5 Charts About Public Opinion on the Affordable Care Act
#1: Attitudes Toward the ACA Continue to Be More Favorable than Unfavorable, Divided Among Partisans
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 show an uptick in overall favorability towards the law, and since then, a larger share has held a favorable than an unfavorable view. The February 2024 Health Tracking Poll shows that about six in ten U.S. adults (59%) hold a favorable opinion of the ACA while about four in ten (39%) hold a negative opinion of the law. Views of the ACA are still largely driven by partisanship; nearly nine in ten Democrats (87%) along with over half of independents (55%) view the law favorably, while about two thirds of Republicans (67%) hold unfavorable views. Explore more demographic breakdowns using KFF’s interactive: The Public’s Views on the ACA.
#2: Pre-Existing Condition Protections Are Some of the More Popular ACA Provisions
The ACA has been the subject of both legal challenges and Congressional actions aimed at overturning the 2010 health care law. However, many of the specific provisions included in the law are popular and the public would like them to remain.
For example, the 2020 California v. Texas 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). As of February 2024, two-thirds of the public say it is “very important” for the guaranteed issue (67%) and community rating (65%) provisions to remain law, including majorities of Democrats and independents. About half of Republicans say each of these protections for people with pre-existing conditions are “very important.” Historically, majorities also say it is very important for many of the other ACA provisions to be kept in place, even if the Supreme Court ruled the ACA unconstitutional and no longer the law of the land.
Though majorities say it is very important for guaranteed issue to remain law, knowledge that this provision is part of the ACA has dropped over the past 14 years. As of February 2024, about four in ten (39%) adults are aware that the ACA prohibits insurance companies from denying coverage based on a person’s medical history, compared to seven in ten adults in June 2010, shortly after the ACA’s inception.
#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 large shares of the public, 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 the ACA Has Helped Them Cite Increasing Access
KFF polling from March 2022 shows about a quarter of the public says 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).
The February 2024 Health Tracking Poll also reveals four in ten (39%) adults say the ACA has made it easier for people like them to get health insurance, while about one in four (23%) say it has made it more difficult. However this perception varies by partisanship, as Democrats are almost three times as likely as Republicans (60% v. 22%) to say the ACA has helped them in this way.
#5: Those Who Say the 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.