5 Charts About Public Opinion on the Affordable Care Act

Note: Figure 1 and the text related to it were updated on November 28, 2023, to include more recent polling data.

#1: Attitudes Toward the ACA Are Divided; More Favorable Than Unfavorable Since 2017

Public opinion of the Affordable Care Act (ACA) has been largely divided along partisan lines since the law was passed in 2010. Following Republican efforts to repeal the ACA in the summer of 2017, KFF Health Tracking Polls found a slight uptick in overall favorability towards the law, and since then a somewhat larger share has held a favorable than an unfavorable view. The most recent KFF Tracking Poll conducted in May 2023 found slightly more than half of the public (59%) hold a favorable opinion of the ACA while about four in ten (41%) hold a negative opinion of the law. Views of the ACA are still largely driven by partisanship: nearly nine in ten Democrats (89%) along with six in ten independents (62%) view the law favorably, while nearly three quarters of Republicans (73%) hold unfavorable views. Explore more demographic breakdowns using our ACA interactive.

#2: Pre-Existing Condition Protections Are Some Of The More Popular ACA Provisions

Over the past decade, the ACA has been the subject of both legal challenges as well as Congressional actions aimed at overturning the 2010 health care law. While the law is not overwhelmingly popular among the public, no replacement plan has garnered significant support from the public. This may be due to the fact that many of the specific provisions included in the law are popular and the public would like for them to remain – even if the entire ACA is overturned. For example, the 2020 Texas v. California case challenged the legality of the individual mandate and brought special attention to the law’s protections for people with pre-existing medical conditions. These provisions prohibit insurance companies from denying coverage based on a person’s medical history (known as guaranteed issue) and prohibit insurance companies from charging those with pre-existing conditions more for coverage (known as community rating). The July 2019 KFF Health Tracking Poll found that a majority of the public says it is very important for many of the ACA provisions to be kept in place, including the guaranteed issue provision (72%) and community rating (64%). While partisans are divided over the importance of keeping many provisions of the ACA in place, majorities of Democrats, Republicans, and independents say it is “very important” to continue each of these protections for people with pre-existing conditions. In addition, few Republicans, Democrats, and independents said they wanted the Supreme Court to overturn these protections.

#3: Pre-Existing Condition Protections Affect Large Shares Of The Public

One reason why majorities across partisans may support the ACA’s protections for people with pre-existing medical conditions is that larger shares of the pubic, regardless of age, gender, racial or ethnic identity, and income report having someone with a pre-existing condition in their household A KFF analysis estimates that 27% of adults ages 18-64 have a pre-existing condition that would have led to a denial of insurance in the individual market prior to the implementation of the ACA. An even larger share of the public believes they or someone in their family may belong in this category. According to the KFF polling data from 2020, about half of the public say they or someone in their household suffers from a pre-existing medical condition, such as asthma, diabetes, or high blood pressure.1

#4: Those Who Say ACA Has Helped Them Cite Increasing Access

Twelve years after the ACA’s passing, about a quarter of the public say the ACA has helped them and their family in some way, while one in five say the law has hurt them. About half of those who say the ACA helped them say allowing someone in their family to get or keep their health coverage has been the main way the health care law has helped them (48%, or 12% of total adults). Three in ten say the law has made it easier for them to get the health care they need (7% of total) and one in five say it has lowered the cost of their health care or health insurance (5% of total).

#5 Those Who Say ACA Has Hurt Them Cite Costs

Among the one in five U.S. adults who say the ACA has hurt them and their families, most say the law has increased costs of health care or health insurance (59%, 12% of total). Smaller shares say it has made it more difficult to access care (22%, 5% of total), or caused someone in their family to lose coverage (11%, 2% of total). The high costs of health care in this country continue to be a major burden for many families.

  1. This estimate is a household measure of all groups and does not classify pre-existing conditions by whether they are or not a “deniable” condition.

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