David M Rothschild on Posted on

The media narrative around the Affordable Care Act, also known as Obamacare, is badly misleading. If we were to believe that narrative, Obamacare is unpopular. This is true insofar as more people say they do not support it than support it. But, some people do not support it because it does not go far enough in providing a public option or universal health insurance coverage; more people support Obamacare or a more comprehensive system than oppose the law. More importantly, there is overwhelming support for Obamacare’s coverage expansions, even if people have a negative feeling towards the moniker. The narrative should read that there is a great hunger for the expanded health insurance coverage of Obamacare (footnote: Democrats bad at branding and messaging).

This article relies on the results from the latest PredictWise/Pollfish Poll from November 28, 2016. We collect the data via smartphone, with Pollfish. More on a methodology and complete results here.

As expected, our poll finds that people do not support Obamacare by name. When asked, “How do you feel about Affordable Care Act (aka Obamacare)”: 44 percent are in favor, 49 percent oppose, and 7 percent do not know. With Trump promising repeatedly to “repeal and replace” Obamacare, it’s not surprising that the public is generally warm to his healthcare “plan”. When asked “How do you feel about Trump’s healthcare policy?”: 50 percent are in favor, 25 percent oppose, and 25 percent do not know. This support comes despite the vagueness of Trump’s replacement plan. On occasion, Trump has pledged a full repeal of Obamacare, while at other times he has promised to retain two of the law’s most popular aspects: allowing children to stay on their parents’ plan until 26 (79 percent support), and ensuring coverage for people with pre-existing conditions (72 percent support). He is also under pressure from Republicans in Congress to cut the healthcare coverage that the Federal Government provides. That Trump will likely nominate Tom Price for secretary of Health and Human Services suggests that his administration might be heading towards a full repeal.

But it is not just Trump’s two favorite aspects of Obamacare that are incredibly popular. 75 percent of voters support requiring insurers to cover birth control, 78 percent support the expansion of Medicaid to families making less than 1.4 times the federal poverty line. It is this expansion that really has accounted for the big drop in uninsured Americans, as it covers the 15 million Americans through the Medicaid expansion, who earn too much to be eligible for traditional Medicaid but not enough to qualify for Obamacare subsidies.

These policies are popular with Trump supporters as well, with at least 65 percent supporting each. While Congressman Price’s plan includes some coverage for people with pre-existing conditions, it drops this popular Medicaid expansion, even though it has been implemented by Republican Indiana governor (and current Vice-President-Elect) Mike Pence, in his own state Indiana

The emergency room has always been the American alternative to comprehensive coverage. A full 90 percent of voters believe that hospitals should be required to provide emergency care to those without health insurance. However, this policy comes at a significant cost; emergency healthcare is both more expensive and less effective than preventative care, and a massive amount of money is wasted trying to collect payment from patients. The public has no appetite for people being left on the hospital stoop to die, so someone ends up paying for coverage. In today’s political climate, this means either forcing people to get insurance, or the having the Federal Government reimburse hospitals for expensive emergency care.

Voters do not like the idea of requiring people to carry health insurance: 73 percent oppose it while only 23 percent support it. But, forcing younger, healthier people onto the insurance exchanges is what keeps costs down for sicker and older people.

This deep dive into our polling data shows that people are demanding the impossible: cheap, comprehensive health insurance that they can purchase only when they need it. Unable to accomplish universal health insurance, Democrats took the unpopular step of mandating health insurance because they recognized it was necessary for the marketplaces to function. To date, Republicans have avoided making explicit how they will negotiate the popular and unpopular provisions of Obamacare, preferring to promise, in Trump’s words, “something terrific”. Now that they have full control of the Presidency and Congress, Republicans have tough choices to make. The majority of Americans might support Trump’s healthcare plan now; do not be surprised if that changes quickly when they find out how much they actually like Obamacare!

Tobias Konitzer is a PhD candidate in communication at Stanford University. Find him on Twitter @KonitzerTobias.

Sam Corbett-Davies is a PhD candidate at Stanford University in computer science. Find him on Twitter @scorbettdavies.

David Rothschild is an economist at Microsoft Research. Find him on Twitter @DavMicRot.