The Kaiser Health Care Survey and Tangible Benefits

The always-fascinating Kaiser poll about the Affordable Care Act had its latest installment Wednesday, and the numbers hinted at a new opportunity for Barack Obama: it’s possible that older Americans could be a potential source of new support for the law in 2012.

First, the topline results, which are nicely summarized by Kevin Drum. There’s not much that’s changed. Overall, more people dislike ACA than like it, but a plurality either support the law or want it strengthened. Only a minority want it repealed, with or without Republican replacement. And almost every individual provision of the law remains popular, with the biggest exception being the individual mandate. Interestingly, most ACA opponents say that their opposition is based on a general dislike of “the direction of the country and what’s going on in Washington right now” rather than anything specific about the law – which is surprising to me, because my impression is that it’s rare for people to admit to such influences on their opinions.

It’s also the case that people don’t actually know what’s in the law. Here’s where we get to the hint about seniors. Kaiser has been tracking, among other things, whether people believe that certain provisions are part of ACA. In most cases, knowledge has been deteriorating over time – for example, 71% of respondents knew that the individual mandate was in the law in April 2010, but only 62% knew that now; 64% used to know about expanding Medicaid, down to 53 percent now.

That’s reversed, however, in two areas. Slightly more people (51 percent to 49 percent) know now that ACA will eliminate the “donut hole” on Medicare prescription medication. And more also know about eliminating co-pays and deductibles for preventative care (36 percent to 29 percent, although in this case the “before” was just a few months ago instead of last year). Notably, the first of these is a pure Medicare issue, and the other has been a Medicare issue so far.

My guess is that what’s happening here is that seniors have a strong interest in knowing about what’s actually happening to Medicare, as well as good resources to let them know. Moreover, these are both tangible benefits that will be fairly easy to directly connect to ACA, unlike something like preventing rescissions, which was critically important but something very people knew about until it happened to them, so eliminating it is invisible. It’s also worth noting that, while increasing, the awareness of this stuff is still low, although presumably it’s much higher among Medicare recipients; alas, no crosstabs on this in the detailed release. It sure seems to me that all of this sounds like a real opportunity for the Obama campaign as it targets swing-voting seniors next year.

The bad news for Obama, however, is that as anticipated people are going to blame anything they are dissatisfied about in health care and health insurance on ACA, and therefore on Obama, while generally not being very aware of the benefits. I do expect that to continue, and since costs will likely be going up and since people are still going to not like their insurance companies, there’s a built-in difficulty with gaining support. Again, that’s partially because the benefits are being implemented slowly, but in large part it’s because of the nature of the benefits. After all, there is precisely no one who is going to be cheering if their premiums go up less than they would have otherwise, even if that’s exactly what happens. So even if everything works exactly as Obama and Waxman and the rest of them hoped, it’s gonna be a tough sell. (Although then again a lot of this, as Kaiser found, is more a reflection of what people think of Obama in general; if unemployment was at 5 percent and Obama at 55 percent, ACA would be a lot more popular).

Anyway: I have no idea how large the chunk is of seniors who are swing voters, but I do suspect they are the group mostly likely to be successfully targeted on health care by the Democrats.

[Cross-posted at A plain blog about politics]

Jonathan Bernstein

Jonathan Bernstein is a political scientist who writes about American politics, especially the presidency, Congress, parties, and elections.