During the year-long debate on health reform, public opinion polls seemed to show a volatile and divided American population. However, a closer examination of these polls and other surveys shows well-established patterns in public opinion that played out in this debate as they have in other debates, according to the study, Liking the Pieces, Not the Package: Contradictions in Public Opinion During Health Reform, published in the June 2010 issue of Health Affairs.
The study showed that while there was majority support for reforming the health care system, opinions did fluctuate on various aspects of the legislation. This mainly happened when individuals recognized that they would be impacted in some way. As the government goes forward with implementation of the Patient Protection and Affordable Care Act, the public's judgment of the law is likely to be based less on political debate, and more on perceived impacts at the personal level as implementation proceeds, according to the researchers.
The study identified several long-standing attributes of public opinion and how they played out during the health reform debate, as follows:
Competing Issues. During the health reform debate, it was easy to forget that health reform is only one of the issues that the public cares about. Following the 2008 election, health care (43%) trailed the economy (73%) and terrorism (48%) as top priorities.
Partisan Contradictions. Public opinion polls throughout the health reform debate show that American's views on health reform were sharply divided by party identification. A poll taken right before the legislation passed found that 75% of Democrats supported the bill, while 80% of Republicans opposed it. However, the study noted that these partisan divisions are nothing new. Polls taken during the 1993-94 health reform debate found that not only were Republicans the least likely to favor the Clinton plan, but they also were the least likely to believe that the health care system needed comprehensive reform.
Persistent Support For Health Reform. Historically, the study noted that Americans have favored addressing problems in the health care system since the mid-1980s. In October 1986, 66% of the public supported completely rebuilding or making major changes to the existing health care system. During the current debate, 54% of the public in January 2010 agreed that economic circumstances made it more important than ever to take on health reform.
Reform Components. The week of the final vote on the Affordable Care Act a poll found that 48% were opposed to the legislation as a whole, 37% were in favor, and 15% were still undecided. However, many were in favor of certain components of the law, such as health insurance reforms (76% said this was "extremely" or "very" important), tax credits for small businesses (72%), and helping close the Medicare drug coverage donut hole (71%).
Personal Impact. The study found that in both the Clinton and Obama health reform debates, Americans were unclear about how reform would affect their families. As the debate progressed, opponents tapped into fears and anxieties about how the proposed solutions might change the status quo, and people became increasingly negative about the perceived personal impact. During the Obama reform effort, those individuals not expecting that health reform would affect their family fell from 43% to 28% over the course of the debate, while those expecting to be harmed increased (from 11% to 32%), and those individuals who expected to benefit from the reforms hovered around 35%.
The study was based on more than fifty nationally representative public opinion polls that have been conducted since 1943. For more information, visit http://www.healthaffairs.org.
For a comprehensive analysis of the Patient Protection and Affordable Care Act, and additional information on health reform and other developments in employee benefits, just click here.
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