Data Note: Strongly Held Views on the ACA
Nearly every month since the ACA was signed into law in 2010, the Kaiser Family Foundation has surveyed the public about their general views on the law, using a question with a four-part answer scale that allows individuals to describe their views as very favorable, somewhat favorable, somewhat unfavorable, or very unfavorable. In reporting trends on this question, we often focus on the “net” favorability, combining the “somewhat” and “very” categories together. Using this method, Kaiser polls have shown an overall increase in ACA favorability over the past year, with 52 percent holding a favorable view of the law in August 2017, up 10 percentage points since June 2016, and nearly 20 percentage points since a low of 33 percent in November 2013.
Digging below the surface and looking at the pattern in strongly-held views (i.e. the share who say they have a “very favorable” or “very unfavorable” view) also reveals an interesting trend. Since its passage, the ACA has suffered from what is sometimes referred to as an intensity gap, with the share of people holding strongly unfavorable views outnumbering the share with strongly favorable views. In other words, people who disliked the law tended to hate it, while those who liked it tended to have more lukewarm feelings. That gap largely closed beginning in the spring of 2017, and in the last four Kaiser tracking polls from May through August, the share with a very favorable view has been roughly equal to the share with a very unfavorable view. This shift occurred because of an increase in the share with a very favorable view, from roughly two in ten from the time the law was passed through early 2017, to about three in ten since May 2017. At the same time, the share with a very unfavorable view has held relatively steady at around three in ten for most of the seven years since the law was passed.
Not surprisingly, this recent increase in strongly favorable feelings towards the ACA has been driven by a substantial increase among Democrats (from 38 percent very favorable in December 2016 to 54 percent in August 2017) along with a more moderate increase among independents (from 17 percent to 26 percent over the same time period). Very few Republicans express a strongly positive view of the law, as has been true since its passage.
As a result of the increasing share of Democrats expressing a strongly favorable view of the ACA, the intensity gap in views of the law by party has significantly narrowed in recent months. In most Kaiser polls from 2010 through 2016, the share of Republicans with a very unfavorable view of the law was roughly 20 percentage points higher than the share of Democrats with a very favorable view, a gap that has narrowed to an average of 9 percentage points across the 5 most recent polls.
The increase in strongly favorable feelings towards the ACA and the narrowing of the intensity gap appears to be the result of Democrats and some independents rallying around a law that many consider one of President Obama’s signature achievements, at a time when the future of that law is being threatened. Democratic sentiment began shifting in late April and May, as the House of Representatives debated and eventually passed the American Health Care Act, which would have repealed and replaced parts of the ACA. Now that ACA repeal has failed to pass the Senate – at least for the time being – it remains to be seen whether Democrats’ increased enthusiasm for the law will continue, or whether strong support will wane as Congress turns its attention to other topics and news about the ACA is likely to be focused on the health insurance marketplaces moving into the 2017 open enrollment period.