Will Americans Come to Love ObamaCare's Insurance Mandate?


It's conventional wisdom that the individual mandate to purchase health insurance is ObamaCare's biggest public liability: Polls consistently show that large majorities of the public are opposed to it and have been since before the law passed.

But might opposition to the mandate soften in the future? The New Republic's Jonathan Cohn looks at public opinion about the Massachusetts mandate, which has been in effect for several years and is less controversial than its federal cousin, and argues that it might:

In last year's poll by the Boston Globeand Harvard School of Public Health, the most recent comprehensive survey I've found, 51 percent of respondents said they supported the requirement that almost everybody get insurance or pay a fine, while 44 percent said they opposed it. Opposition to the mandate was higher than it had been one year previously, but support for the law as a whole had increased during that span. Sixty-three percent said they supported the Massachusetts scheme, while just 21 percent said they opposed.

Cohn suggests that "there are reasons to think that the mandate would gain public acceptance, or at least become a lot less controversial, if it survives the Supreme Court and congressional Republicans."

Predicting the swings of public opinion in advance is obviously tricky business, so it's possible that opposition to the mandate could slip. But I wouldn't be too confident. There's a big difference between how Massachusetts residents perceived both RomneyCare and its mandate prior to passage and how the U.S. public felt about ObamaCare and its health coverage requirement before it became law: Namely, a majority of Massachusetts residents were in favor of RomneyCare-style health reform and its mandate before it passed. But that's just not true of ObamaCare.

According to a 2008 survey of public opinion about the Massachusetts health law published in Health Affairs, there was "a favorable political environment" in the state before the law was passed. The mandates and expansions of government care that are now driving opposition to the national plan were supported by solid public majorities. In 2003, for example, majorities supported an employer mandate (76 percent), an individual mandate (56 percent), and an expansion of state-run health programs (82 percent). In 2005, the year the bill was passed in the state legislature, the report notes that 66 percent of the state reported supporting a universal coverage ballot initiative. And immediately after passage, before most residents had had the opportunity to interact with the system, support remained high, with 61 percent of state residents supporting the law.

Compared with the Harvard poll Cohn cites, the numbers haven't changed much: Support for the mandate is down by five points since 2003. Support for the law as a whole is up two points since immediately after passage.
That just doesn't match the national mood, where the political environment has consistently been far less favorable to President Obama's health law. Since before the law's passage, more of the public has opposed the law than supported it. Indeed, in the months following the law's passage in 2010, opposition was so strong that several political scientists have reported evidence that it may have cost Democrats as many as 25 seats in the House — and majority control.

Cohn suggests that national feelings about the mandate may evolve to look more like they do in Massachusetts. But I think the more convincing story here is that the public's opinion doesn't change much over time: Massachusetts residents liked their health care law and its mandate prior to passage, and they like it still. If the national polls follow a similar pattern, it's quite possible that Americans will continue to dislike both ObamaCare and its insurance mandate.