Obama’s gun safety proposals are polling much higher than his healthcare reform bill did three years ago.

This is also the main explanation for why President Obama’s gun plan is doing fairly well among independents and southerners. Obama lost both groups in the 2012 election, yet his post-election bounce has temporarily endeared him to them.

The chances are that he can’t maintain this surge in popularity, as most second-term bounces don’t last as long as the first-term ones. Obama will likely maintain a positive net approval overall, but not among certain subgroups. If his subgroup approval eventually matches his election margins, then he’ll start to show negative numbers among independents and southerners.

The question, then, is whether the high correlation between support for Obama’s administration and its gun policy signals that support for gun control is also poised to drop. It makes sense that it would. I’d also anticipate that this drop will be among the same subgroups as for Obama’s overall approval. That’ll mean that the current support for the gun plan among independents and southerners goes up in smoke.

Many House representatives up for re-election in 2014 are likely aware of the relationship between Obama’s gun proposals and his approval. Right now, that’s not an issue, but a fall in Obama’s approval would make this high correlation a problem. I don’t believe that legislators from areas where Obama’s approval is negative would want to be associated with a bill whose popularity is tied directly to presidential ratings. I’m talking about senators from red states who are committed to opposition, or waffling, on gun control – like Max Baucus, Mark Begich, Tim Johnson, Mary Landrieu, Mark Pryor, and, to a lesser extent, Kay Hagan.

So, we shouldn’t be surprised by a decline in support for Obama’s gun control package, nor by more obfuscation from vulnerable Democrats, who want to tread very carefully on guns. This doesn’t mean any gun package is over before it’s begun. Universal background checks, which are supported by about 90% of the public, seem to be picking up some steam.

But gun control legislation, on the whole, will be difficult to pass – and not just on the face of the proposals, but because red state legislators facing re-election simply won’t want to be associated a bill so closely tied to the popularity of President Obama.

Harry J Enten

Margin of Σrror

Category Archives: US healthcare

The US healthcare paradox: we like the Affordable Care Act but fear Obamacare | Harry J Enten

GOP governors are reading the polls on whether to support Medicaid expansion | Harry J Enten

How the fate of gun control is tied to presidential popularity | Harry J Enten