By Cossy Hough, LCSW
If you have been following the healthcare coverage debate over the last several months, you may have noticed an interesting trend regarding people's perception of what the government's role in healthcare coverage should be. Many had assumed the Affordable Care Act (ACA) would be repealed right away with the election of a Republican President. A repeal had been promised and worked on for years. Prior to the presidential election of 2016, House Republicans held over 50 votes on repeals and changes to the ACA. They seemed poised for repeal in January 2017. So, what's happening? Could it be that we're in a slow shift of culture in the U.S. towards an expectation of more federal government involvement in provision of healthcare coverage?
There have been a multitude of efforts to repeal, and sometimes replace, the ACA. Efforts started in 2009 before the ACA was signed into law. Many of the GOP's criticisms of the ACA have been rooted in the value of autonomy and choice and smaller federal government. When efforts to block the implementation of most of the ACA failed, the GOP appeared to support the least amount of governmental involvement in healthcare as possible while also supporting the most popular aspects of the ACA. In replacement plans, individual mandates for health insurance coverage have been dropped. Replacement efforts have included provisions for:
Most of these efforts seem to support less governmental control and more autonomy. Is that why repeal and replacement of the ACA keeps failing? Where does the public stand now on healthcare coverage?
The Kaiser Family Foundation updated their findings in July 2017 regarding public opinion of the ACA. They report a trend in the public being more supportive of the ACA (see chart). More than 50% of the American public now has a favorable view of the ACA.
The Kaiser Family Foundation also reports that, of the 61% of the public that has an unfavorable view of the GOP ACA replacement plan “one-fourth (23 percent) say it is because they think the replacement plan will have a negative impact on people” (see chart below). This recent Kaiser Family Foundation report goes on to digest more public opinion of repeal and placement of the ACA and much of the data of support vs not support of a placement falls predictively among political party lines (Click on “Things We Like” for a link to the report in it’s entirety).
Public opinion about a potential single-payer healthcare and the government’s role in covering medical expenses is also notable. According to the results of a Pew Research Center poll released in June, 33% of poll respondents now favor a single-payer healthcare system. That result is an increase of 5% since January of 2017 and 12% since December of 2015. The results of the Pew Research Center poll also indicate that 60% of the public say that the federal government is responsible for providing healthcare coverage to all Americans. With estimates of 22-24 million Americans losing health insurance coverage depending on the version of ACA replacement, is repeal and replace doomed?
Shifts in culture take time. Has there been enough time to start talking about whether a shift in thinking about healthcare coverage in the U.S. is occurring? Are we moving towards a place that the collective is becoming more valued or is that reading too much into current events? How does a true shift in culture get measured? By polls…feedback to elected officials…elections? If there is a shift occurring, where are we right now and what’s on our horizon?
What do you think?
Will Francis, LMSW
Government Relations Director,
National Association of Social Workers,
Cossy Hough, LCSW
Clinical Assistant Professor, The University of Texas at Austin,
School of Social Work
Anna Stelter, LMSW, MPH
Health Policy Analyst
Texas Health Institute
Alison Mohr Boleware, MSSW
Mental Health Policy,