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

During Republican efforts to repeal the Affordable Care Act (ACA) during the summer of 2017, KFF Health Tracking Polls began to find a slight uptick in overall favorability towards the 2010 health care law. However, the most recent KFF Tracking Poll shows favorability towards the law is down slightly. Nearly half of the public (46%) hold favorable opinions of the ACA while four in ten hold a negative opinion of the law. Across partisans, about eight in ten Democrats (79%) have a favorable view of the ACA compared to nearly half of independents (47%) and one-sixth of Republicans (16%). Explore more demographic breakdowns using our ACA interactive.

Figure 1: The Public Is Somewhat Divided On The Affordable Care Act

#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#3: The Least Popular ACA Provision Is No Longer In Effect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: Majorities Say ACA’s Pre-Existing Condition Protections Are Important

In 2018, President Trump’s administration announced – as part of a lawsuit known as Texas v. United States, brought by 20 Republican state attorneys general – it will no longer defend 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). The majority of the public say it is “very important” to them that the ACA’s provisions protecting those with pre-existing conditions remain law even after hearing that these protections may have led to increased insurance costs for some healthy people.

Figure 4: Majorities Say Pre-Existing Condition Protections Are Very Important To Them

#5: Large Shares Support State Actions on Pre-Existing Condition Protections

On December 14, 2018, a federal judge ruled that the entire ACA – including the protections for people with pre-existing conditions – is unconstitutional. While an appeal of this decision is expected, thereby triggering district court and possibly Supreme Court actions, the November KFF Health Tracking Poll finds a majority of the public – including 87% of Democrats, 67% of independents, and about half of Republicans – say they would want their state to establish protections for people with pre-existing health conditions if this part of the law was ruled unconstitutional, even if this means some healthy people may pay more for coverage.

Figure 5: Majorities Say They Would Support State Action If ACA’s Pre-Existing Condition Protections Are Ruled Unconstitutional

#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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