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Obamacare is 5 years old, and Americans are still worried about death panels

When Democrats passed the Affordable Care Act in 2010, they knew it wasn't popular — poll after poll showed pluralities, if not majorities, opposed to the legislation after the bruising national fight that led to its passage. But Democrats had a theory about the law: as time went on, and Americans started to gain coverage, the law's favorability would rise.

"As that bill is enacted, it’s going to become more and more popular," Sen. Charles Schumer (D-NY) predicted on Meet the Press in March 2010.

"I think that [the law] over time is going to become more popular," David Axelrod, then a senior adviser to President Obama, declared in September.

Five years later, it's fair to declare that prediction dead wrong: 83 percent of Americans still hold the same opinions they did in 2010. And of those who have changed their minds, 58 percent of them have become more negative toward the law, a new Vox poll conducted by PerryUndem shows.

If there's any area of consensus, it's in misperceptions of the law: 82 percent of Americans either say the price tag has gone up, or aren't sure (the law's price has actually decreased as compared with initial estimates), and only 13 percent know the law met its first-year enrollment goals.

Taken overall, the poll paints a frustrating picture for Democrats: most Americans aren't changing their opinion; those who are have mostly become more negative; and some widely held beliefs about the Affordable Care Act are far from accurate.

But it's not all good news for Republicans, either: though most Americans dislike Obamacare, more want to see it improved than repealed. Democrats have lost the battle — they haven't made the health law more popular — but in thwarting repeal, and keeping Obamacare in place, they're arguably winning the war.

Why opinions are stuck: Democrats and Republicans think the law is having different effects

If you want to understand why the public remains so divided on Obamacare, it's helpful to look at what they think the health-care law is doing.

floating chart

(Anand Katakam / Vox)

Overall, 60 percent of Americans think more people have gotten health coverage through Obamacare. All evidence we have suggests this is true: data from Gallup, the Commonwealth Fund, Robert Wood Johnson Foundation/Urban Institute, RAND Corporation, and the Kaiser Family Foundation all have similar findings — namely, that millions more people have insurance than before Obamacare's insurance expansion.

But there's a stark divide between parties: 74 percent of Democrats agree with the fact that Obamacare has increased health coverage, compared with only 49 percent of Republicans.

Conversely, 54 percent of the country thinks businesses are cutting back on their employees' hours so they can dodge Obamacare's employer mandate. (There is evidence of this happening in isolated cases, but not at a widespread level.) Seventy-four percent of Republicans think this is true, compared with 42 percent of Democrats.

A similar divide shows up on insurance costs: 70 percent of Republicans say costs are going up as a "direct result" of Obamacare, while only 33 percent of Democrats agree with this statement. The best evidence we have shows that Obamacare has had a negligible effect on insurance premiums for people who get insurance at work, and that premiums have actually grown slower in the individual market since the start of the insurance expansion.

Most Americans don't think they have enough information about the law

Fifty-seven percent of the American public doesn't think they have enough information about the health-care law — and 60 percent don't think they understand how the law affects them specifically.

Those information gaps matter: the Vox poll shows that people who say they don't understand how the "law affects me" are less likely to know what's actually in the Affordable Care Act. When you compare them with people who say they do understand the law's affects, they are 32 percentage points less likely to to know that the health-care law provides tax credits to help low- and middle-income Americans purchase insurance coverage. And they are 21 percentage points less likely to know that Obamacare bars insurers from denying coverage to people who have preexisting conditions.

So information matters: and one reason a lot of Americans are stuck on the law might be because they don't understand what it means for them — and whether their health care is changing as a result.

Here's a surprise: most Americans do know the most important parts of Obamacare

Obamacare's insurance expansion arguably has three really important policies: the end of preexisting conditions, a mandate to purchase insurance, and subsidies to help low- and middle-income Americans purchase coverage.

The Vox poll shows that a majority of Americans know about these three parts of the health-care law. Three-quarters of Americans know there is a mandate to buy insurance in Obamacare; 64 percent are aware that preexisting conditions no longer exist; and a slim majority, 54 percent, know about the financial help now available to buy a plan.

Awareness levels are similar among Democrats and Republicans, suggesting that some facts about the health-care law have broken through — even if they're not swaying how voters think about the law.

Death panels? Subsidies for undocumented workers? Those myths persist today.

Twenty-three percent of Americans, for example, think undocumented immigrants can get financial help to purchase health insurance. Fifty-five percent said they weren't sure, while 20 percent got the right answer: undocumented immigrants cannot get financial help through the marketplaces. (They can't actually buy coverage through the marketplaces at all, even using their own money.)

Republicans are significantly more likely to believe these three Obamacare myths than Democrats, a sign of how politics colors the public's perception of how Obamacare actually works. Republicans, for example, are 25 percent more likely to believe that undocumented workers can get financial help under Obamacare and 15 percent more likely to believe end-of-life panels exist.

The myth that's duped everyone: Obamacare is getting more expensive

Forty-two percent of Americans think Obamacare has gotten more expensive over the past five years. Only 5 percent of poll respondents hit on the right answer: budget estimates for the Affordable Care Act have consistently fallen since it became a law.

Make no mistake: Obamacare spends a lot of money on its tax credits and Medicaid expansion. It recoups some, but not all, of that new spending with hundreds of billions of dollars in Medicare cuts, which reduce federal health spending. The bulk of the remainder is made up with tax increases. But back when the law was passing, Republicans argued up, down, and sideways that the Congressional Budget Office was sharply underestimating the amount of money Obamacare spends.

In fact, the CBO overestimated the cost of Obamacare — and by quite a lot. In April 2014, it marked down its Obamacare projection by more than $100 billion. Much of the revision comes down to the fact that health-care costs have grown very slowly during 2009, meaning it's less expensive for the government to help millions of Americans purchase coverage. Just this month, CBO released new projections showing that Obamacare's subsidies would cost 20 percent less over the next decade than initially expected.

The government is now spending less on health care than CBO had projected back in January 2010 — a projection that didn't include any Affordable Care Act spending at all.

Most Americans aren't directly experiencing the health-care law — or at least don't think they are

This seems to be the fatal flaw in Democrats' theory about Obamacare politics: the law has not majorly changed how health care works for the vast majority of Americans.

obama signature

(Wikimedia Commons)

Most Americans continue to get health insurance the same way they did prior to the Affordable Care Act: through their employer, or through a government program (largely Medicare and Medicaid).

In the Vox poll, 16 percent of Americans said they had been helped by the law — the same percentage that said they gained insurance through Obamacare. Another 54 percent thought the law had no effect on their lives, and 28 percent said they'd been affected negatively.

It's unlikely that the number of Americans who say they've been helped by the law will edge up soon — or ever. The Congressional Budget Office projects that 24 million people will have coverage through the marketplaces in 2025, about 7 percent of the projected population (347 million). Obamacare enrollees will always make up a small minority of those with health insurance in America.

PerryUndem Research/Communication conducted the survey among n = 1,067 adults 18 and older nationwide, March 4 through 12, 2015. The survey was administered among a nationally representative sample of adults, using GfK's Knowledge Panel. The margin of error is + 4.1 percentage points.


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