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Polling the ACA

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Supporters of the Affordable Care Act will find this CBS/NYT poll result unsettling, but I don't think it's particularly surprising:

In the latest poll, 47 percent said they oppose the [health reform] law while 36 percent approve, with the rest having no opinion. The results are similar to previous surveys that have consistently found the law's detractors outnumbering its supporters

My own views aside (more on those below), I'm not sure this result is as meaningful as you might think. When you ask people about complicated legislation, and this one has many obscure moving parts (IPAB, exchanges, accountable care organizations), they often don't much like it, in no small part because they very reasonably don't want to endorse something they don't know enough about.

Plus, there's been so much distortionary noise around the ACA, unless you're a health policy wonk, how are busy people supposed to filter out the noise?

In terms of public opinion, then, I think you get less insight from the poll question behind the headline -- "do you approve or disapprove of the health care law that was enacted in 2010?" -- than from specific, immediately understandable parts of the bill.

For example, 85% approve of the part that says insurers have to cover pre-existing conditions; 68% approve of the part that lets parents keep their kid on their health coverage plan until he or she is 26; 77% approve of closing the Medicare prescription drug coverage gap. For public opinion polling, such percentages are stratospheric.

Of course, these are clear benefits of the legislation. The individual mandate--the requirement that certain people either have insurance or they pay a penalty -- doesn't poll that well.

FWIW, OTEers know I'm a supporter of the ACA and am encouraged by stuff I've read suggesting its legality should be approved by the SCOTUS. That's not because I'm sure it will work, where "work" means providing coverage to the millions without and bringing cost growth and the share of expenditures on health in line with that of other advanced economies. It's because modern systems that do "work" in the above sense have similar features to the ACA -- pooling across large, diverse populations (risk pooling dilutes costs), mandates (avoids adverse selection), explicit cost control mechanisms (cost targets, those "accountable care" provider groups noted above, IPAB -- to name a few).

Given the extent of the uninsured in America along with the cost pressures on public budgets, the private economy, and families, we must see if these mechanisms work here. If they fail, we'll need to try new ones. But no reform at all -- the status quo-is not a viable option. So let's hope the court gets this right.

Full poll results here.

This post originally appeared at Jared Bernstein's On The Economy blog.

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