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Many Want Changes to the Health Care Law but Few Support Its Immediate Repeal

Issue Brief
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​© 2016 Getty Images/Mutlu Kurtbas

Few Americans want to keep the nation’s health care law just as it is now, but most do not want to see it completely dismantled either. According to the latest national poll from The Associated Press-NORC Center for Public Affairs Research, only 12 percent want the Affordable Care Act (ACA)—also known as “Obamacare”—kept in its current form while 40 percent say former President Barack Obama’s signature domestic achievement should be preserved, albeit with improvements. On the other side, 16 percent say the law should be repealed immediately, although twice as many, 31 percent, want President Donald Trump and Congress to wait to repeal the law until a substitute is ready.

During his campaign for president, Trump promised to “completely repeal Obamacare,” and with a Republican majority in both chambers of Congress, the Trump administration is well-positioned to make that happen. The U.S. House of Representatives and Senate recently passed budget measures that are considered the first steps in the process.

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Many elements of the health care law are popular, and the majority of Americans want to retain them in any replacement law Congress might pass. The elimination of charges for many preventive treatments, the ban on excluding people with pre-existing conditions from insurance coverage, and the ability for young adults to remain on their parents’ insurance until age 26 have the most support for inclusion in the new law. The public does not support including the mandate for most Americans to have health insurance or pay a fine in a replacement law.  

In general, half of Americans support the ACA while about a third oppose and 15 percent are noncommittal. Supporters consider the law’s role in expanding health insurance coverage for less affluent Americans, making health insurance more affordable, and protecting against insurance denial based on pre-existing conditions to be particularly important reasons for their defense of the law. Increased out-of-pocket costs and unhappiness with the size of the government’s role in health care are important reasons for opposition to the law.

The nationwide poll was conducted January 12-16, 2017, using the AmeriSpeak Panel, the probability-based panel of NORC at the University of Chicago. Online and telephone interviews using landlines and cell phones were conducted with 1,036 adults.

Key findings from the poll include:

  • Fifty-three percent disagree with the new administration and say the health care law should be kept. But only 12 percent of Americans support keeping the law as it now; 40 percent would like to see changes to make it better. Nearly half of Americans, 46 percent, agree that the law should be repealed. However, 31 percent want to wait until a replacement law is ready while only 16 percent want to see the law repealed immediately.
  • Some elements of the health care law are popular with the public regardless of their stance on the repeal. Even a majority if those who oppose the law support eliminating out-of-pocket costs for some preventive health care, allowing adult children to remain on their parents’ insurance until age 26, and protecting people with pre-existing medical conditions. The individual mandate that requires most Americans to be insured or pay a fine is the least popular element of the law, even among those who support it.
  • Despite provisions in the health care law that benefit Americans regardless of their source of health insurance, 46 percent say they have not been personally affected by the law, and 26 percent say it has had a detrimental effect. Only 27 percent say the law has improved their lives.
  • Overall, 40 percent say the health care law has helped average Americans, 33 percent say it has hurt them, and 25 percent do not perceive any difference. Fifty-three percent say the health care law has helped low-income families, and 44 percent say it has been beneficial for women. But 41 percent say the law has hurt small businesses.  
  • Fifty-six percent of Americans are extremely or very concerned that many people will lose their coverage if the health care law is repealed. And 49 percent expect the elimination of the health care law to be detrimental for most Americans; only 26 percent think it will be advantageous.  
  • The idea of a government-financed single payer insurance program gets mixed support. Thirty-eight percent favor the concept, while 39 percent oppose it. Support drops to 24 percent when financial implications of large government spending increases are raised.


Many Aspects Of The Health Care Law Are Very Popular, Even Among Those Who Would Like To See It Repealed.

Trump and Republicans in Congress have made repeal of the ACA a top priority. Forty-six percent of Americans agree that the law should be repealed, but 53 percent would prefer to see the law preserved, at least in some form.

Three-quarters of those who want to keep the health care law would like to see improvements made to the program. Two-thirds of Americans who want the health care law dismantled want to see a replacement in place before repeal. Only one-third say the law should be repealed immediately.

Even those who want to see the health care law repealed favor many aspects of the law. At least 3 in 5 of those who oppose the health care law say they support prohibiting insurance companies from denying coverage based on pre-existing conditions, allowing children to stay on their parents’ policies until age 26, and eliminating out-of-pocket costs for preventative services. The individual mandate that requires most Americans to have health insurance or pay a penalty is the most unpopular element of the health care law.

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Supporters Of The Affordable Care Act Praise The Law For Helping The Poor While Those Who Oppose It Criticize It For Increasing Costs For Consumers.

Separate from whether or not they endorse repealing the law, 50 percent of Americans say they support the ACA while 35 percent oppose it and 15 percent neither support nor oppose the law.

Those who support the ACA find arguments regarding pre-existing conditions and expanding coverage to less affluent Americans to be particularly persuasive. Critics of the law are highly motivated by concerns regarding increased costs to individuals, and to a lesser extent, government intrusion into health care, the mandate, and government spending.

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More than half of Democrats (63 percent) and independents (64 percent) who oppose the law say it’s because the law doesn’t go far enough in expanding coverage. Only 36 percent of Republicans agree.

Though Several Provisions Of The Health Care Law Have Positive Implications For A Large Number Of Americans, Only About A Quarter Say Their Lives Have Been Favorably Affected By The Law.

On balance, Americans regard most groups as better off or unaffected by the health care law. About half say lower-income families are better off because of the law, and about 4 in 10 say women are better off. However, 4 in 10 say small businesses are worse off because of the law.

Some features of the health care law impact all who go to the doctor regardless of the source of their health insurance, such as no out-of-pocket costs for annual wellness visits and preventative services. In spite of these broad provisions, 46 percent of Americans say they haven’t been personally impacted by the health care law, and another 26 percent say it has a detrimental effect.

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A Majority Express Concern That Many Americans Will Lose Their Health Insurance As A Result Of Repealing The Health Care Law, And Nearly Half Say Repeal Will Leave Many Americans Worse Off.

Fifty-six percent of Americans are concerned that eliminating the health care law will cost many people their health insurance, 27 percent are somewhat concerned, and 17 percent are not very or not at all concerned. Nearly half, 49 percent, say overturning the health care law would be detrimental for most Americans, and only 26 percent say it would advantageous.  

Eight in 10 Democrats express concern that many Americans will lose their health insurance if the ACA is repealed, while most Republicans say they are just somewhat concerned or not at all concerned about this possibility. A majority of Republicans say that most Americans will be better off if the law is repealed while over three-quarters of Democrats say Americans will be worse off.

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A possible alternative to the health care law that some politicians, particularly in the Democratic Party, have supported would be what is called a “single payer system” where the government provides all Americans with the same health insurance plan. Support for single payer health insurance breaks along party lines. Overall, 38 percent favor and 39 percent oppose the idea while 22 percent neither favor nor oppose. About half of Democrats favor a single payer system while most Republicans oppose it. Among independents, 33 percent support a single payer plan, 36 percent oppose, and 27 percent neither support nor oppose.

Support decreases when fiscal implications are introduced. Just 24 percent of the public supports a single payer system if it would result in large increases in government spending, with Democrats being more likely to support it than either independents or Republicans.

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About The Study
Survey Methodology
This survey was conducted by The Associated Press-NORC Center for Public Affairs Research and with funding from NORC at the University of Chicago. Data were collected using AmeriSpeak Omnibus®, a monthly multi-client survey using NORC’s probability-based panel designed to be representative of the U.S. household population. The survey was part of a larger study that included questions about other topics not included in this report. During the initial recruitment phase of the panel, randomly selected U.S. households were sampled with a known, non-zero probability of selection from the NORC National Sample Frame and then contacted by U.S. mail, email, telephone, and field interviewers (face-to-face).

Interviews for this survey were conducted between January 12 and 16, 2017, with adults age 18 and over representing the 50 states and the District of Columbia. Panel members were randomly drawn from AmeriSpeak, and 1,036 completed the survey—814 via the web and 222 via telephone. The final stage completion rate is 31.1 percent, the weighted household panel response rate is 34.3 percent, and the weighted household panel retention rate is 94.4 percent, for a cumulative response rate of 10.1 percent. The overall margin of sampling error is +/- 3.7 percentage points at the 95 percent confidence level, including the design effect. The margin of sampling error may be higher for subgroups.

Once the sample has been selected and fielded, and all the study data have been collected and made final, a poststratification process is used to adjust for any survey nonresponse as well as any non-coverage or under- and oversampling resulting from the study specific sample design. Poststratification variables included age, gender, census division, race/ethnicity, and household phone status. The weighted data, which reflect the U.S. population of adults age 18 and over, were used for all analyses.

All differences reported between subgroups of the U.S. population are at the 95 percent level of statistical significance, meaning that there is only a 5 percent (or lower) probability that the observed differences could be attributed to chance variation in sampling.

A comprehensive listing of the questions, complete with tabulations of top-level results for each question, is available on The AP-NORC Center website: www.apnorc.org.

Contributing Researchers
From NORC at the University of Chicago
Marjorie Connelly
Dan Malato
Emily Alvarez
Jennifer Benz
Trevor Tompson
Liz Kantor
Nada Ganesh

From The Associated Press
Emily Swanson

About the Associated Press-NORC Center for Public Affairs Research
The AP-NORC Center for Public Affairs Research taps into the power of social science research and the highest-quality journalism to bring key information to people across the nation and throughout the world.

The Associated Press (AP) is the world’s essential news organization, bringing fast, unbiased news to all media platforms and formats.

NORC at the University of Chicago is one of the oldest and most respected, independent research institutions in the world.

The two organizations have established The AP-NORC Center for Public Affairs Research to conduct, analyze, and distribute social science research in the public interest on newsworthy topics, and to use the power of journalism to tell the stories that research reveals.