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Health Care Reform… Is That What Government’s For?

Naval Medical Center, San Diego

Flickr/U.S. Navy photo, Todd Hack

The U.S. Supreme Court’s ruling on the Affordable Care Act June 28 has consumed lots of attention. Republicans are talking about repealing the act, while Democrats defended the law as “transformative of our society.” Why is it that this has become such a polarizing issue?

Pew Research Center President Andrew Kohut, a veteran pollster, shared some insight, based on his public opinion surveys, in a wide-ranging conversation this week with PBS NewsHour’s Jim Lehrer:

“Instrumental to the dislike of this program is the mandate,” said Kohut, referring to polling last month that showed that Americans are divided on the Obama-backed health reform law but that a majority disapprove of the “individual mandate,” that requires individuals to purchase health insurance coverage or face a penalty. “What has been overwhelming is the reaction to the mandate in particular and the concern about the role of government.”

The role of government… in health care and so many other aspects of American life… has become a central point of debate this election year.

Take a look at this graph from the Gallup poll: A decade ago, roughly 6 in 10 people believed the federal government had a responsibility to make sure all Americans have health care coverage. Now just 5 in 10 think so.

Gallup health care survey 2000-2012

Gallup health care survey 2000-2012

Yet, the government’s role in ensuring health care coverage under the Affordable Care Act is a much smaller one than in other proposals Americans have debated in recent years.

Remember the “public option”…? That was the proposal for a government-run insurance plan to compete with private insurers as part of the health care overhaul. It was widely popular, according to a New York Times poll in 2009.

The national telephone survey, which was conducted from June 12 to 16, found that 72 percent of those questioned supported a government-administered insurance plan — something like Medicare for those under 65 — that would compete for customers with private insurers. Twenty percent said they were opposed.

But it didn’t pass muster in Congress and didn’t end up in the final version of the law.

Looking back a little further, Ezra Klein, writing in the New Yorker, reminds us that the “individual mandate” that conservatives now consider a government intrusion, actually began its life as a conservative idea.

The mandate made its political début in a 1989 Heritage Foundation brief titled “Assuring Affordable Health Care for All Americans,” as a counterpoint to the single-payer system and the employer mandate, which were favored in Democratic circles.

Here’s a link to that brief, by Stuart M. Butler with the conservative Heritage Foundation, which formed the basis for a Republican alternative to President Clinton’s plan for health care reform in the early 1990s.

A lot of Americans still don’t fully understand what the Affordable Care Act would do (or what the Supreme Court did last week). In fact, the New York Times reports, some of the politicians campaigning to repeal the law are actually proposing to replace it with… elements that are already in it.

A spokesman for Representative Rick Berg, Republican of North Dakota who is seeking a Senate seat, told a reporter in his state that Mr. Berg wants to replace Mr. Obama’s health care law with one that does not deny insurance coverage to people with pre-existing conditions and closes the “doughnut hole” — a gap in pharmaceutical coverage — for people on Medicare. Those are two of the most popular provisions of the law Mr. Berg would repeal, which would be difficult to replicate without the regulatory mandates and tax increases he has vowed to reverse.

So what IS in the law? For an easy overview, check out this animated video from the Kaiser Family Foundation. It was produced before the Supreme Court’s ruling (and has been viewed more than 400,000 times) but most of it still holds true:

And then let us know what you think: What IS the role of government in terms of health care?