A comprehensive analysis of data from 27 public opinion polls conducted by 14 organizations, including a poll in September of those most likely to vote, shows an electorate polarized by political party when it comes to the Affordable Care Act (ACA). A majority of Republican likely voters want the next Congress to repeal the law (56%), with an additional 27% favoring scaling it back. In contrast, a majority of Democratic voters want the new Congress to move ahead with the law (74%), either by implementing the current law (30%) or expanding its scope (44%). Independent likely voters fall in between, with 34% favoring repealing the law, 27% scaling it back, 8% implementing the current law, and 26% expanding it.
"The intensity of partisan feeling about the ACA in this election could make the next phase of its implementation a very contentious issue in the next Congress," said Robert Blendon, professor of health policy and political analysis at Harvard School of Public Health and co-author of the analysis that appears as an online Special Report on October 29, 2014, in the New England Journal of Medicine.
The polling results not only show health care as the third-ranked issue in this election, but also portray a number of other striking findings. Despite millions of Americans who were uninsured now receiving coverage under the ACA, public approval of the ACA has not improved since it was enacted four years ago. Only a minority of Americans approve of either the ACA or President Obama's handling of health care policy.
In addition, the polling analysis shows that there has been a cultural shift among many Americans toward a key principle behind the ACA. In 2007, during the presidential primaries, public support for the view that the federal government has responsibility to make sure all Americans have health insurance coverage was at 64%. In 2014 this figure has declined to 47%, and it is even lower among likely voters (41%). Of importance for the election outcome, support for the principle of universal coverage was 70% among Democratic likely voters and 12% among Republicans.
"The polling results point clearly to why the election outcome will matter for the ACA," said Blendon. "Democrats, were they to be in the majority in Congress, would reflect the views of their party's voters in favor of moving ahead with the implementation of the law, with a high priority on achieving universal coverage. With Republicans in the majority, they would see repealing or scaling back the ACA as reflecting the views of their core voters. In addition, they would likely place a lower priority than Democrats on achieving universal coverage the upcoming congressional term."