February 22, 2018

Health Affairs Web First: Significant Shifts Detected In Public Opinion About The ACA

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Since the Affordable Care Act (ACA) became law in 2010, Americans have remained deeply divided in their overall assessments of the law and whether it should continue. A new study, being released as a Web First by Health Affairs, compared public opinion about the ACA between 2010 and 2014 and found a significant increase in appreciation for the tangible effects of the law in widening access to health insurance.

The proportion of Americans who believed that reform had little or no impact on access to health insurance or medical care diminished by 18 percentage points from 2010 to 2014, while those who considered reform to have some or a great impact increased by 19 percentage points. (See exhibit below.) The study also found a statistically significant softening of opposition among those who held unfavorable views in 2010. According to the authors, while the ACA’s concrete effects are increasingly recognized (even by Republicans), the toxic political environment continues to split overall evaluations of the law itself.


To compile their study data, the authors, Lawrence R. Jacobs and Suzanne Mettler, tracked respondents’ responses through three waves of a panel study conducted in the fall of 2010, 2012, and 2014. Fifty-five percent (660 out of 1,200 panelists) responded to all three waves.

“The public’s view of health reform is a combination of appreciation of the tangible effects of the ACA and deep reservations about the law flowing from partisan and political distrust,” the authors concluded. “However, the sustained battle over health reform may not preclude incremental changes that advance each party’s agenda within the ACA framework.” Looking ahead, they suggest that “an era of grand vision may transition to one characterized by the slow grind of the legislative process.”

Lawrence is a professor at the University of Minnesota; Mettler is a professor at Cornell University.

This study will also appear in the May issue of Health Affairs.

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