The American public appears divided over health care. The puzzling thing about this apparent divide in opinions about health care reform is that people are actually not divided about health care reform. Polls show current disagreement over the Affordable Care Act, despite broad, bipartisan consensus from the public and the major political parties over what should have been in the health care reform legislation. Americans agreed, parties followed, and we got exactly what we wanted.
The Kaiser Family Foundation has a vivid infographic that shows the apparently severe divide in voters’ opinions about the Affordable Care Act (ACA). About 40% current support the law and 40% oppose, with 20% undecided. This means that there is no clear majority opinion. The Kaiser infographic also allows you to break out results by party identification: the result is a clear partisan divide, with Republicans overwhelmingly opposed and Democrats overwhelmingly supportive. These make the facts seem pretty clear, but are they really?
The Kaiser tracking poll data is based upon the following question: “As you may know, a health reform bill was signed into law in 2010. Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?”
A key part of that question is the phrase “given what you know about the health reform law.” Another key piece of evidence offered by Kaiser is data about how well people understand the law. A solid 47% percent of the public says they feel confused about the legislation—that is, more people are confused about the legislation than actually have a positive or negative opinion of it.
What should we make of the polls (like Kaiser’s) that show a large divide in public opinion? One answer is that we shouldn’t make much of those polls at all. It is not the public’s fault that they do not understand the legislation—the Obama administration largely failed to communicate the health care reform plan (either the President’s desired plan or the final plan as written in the ACA and approved by Congress).
The public has largely followed partisan cues about whether or not they should support the legislation. These cues distract from a national consensus about the core policy changes in the ACA. For instance, the 2008 Democratic and Republican health care platforms specifically called for protecting individuals with pre-existing conditions, providing citizens with more information about health care and health insurance, focusing on preventive and integrated care, increased federal funding for medical and public health research, and for creating interstate competition in health care reform. All of these policies are part of the ACA.
The facts of health care reform suggest that if voters learn the fact they might change their opinions about the ACA. Frankly, the public agreed in 2008 that health care reform was necessary.
There are a lot of other changes in the health care reform law, which can distract from the consensus about the core changes. And, there’s been plenty of misinformation floating around in media and political speeches. (More on that in a future post.)
And, of course, there is the individual mandate, which is now being considered by the Supreme Court. The deepest irony of health care reform emerges in this National Public Radio story from the early stages in the 2008 presidential primaries, where Mitt Romney decides not to pursue his innovative, bipartisan plan for a universal health care mandate that was championed when implemented in Massachusetts. Indeed, in 2008 a majority of the public (including majorities of both major political parties), supported the individual mandate.
So why aren’t Americans satisfied with the ACA? And why do we seem so polarized? The answer seems to be a mix of cue-taking from political elites and our own motivated reasoning. Indeed, we take cues from elites because trust and identify with them—strong partisans feel they can trust their party’s leadership to tell them what is right and wrong. When the parties express support or opposition for the ACA, partisans follow suit. We are also motivated to defend our prior opinions. Most people do not know a lot about health care reform; it’s not their fault—politicians and the media did not give us enough information. So, we formed opinions the only way our minds know how: by processing the limited available information, the cues we get from politicians and expert commentators, and then formed a summary evaluation of the legislation. After that, our views of anything new we hear about the law is constrained by what we already think. If we were already opposed, new information only reinforces that opposition. If we were already supportive, the same process is at work.
Opinions seem divided, but that is because polls do not capture the complexity of voters’ understanding of and opinions toward health care reform. The facts are that voters largely agree about the fundamentals of reform, but politicians have prevented the public from seeing the connections between their support for individual parts of the legislation and their broader support for reform. Nearly everyone wanted reform in 2008 and the ACA provided almost everything that voters and parties cited as important (though compromise meant that Republicans did not get tort reform and Democrats did not get a public health care option). The ACA was a bipartisan compromise wrapped in a façade of partisan debate; this has led many people to falsely think that it was the best or worst legislation ever despite their views on individual parts of the reform.
Indeed, the Kaiser infographic that opened this post—which seems to show a sweeping divide in opinions over health care reform—might just as easily be read as the distribution of public opinion that inevitably results from a legislative process where everybody gets some of what they want but loses something else they want in the name of a more important goal: compromise.