As we approach the one-year anniversary of the passage of the Affordable Care Act, public opinion hasn't really changed much, confounding the expectations of both conservatives (who thought all Americans would grow to hate it) and progressives (who thought Americans would grow to love it). As Ezra Klein argues after looking at some survey data, "Taken together, these polls help explain why health-care reform remains so bitterly contested a year after passage: A slim plurality of Americans have an unfavorable view of the law, which gives Republicans support in their efforts to challenge it, but a majority of Americans oppose efforts to repeal or water down the law, which gives Democrats confidence in their efforts to defend it."
It's also true that this is likely to produce a kind of policy stalemate, in which Republicans keep advocating repealing the law or destroying it in some other way (say by denying it funding), but they're never quite able to. That's assuming that President Obama gets re-elected, of course; if a Republican wins in 2012 and Republicans control Congress, they probably will repeal it.
But there's something else important to understand about what the ACA will become once all its provisions are implemented in 2014. The ACA is not a single program, in the sense that Medicare is. Medicare is complex and affects the entire health-care system, but it is essentially one thing. It's an insurance program for the elderly; some Americans are in it, others aren't. At the broadest level, it's fairly easy to understand. The ACA, on the other hand, is a lot of different things. It's an expansion of Medicaid. It's subsidies to help low- and middle-income people purchase insurance. It's the creation of insurance exchanges where people who don't get their insurance from their employers can buy it. It's a set of new rules insurance companies have to follow. It's a whole bunch of pilot programs to test alternative ways of delivering care. It's new policies affecting Medicare itself. Each one of us will be affected by some of these provisions more than others.
You can repeal it, of course, just by passing a law saying everything covered in the ACA is now void. But for better or worse, people won't be saying, "Keep your hands off my Affordable Care Act" or "Get me out of this Affordable Care Act," because the things they like or dislike will be specific programs and provisions established by the ACA, not the ACA itself. In fact, I wouldn't be surprised if around 2016 or so we stop talking about the ACA or "Obamacare" altogether. We'll still talk about health-care policy, of course, but it will be about the specific things we want to change or add. And that, frankly, will be a relief.
