In public opinion, the battle over the Affordable Care Act has come to a stalemate. Depending on how you ask the question, a majority of the public disapproves of the law, but a majority also doesn't agree with Republicans that it should be repealed. On the simple approval question, poll results look just about the same as they did five years ago, which is remarkable given all the fighting over it and everything that has happened, good and bad, in its implementation. But there's something remarkable in this new article in the New England Journal of Medicine that we really need to take notice of, because it represents a significant shift in how some Americans think about health care:
Over the past decade, there has been a cultural shift in Americans' attitudes about the principle of universal health care coverage, one of the main rationales for the ACA. In 2007, during the presidential primary season, public support for the view that the federal government has a responsibility to make sure all Americans have health insurance coverage was at 64% (Gallup, 2007). By 2014, this number had declined to 47% (Pew, January–February 2014). In addition, there has been a decline in overall public trust in the federal government to handle domestic problems such as health care from 51% in 2012 to 40% in 2014, which may also play a role in depressing public support for the ACA (Gallup, September 2014).
One often unrecognized factor that may be contributing to these overall findings is the extraordinary level of paid negative advertising opposing the ACA that has taken place since the law was enacted. A recent study reported that $445 million had been spent for advertising related to the ACA through the beginning of 2014. Of that amount, 94% was expended on negative ad messages about this national law. Moreover, the large volume of advertisements against the ACA has continued throughout the campaign season, with 37,544 anti-ACA ads between August 1 and September 11, 2014.
I want to take the second part first. This has been a truly spectacular propaganda campaign, full of lies and fear-mongering, meant to fill Americans with fear and hatred of this law. In fact, unless somebody can correct me, I don't think there's ever been a campaign against a piece of legislation that even approaches this magnitude. I suppose that the fact that in the face of all that the law still retains significant support is something to be thankful for.
But what about the decline in people saying that the government should make sure everyone has health insurance? I wanted to see how this broke down by party, and it turns out that Gallup has asked this question repeatedly, the last time about a year ago:
Prior to Barack Obama's election, the idea that the government shouldn't bother making sure all people have health coverage is something that most Republicans believed. But now it's something that nearly all Republicans believe. There has been a significant movement among independents, but given that there are very few "true" independents, I'm guessing that most of that comes from the Republican-leaning independents.
That monumental propaganda campaign may not have killed the law, but it bought this: the GOP is now, more emphatically than ever, the party of "I got mine, and the rest of you can go to hell." Ayn Rand is smiling.