Health Care Law Still on Trial in the Court of Public Opinion

Today, the Supreme Court ruled the Patient Protection and Affordable Care Act (ACA or ObamaCare)'s individual mandate can stand as a tax, thereby judging it constitutional. Chief Justice John Roberts was the swing vote in the 5-4 ruling. In stark contrast, polls have found consistent opposition to the law and public skepticism of its constitutionality.

A Fox News poll in early June found that 59 percent believe the individual mandate, if not the whole law, is unconstitutional. This is largely unchanged from a March Reason-Rupe poll which found 62 percent believe it is unconstitutional for Congress to require Americans to have health insurance. According to the same Fox News poll, 60 percent of Americans believe the federal government's forcing Americans to buy health insurance is a violation of individual rights protected by the Constitution.

According to the March Reason-Rupe poll, the more people know about the health care law, the more likely they are to oppose it. Intensity is clearly against the law, among those who say they know most about the law, 70 percent have an unfavorable view of it, 29 percent have a favorable view of it.

A series of New York Times/CBS News polls find consistent opposition to the law. Soon after the law was passed in 2010, 53 percent disproved of the health care law, and 32 percent approved. Public sentiment has remained consistently opposed; the most recent poll conducted May 31-June 3rd of this year found 48 percent disapprove and 34 percent approve of the law.

 

An additional hurdle for the law will be public reaction to the law's unintended consequences, for instance the likely steep increases in health insurance premiums, rationing, etc. Even Affordable Care Act chief architect Jonathan Gruber is backtracking on an earlier analysis, now saying individuals will experience dramatic premium increases.

Fifty-four percent of Americans expect the new health care law to result in rationing of the kind recess-appointed Medicare chief Donald Berwick thinks should be in place. For instance, in an his 1996 co-authored book, Berwick writes one of "the primary functions" of health regulation is "to constrain decentralized, individual decision making" and "to weigh public welfare against the choices of private consumers."

The public reaction to unintended consequences stands to undermine even the more popular aspects of the law. For instance, although a majority of Americans (52 percent) favor the ACA's community rating provision, which prohibits health insurance companies from charging different premiums based on medical history, support for this provision declines if it were to result in higher taxes (support drops to 37 percent), higher premiums (support drops to 38 percent), and longer wait times to see a specialist (41 percent).  Most dramatically, however, opposition skyrockets to 76 percent against the community rating provision if it were to result in lower quality health care.

According to the same March Reason-Rupe poll, 47 percent of Americans believe the employer mandate will lead to worker lay-offs and 58 percent think it will cause employers to pay their workers less.

In sum, although the health care law survived the Supreme Court ruling, it may have greater difficulty in the court of public opinion. The potential for lower quality care, higher premiums, longer wait times, rationing, and other unintended consequences may create additional obstacles for those who wish to continue reform in the direction of the ACA.

Emily Ekins is the director of polling for Reason Foundation where she leads the Reason-Rupe public opinion research project, launched in 2011. Follow her on Twitter @emilyekins.