Ignorance, Polarization, and the Future of the Affordable Care Act

Ron Brownstein today adds to the long list of things William Kristol has been wrong about:

In a famous memo that successfully rallied Republicans to oppose Clinton’s health care plan, the conservative thinker Bill Kristol warned that if Democrats succeeded in providing universal coverage it “will relegitimize middle-class dependence for ‘security’ on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.”

Now that Obama has achieved the sweeping health reform that Clinton (as well as Richard Nixon and Harry Truman) could not, none of that has occurred. The law is building institutional support among hospitals, insurers, and to a lesser extent physicians that could make it tougher to repeal even if Republicans win unified control of government in 2016. But polls suggest the ACA has done more to reinforce than resolve the doubts about activist government that have been growing in the white middle class for many years.

Brownstein makes this observation in the course of analyzing indications from public opinion research that Americans’ attitudes on the Affordable Care Act break down on racial lines more than on who actually benefits from the legislation:

In the latest monthly tracking poll by the nonpartisan Kaiser Family Foundation, 67 percent of African-Americans and 48 percent of Hispanics, compared with just 34 percent of whites, said they had a favorable impression of the law. Among all minorities, 55 percent expressed a favorable view of the law.

These numbers also, of course, tend to track approval and disapproval ratings for the president, and affiliation with the two parties. And Obamacare is least popular among the non-college educated white folks most hostile to Obama, the Democratic Party, and the “redistribution” programs that think of the Democratic Party as championing on behalf of people who are not like them.

Polls have consistently found that most whites do not view the health care law as a universal program that will benefit themselves or their family. Instead, they perceive it primarily as a transfer program that will help the poor and uninsured. “A lot of white voters assume that what the ACA was going to do was provide health insurance to very poor people, which they think of as being largely minority, and they just haven’t learned enough or heard enough to convince them to change that assumption they’ve had from the beginning,” says [Guy] Molyenux.

[Robert] Blendon agrees. Among whites, he says, the ACA “hasn’t caught on as a universal program where everybody feels they are getting something out of it.”

Many of the benefits of the ACA–notably the provisions banning discrimination against people with pre-existing conditions and enabling children up to the age of 26 to stay on their parents’ insurance policies–are in fact likely to benefit people from all sorts of backgrounds, and the private insurance purchasing exchanges offer guaranteed and subsidized coverage for people well up the income ladder. But no: it’s not like Medicare where it’s easy to see your benefits, and you know most people benefiting from it have been contributing via payroll deductions and premiums payments for many years.

Over time, obviously, if it is not repealed and mutilated beyond recognition, the ACA benefits will become better known and less feared, and sad to say, less identified with Barack Obama. Some day it may even be accepted by Republicans. But ignorance, prejudice, and polarization will hold down approval of the law for some time, which will give the GOP every incentive to hold out for its destruction.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.