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Public Opinion and the ACA

Posted by John McDonough  December 1, 2011 10:45 PM

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As proof of my hopeless nerdiness, each month I eagerly await the release of the Kaiser Family Foundation’s health tracking survey.  It’s always informative and this month’s is no exception. 

Here’s the eye-popper: one third (35%) of Americans think the Affordable Care Act (ACA) allows a government panel to make decisions about end-of-life care for people on Medicare (another 12% say they don’t know), in other words, death panels.  (For those in need of the truth, please see Politifact.)

Deeper into the survey, there is some important analysis.

As we know, Americans are sharply divided when it comes to the ACA, 44% viewing it unfavorably and 37% viewing it favorably – see the chart below.  The new numbers look better than they did in October, but that’s not saying much at all.   


A5 Unfavorable_Views_Somewhat_Higher_Than_Favorable_Views_in_November.jpg

And yet, we know that many Americans don’t like the ACA, not because it goes too far, but because they believe it does not go far enough.  Persons who oppose the ACA because it is not strong enough don’t have much in common with people who feel it goes too far, yet the above chart lumps them together.  Wouldn’t it be helpful if we could distinguish those two groups? 


Fortunately, the smart folks at Kaiser had the same idea as well.  See this chart below:


A1 Half_Want_Health_Care_Law_Kept_As_Is_Or_Expanded4.jpg So 50% of Americans approve of the ACA or want it strengthened, while 39% percent want it completely repealed or repealed and replaced with something else.  Hmmmm.  And what’s the partisan breakdown of  these four viewpoints?  See below:


A4 Partisan_Divisions_As_To_What_Next_For_Health_Reform3.jpg

So 32% would like the law strengthened and expanded, while 24% would like to see it completely repealed.  18% would like the law kept as is and 15% would like to see the law repealed and replaced with an unstated alternative.  The sharp divide between Republicans and Democrats says a lot about why the politics of this issue are so tough.  I wonder what the numbers would be if people understood that the law does not contain “death panels?” 

Analysis of the ACA which only focuses on favorability/unfavorability -- and which presumes that all the unfavorables feel the ACA goes too far -- is simplistic and masks more than it reveals.

This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »


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