Polls on Obamacare Tell Us Instead About Politics
Sarah Kliff today pulled some interesting findings from the latest Kaiser health poll. They show an intense partisan split among those who claim to have benefited from the Affordable Care Act and those who claim to have been harmed by it. Gallup had similar numbers.
It's certainly possible, as Kliff points out, that the split in the poll reflects reality: that Democrats have been helped and Republicans have been harmed by the law. But it's far more likely that this is just partisanship at work.
Sorry to keep beating this horse, but the design of the ACA practically guarantees such a result. This isn't a law similar to Medicare, with easily identified benefits and costs. Many Obamacare benefits -- for example, those derived from regulations on insurance companies -- are practically invisible to most policy holders. So are most of the costs, such as the tax on medical devices. That tax is mostly passed along to consumers, yet consumers rarely know what specific charges their insurance pays for, or how those charges affect premiums.
Moreover, since almost everyone has some interaction with health care and health insurance, it's easy for people to attribute -- correctly or not -- personal experiences to Obamacare. By contrast, most people don't similarly experience Wall Street reform in their daily lives.
All of which is to say that the working status of the ACA is best understood from objective indicators, such as medical inflation rates, the number of people insured and overall patient outcomes -- and not from public opinion. (Those elements are hard enough to determine from objective data!) It's basically impossible to get an accurate read from public opinion because direct questions about how Obamacare has affected respondents are bound to activate partisan frames.
The best way to incorporate public opinion is probably to draft questions that are outside the sphere of political hot buttons. For example, I'd be interested in comparing consumer opinions on satisfaction with their health insurance (including access to it) before and after the implementation of the ACA.
One last point: As long as reactions to the ACA break down along party lines, there's no reason to expect those reactions to influence elections in 2014 or 2016 significantly. It's possible that added intensity on the Republican side could have some effect on turnout, but there would be no way to know whether such a spike is a result of health care reform or some other force. The partisan splits on personal interactions with the ACA suggest that if intensity on one side or another goes up, it's more likely due to something other than Obamacare.
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