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Support for Federal Health Spending Is Down. Could the ACA Be the Reason Why?

The Affordable Care Act — the largest overhaul of the U.S. health care system in history — is estimated to cost the federal government more than $700 billion over 10 years. Democrats traditionally have been the law’s biggest cheerleaders, but a new study finds that “support for health spending” dropped not only among Republicans and independents, but also among Democrats “following and in direct response to the passage of the ACA.”

Study co-author Stephen Morgan, the Bloomberg Distinguished Professor of Sociology and Education at Johns Hopkins, in a release said, “One would expect strongly partisan responses to the passage of Obamacare, but the decline in support is from everyone,” adding, “Our interpretation is that attitudes toward spending on health are distinctly negative.”

Thwarting Expectations

Past polls have found — as expected — that Republicans largely disapprove of the ACA, while Democrats favor the law. However, the Johns Hopkins study found that the ACA’s passage “decreased support for spending on health among Democrats, Independents and Republicans, contrary to the conjecture that a rigid partisanship equilibrium has taken hold among voters in the United States.” In fact, according to Politifact, previous “aggregate polling shows a plurality of Americans continue to oppose the law, and at no point since it passed have more people favored it than opposed,” adding, “Public opinion of the health care law was underwater even before the bill fully materialized, and it hasn’t recovered.”

The Johns Hopkins study is based on data from the General Social Survey from 2004 through 2014. The data are particularly pertinent because the most interviews for the 2008 cross-section sample took place before the economic recession “erupted in dramatic enough fashion that many GSS respondents would have taken note of it, and all interviews were concluded before the fall election.” In addition, the majority of interviews for the 2010 cross-section sample were taken after the ACA’s passage, when “[e]ven respondents who would not be characterized as high-information voters would likely be aware of at least some of the debate over its passage and implementation.”

Between 2004 and 2008, Democrats most widely supported additional federal spending on health care, with 82% to 86% saying “too little” federal money was spent. However, about two-thirds of Republicans and independents also supported increased federal spending on health care in that time, according to the study.

While the decline in support for health spending after the ACA’s passage was largest among Republicans, the study authors note that a decline was “clear … for all three groups.” The study found that the rate of voters who thought the federal government spent “too little” on health care declined by 25% among Republicans, 11.8% among Democrats and 10.7% among independents from 2008 to 2010.

“[C]onservative cold fronts can emerge in liberalizing climates, even though this decline is for a single spending area and provides no evidence of a broader cold front,” the authors wrote. The authors estimate that the ACA’s passage “fueled” such a “cold front” from its passage in 2010 through 2014.

What Else Could Be Going On?

The study authors noted and attempted to disprove several other theories for the change in public opinion on health spending.

For instance, some stakeholders have suggested that the economic recession could have resulted in the “cold front” on health spending. While the authors acknowledge that such an explanation “cannot be entirely eliminated from plausibility,” they note that “the GSS … asks respondents about other spending areas beyond” health care. “If either the recession or stimulus spending were responsible for the decline in support for health spending, then we would expect to see declines in support for spending in other areas as well, with declines largest in areas where stimulus funds were committed,” but this is not the case, according to the study. For example, there was “little to no change” in support for federal spending on scientific research, among Democrats, Independents and Republicans.

The authors also noted that Democrats could “simply … feel an important social problem has at long last been addressed” via the ACA, and therefore believe that increased federal spending on health care is unnecessary. However, they found that “Democrats also expressed less support in 2010 through 2014 for governmental responsibility for meeting the costs of health care.” They added, “If Democrats favored lower spending on health in 2010 through 2014 because they felt that the ACA had met a need, we would either expect no change on government responsibly toward health care or even a more positive response on government responsibility.”

In addition, the authors wrote that some critics could “argue that the GSS reveals a general distaste for federal spending.” However, “an analysis of all areas of spending polled for the GSS does not reveal a general displeasure with spending,” they wrote.

What’s the Big Picture?

The findings of the new study “contradic[t] the expectations of strong partisanship narratives,” even after going through supplemental analyses, according to the researchers. So what does that mean for politicians?

According to the Washington Post‘s “The Fix,” the findings give weight to the idea that Democrats “paid a political price for passing the ACA.” Scott Clement, a survey research analyst at the Post, wrote that “the bigger lesson is Americans tend to turn in the opposite direction of policy; Democrats won big in passing health care reform, but the public’s appetite for more ambitious action has shrunk.”

Around the Nation

Under consideration. In its new term, the Supreme Court likely will consider cases challenging the ACA’s contraceptive coverage rules.

Partial payment. Health insurers that sold plans through the ACA’s exchanges will receive only a small portion of what they expected from 2014 risk corridors payments.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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