After 16 Years, Partisans Still View the Affordable Care Act Very Differently

Isabelle Valdes

On the 16^th anniversary of the Affordable Care Act’s (ACA) passage, most of the public (61%) view the law favorably, though opinions and debates remain as partisan as ever. Our newly revamped interactive—Tracking the Public’s Views on the ACA—reveals 90% of Democrats say they have a favorable opinion of the ACA compared to 64% of independents and just 32% of Republicans this March.

Partisan divides over the ACA are not new; Republicans have maintained overwhelmingly negative sentiment, and Democrats a positive one, toward the ACA since its passage. While overall views of the law are polarized, cornerstone provisions of the ACA are widely popular. For example, majorities across partisanship say that protections for people with pre-existing conditions are “very important.”

When we do see shifts in favorability among Republicans and Democrats, it’s typically around major events relevant to the law as you can see in our ACA interactive. Most recently, shifts occurred around the debate over enhanced premium tax credits (“ePTCs”) for people who purchase coverage through the ACA Marketplaces. There was a decline in favorability, driven by Republicans, in January of this year at the height of news coverage of the ePTC debate, though favorability has since started to rebound. The interactive displays ACA favorability over time, not only by partisanship but by age, household income, education, and other demographics.

Our recent KFF Follow-Up Survey of Marketplace Enrollees and KFF Health Tracking Poll also show health care costs more broadly may be an important electoral issue this fall. Three-quarters of registered voters say the cost of health care will impact their decision to vote in the upcoming midterms, as do a similar share of registered voters enrolled in the ACA Marketplace in 2025—a group directly impacted by the expiration of the enhanced tax credits.

While we may not see candidates calling for the repeal of the ACA as was common during campaigns a decade or more ago, conversation about the ACA is likely to still play a role on the campaign trail in 2026. Democratic candidates may try to keep the focus on Republicans’ decision to not extend the tax credits and blame them for increasing costs, while some Republicans will instead blame the ACA itself for increases in health care costs (for example, labeling it the “Unaffordable Care Act”). We can expect that as voters continue to grapple with the affordability of coverage and care, the partisan legacy of the ACA will almost certainly figure into debates about health care costs this fall.