#1: Attitudes Toward the ACA Are Divided; Somewhat 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 October 2020 found over half of the public (55%) now hold a favorable opinion of the ACA while about four in ten (39%) hold a negative opinion of the law. Across partisans, over eight in ten Democrats (85%) have a favorable view of the ACA compared to about six in ten independents (59%) and a much smaller share of Republicans (18%). Explore more demographic breakdowns using our ACA interactive.

Figure 1: Clear Majority Of Public View The ACA Favorably

#2: Partisans Are Split On The Supreme Court Overturning The ACA

In June 2020, the Trump administration issued a brief asking the U.S. Supreme Court to overturn the ACA. The brief was filed in support of an ongoing challenge to the ACA by a group of Republican attorneys general in California v. Texas, a case that challenges the legality of the ACA in light of the zeroing out of the individual mandate penalty in the 2017 Tax Cuts and Job Acts. The death of Supreme Court Justice Ruth Bader Ginsburg on September 18 and the possibility of the Senate confirming a new Justice appointed by President Trump before the presidential election has brought heightened attention to the potential outcome of this case and the future of the ACA. In October 2020, a majority (58%) of the public said they do not want to see the Supreme Court overturn the 2010 health care law, and eight in ten (79%) said they do not want to see the ACA’s protections for people with pre-existing conditions overturned. There are partisan differences on both questions, with the majority of Democrats and independents saying they don’t want the Court to overturn the ACA or pre-existing condition protections. However, among Republicans, three-fourths (76%) say they want to see the ACA overturned, but two-thirds say they do not want to see pre-existing condition protections overturned.

Figure 2: Majorities Do Not Want Court To Overturn ACA’s Pre-Existing Condition Protections, Republicans Want Entire Law Overturned

#3: Most Say It Is Important That Pre-Existing Condition Protections Remain In Place if ACA Is Overturned

If the Supreme Court overturns the ACA, a host of provisions could be eliminated, including 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 divide over the importance of keeping many provisions of the ACA in place, majorities of Democrats, Republicans, and independence say it is very important to continue each of these protections for people with pre-existing conditions.

Figure 3: Most Say It Is Important That ACA Provisions Remain In Place

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

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 most recent survey data, about six in ten of the public say they or someone in their household suffers from a pre-existing or chronic medical condition, such as asthma, diabetes, or high blood pressure.1

Figure 4: Nearly Six In Ten Americans Say They Or Someone In Their Household Has A Pre-Existing Or Chronic Health Condition

#5: Voters Prefer Joe Biden’s Approach To The ACA And Pre-Existing Condition Protections Over President Trump’s

A majority of registered voters say Democratic presidential nominee Joe Biden has the better approach to determining the future of the ACA (57%) and to maintaining protections for people with pre-existing conditions (56%), while roughly four in ten prefer President Trump’s approach on each of these issues (37% and 36%, respectively). Partisan voters break along expected lines, with large shares of Republican voters preferring the president’s approach, and large shares of voters who identify as Democrats preferring former Vice President Biden’s approach. Among the crucial group of swing voters – those who say they are undecided or say they are “probably” going to vote for either Trump or Biden but haven’t made up their minds yet – the former Vice President has a large edge over President Trump on this question, with about six in ten (58%) preferring Biden’s approach on the ACA, about three in ten (28%) preferring Trump’s approach, and one in ten (11%) saying they aren’t sure.

Figure 5: Partisans Split On Whether They Think Trump Or Biden Has The Better Approach To ACA, Protections For Pre-Existing Conditions

  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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