#1: Attitudes Toward the ACA Continue To Be More Favorable Than Unfavorable

Following Republican efforts to repeal the Affordable Care Act (ACA) in the summer of 2017, KFF Health Tracking Polls have found a slight uptick in overall favorability towards the 2010 health care law. The most recent KFF Tracking Poll shows over half of the public (52%) hold favorable opinions of the ACA while about four in ten (41%) hold a negative opinion of the law. Across partisans, over eight in ten Democrats (83%) have a favorable view of the ACA compared to roughly half of independents (52%) and a much smaller share of Republicans (22%). Explore more demographic breakdowns using our ACA interactive.

Figure 1: Larger Share of Public View ACA Favorably Than Unfavorably

Figure 1: Larger Share of Public View ACA Favorably Than Unfavorably

#2: Americans Continue To Hold Favorable Opinions Of Many ACA Provisions

Many of the ACA’s provisions continue to be quite popular, even across party lines. A majority of the public – regardless of party identification – hold favorable views of almost all of the ACA’s major provisions. Most popular are allowing young people to stay on their parents’ insurance plans until age 26, establishment of the ACA marketplaces, financial help for some Americans who buy their own insurance, closing the Medicare “doughnut hole,” and eliminating out-of-pocket costs for preventive care.

Figure 2: Americans’ Opinions Of ACA Provisions

#3: The Least Popular ACA Provision Is No Longer In Effect

In previous KFF Health Tracking Polls, one of the ACA’s provisions – the individual mandate which required nearly all Americans have health insurance or pay a fine – was consistently viewed unfavorably by a majority of the public. Since the law’s passage, about six in ten Americans viewed the individual mandate unfavorably. As part of the federal tax bill passed in 2017, Congress zeroed out the dollar amount and percentage of income penalties imposed by the individual mandate.

Figure 3: Majority Hold Unfavorable View Of Individual Mandate Provision Of The Affordable Care Act

#4: Partisans Are Split On The Supreme Court Overturning The ACA And In Their Worry About How Current Legal Battle May Affect Their Own Coverage

Earlier this year, the U.S. Court of Appeals for the 5th Circuit heard oral arguments in Texas v. United States, the court case challenging the future of the ACA. This case stems from a lawsuit brought by Republican state attorneys general and supported by the Trump administration in which a federal judge ruled the entire ACA invalid. If the judge’s decision takes effect, a host of ACA provisions will be eliminated, chief among them are the ACA’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). While the public is divided on whether they would like to see the Supreme Court overturn the entire ACA, a slight majority (56%) say they are “worried” that they or someone in their family will lose health insurance coverage in the future if the Supreme Court overturns the health care law. There are stark partisan differences on both of these questions as Democrats are more likely than their Republican counterparts to say that they would not like to see the law overturned and to say they worry about losing health coverage if the law is overturned. Independents are more divided on both questions.

Figure 4: About Half Do Not Want To See the ACA Overturned By Supreme Court, And Majorities Worry About Their Coverage

Figure 4: About Half Do Not Want To See the ACA Overturned By Supreme Court, And Majorities Worry About Their Coverage

#5: Most Say It Is Important That ACA Provisions Remain In Place

With the ACA and its various provisions under legal threat from the ongoing federal court case (Texas v. U.S.), the July 2019 KFF Health Tracking Poll finds a majority of the public say it is important for many of the ACA provisions to be kept in place. Yet, as with anything related to the ACA, there are partisan differences, with smaller shares of Republicans saying it is “very important” for some of the less popular provisions to remain in place.

Figure 5: Most Say It Is Important That ACA Provisions Remain In Place

#6: Pre-Existing Conditions Impact 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 medical condition, such as asthma, diabetes, or high blood pressure.1

Figure 6: Majorities Of Americans Say They Or Someone In Their Household Has A Pre-Existing Condition

  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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