Why The Health Law is Not More Popular

My colleagues at Duke Peter Ubel, Aaron Kay and Gavan Fitzsimons with an op-ed in today’s Philly Inquirer addressing this question of why the ACA is not more popular one year later. It is not the details of the law they say, but the uncertainty surrounding its implementation due to the political conflict. Interesting read, a few highlights.

Despite all the controversy that preceded the enactment of health-care reform a year ago today, most health-policy experts confidently predicted that the public would soon embrace it. They pointed out that Medicare, which was quite controversial when it was established in the 1960s, rapidly grew in popularity. Much the same happened with Medicare Part D, President George W. Bush’s extension of coverage to medication.

Later in the piece they give their answer of why the ACA has not become more popular

Obama’s health-care reform is unpopular not simply because it’s complicated, or because it increases government spending at a time when people are in a budget-cutting mood. Rather, it’s unpopular largely because it doesn’t seem inevitable.Behavioral science has shown us that most people find uncertainty very difficult, especially when it surrounds a possible change in their lives. Halfhearted attempts at change often produce knee-jerk negative reactions. People are not inclined to adapt to a change that may never occur or that seems unlikely to stick. Such situations are likely to breed backlash…..

But when the uncertainty is removed, backlash tends to dissipate and sometimes even reverse. When people know what cards they have been dealt – when they feel confident about what to expect in the future – they tend to begin the process of rationalizing and adapting to the change.

This interpretation puts the focus on the politics and the legal challenges and not the policy. If the individual mandate is struck down by the Supreme Court, in policy terms the law could be salvaged but perhaps not in behavioral sciences (public perception) terms.  Likewise, if it is upheld, then this suggests the process of acceptance probably begins.  The ‘sides’ could wait for the court case or move to a compromise.  The ‘anti’ side probably has more to gain from waiting it out than cutting a deal in political terms and the ‘pro’ side has no choice; takes two sides to negotiate.

Update: pollsters from ‘both sides’ talking about public opinion and the ACA via Kaiser Health News.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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