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Survey suggests partisanship doomed health care reform, public split on many ACA components

A greater Republican division on the issue of health care reform than originally thought in addition to the Democrats’ determination to not repeal the Affordable Care Act, led to the failure of health care reform efforts thus far, according to a special report recently published in The New England Journal of Medicine.

“Fundamental divisions among Republicans point to an underlying reason why Republicans in Congress had such difficulty agreeing on a single repeal and replace plan. These divisions were not helped by the fact that President Donald Trump’s role in the debate was seen so poorly by the general public,” Robert J. Blendon, ScD, and John M. Benson, MA, of the Harvard T.H. Chan School of Public Health, wrote.

“Throughout the debate, the majority of Republican adherents favored repealing the [Affordable Care Act] whereas Democrats did not,” they added.

This divide also appears to be reflected in public opinion surveys. Blendon and Benson reviewed 27 recent polls and found that, on average, 49% approved of the Affordable Care Act (ACA), whereas 44% disapproved of it as of July 2017.

In addition, 60% of all Americans felt health care falls under the federal government’s jurisdiction in June 2017, up from 42% in 2013, which is “the most significant change since the implementation of ACA,” according to a press release.

Among some of Blendon and Benson’s other findings from the poll analysis:

•72% would rather keep the number of people covered by Medicaid as it was with ACA; 22% said they would rather it be at pre-ACA levels;

•57% support the idea of financial assistance helping buy insurance to the same number of people as ACA does now; 12% would like to see that assistance go to significantly fewer people;

•50% were against removing the requirement that penalized those who did not obtain health care coverage and 48% favored removing this requirement; and

•37% preferred giving states less federal funding for Medicaid but increasing the flexibility on how the money should be spent and who should be covered.

The ideological split was also seen along party lines, according to the authors.

•89% of Democrats leaned towards more people having health insurance and 56% of Republicans liked the idea of lowering government spending;

•87% of Democrats felt the federal government should play a major role in enhancing the country’s health care system, compared to 28% of Republicans; and

•85% of Democrats thought the federal government should be responsible for guaranteeing that all Americans have health care coverage, as opposed to 30% of Republicans.

“On most specific policy issues in the debate, Republicans and Democrats disagreed, but there is one major exception,” Blendon and Benson wrote. “The two parties’ adherents agree that the number of people covered by Medicaid should not be reduced in any replacement bill.”

The latest attempt to repeal ACA, known as the ‘skinny repeal,’ called for reductions to medical and health services research, primary care training programs and many other essential health care programs and research. It was widely criticized by many medical societies, including the AAFP and ACP.

Upon that bill’s failure, President Trump criticized those who voted against the plan, then repeated a call “to let Obamacare implode, then deal.”

Speculation is that such an implosion could hold off on enforcement of the individual and employer mandates, as well as granting state waivers to avoid certain ACA requirements, terminate the cost-sharing subsidy payments, and eliminate funding for ACA enrollment and education activities.

The House and Senate are in recess until Sept. 5. – by Janel Miller

Disclosure: Both Blendon and Benson report receiving grant support from the Robert Wood Johnson Foundation outside the submitted work.