What the public knows

On the day the new health insurance exchanges made their debut in states across the USA, the public remains thoroughly confused about what the new health care law means. Teaching courses on health care reform, policy analysis, and health care in popular culture to savvy undergrads provides me with a small army of astute health care observers. Yesterday, six of my students shared the following video from Jimmy Kimmel with me:

The interviews presented in the video underscore the political problem facing the ACA. People’s views on health care reflect their partisan loyalties, ideology, and level of information. Most Americans still don’t understand the complexities of the law, how it will affect them, and what it means for the country. This is not simply a result of “misinformation” campaigns by opponents, although it’s clear that individuals’ perceptions of the law are shaped by their views of the President. Recent polls, however, suggest that “ObamaCare” can also have a positive impact on public perceptions, depending on whether respondents live in traditionally “red” or “blue” states. Support for the ACA/Obamacare, therefore, will remain mixed for the foreseeable future, and will vary widely from state to state. To change this state of affairs, supporters of reform must tell a new policy story that can bridge the gap between the insured and uninsured, and between businesses and employees. The rhetoric about health care reform continues to divide us, rather than bring us together. 

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Trust in government and health care reform

Public support for the Affordable Care Act (“ObamaCare”) is at an all time low, even as federal and state officials scramble to prepare the law’s new health insurance exchanges to enroll millions of new consumers this fall. The Kaiser Family Foundation’s April 2013 Health Tracking Poll revealed that only 35% of Americans hold “favorable” views of the ACA, compared to 42% who continue to oppose the law.

The ACA has a growing PR problem. Most Americans neither like nor understand the law’s goals or requirements. The Obama administration continues to pitch the benefits of the ACA in public events around the nation, but Americans aren’t buying the notion. Indeed, support for the ACA has steadily eroded since November 2012 (43% favorable) to 35% today. Supporters of the law hold Republicans responsible for its continued unpopularity, but there’s more here than meets the eye.

Officials are now preoccupied with the nitty gritty details of policy implementation – signing up insurers, designing web sites, and educating the public about the new coverage requirements, penalties, and options for purchasing subsidized insurance. This is a major undertaking, but the Obama administration and supporters of the ACA face a much larger challenge than simply ensuring that the exchanges work as intended. The future of the ACA, and of efforts to expand health insurance coverage to millions of uninsured Americans, ultimately rests on the ability of the president to restore faith in public authority. Recent scandals with the IRS and NSA monitoring of phone calls and emails did little to help matters on this front, but the issue is not new. The most recent Wall Street Journal/NBC News poll in early June found that Americans were evenly divided (48% yes, 48% no) on the question of whether “Government is doing too many things better left to businesses and individuals.”  Seen in this context, weakening public support for the ACA is a symptom of declining trust in government and diminished confidence that government should take on new or expanded roles in the economy. Since less than a third of the public was “generally optimistic” about “our system of government and how well it works” in the most recent NBC News/WSJ poll, the burden of proof rests with the Obama administration to make the case to the public that health care reform is not only in the public’s interest, but that government – not the private sector – is best suited to handle the task. As I argued in the conclusion to Cries of Crisis, “the success of health care reform depends upon the ability of policy makers to convince a skeptical public that progress is not only possible, but also consistent with American ideals. Reformers must persuade Americans to suspend their doubts, if not outright hostility, towards government.” Until then, the future of the ACA rests on shaky ground.