Don't Repeal Obamacare Without Replacement, Most Americans Say

Three-quarters of Americans either want to keep the Affordable Care Act (ACA) or think Congress should have a replacement plan ready before undoing President Barack Obama’s signature healthcare law, according to a new poll.

The Kaiser Health Tracking Poll found released Friday found that Americans are as divided as ever over the ACA, with 47% saying they don’t want the law repealed. The finding shows what Kaiser polls have found since 2010—the country is evenly divided over “Obamacare,” with 46% viewing it unfavorably and 43% favorably. But the new poll revealed something new: another 28% don’t want the law repealed without something to take its place—only 20% support an immediate repeal with a new plan to come later.

On Wednesday, the Senate voted 51-48 to open debate on a budget resolution that would be the vehicle for undoing the ACA while dodging a Democratic filibuster. If Congress moves to gut the healthcare law in the first days of the 115th session, a budget reconciliation bill could reach President-elect Donald J. Trump soon after he takes office January 20.

However, there are signs Republicans are growing wary of threatening coverage for 20 million Americans who have gained it since early 2014, including many in states that voted for Trump. Since the election, published reports show some voters who voted for Trump didn’t really think he would undo Medicaid expansion.

US Senator Rand Paul, R-Kentucky, has said he will vote against the budget move for unrelated reasons, but his state has seen the second-largest drop in the uninsured rate under the ACA. Another GOP senator, Tom Cotton, R-Arkansas, called for a having a replacement this week—his state has seen the largest decrease in uninsured. On Thursday, HHS announced that the number of Americans who went without health coverage because of preexisting conditions has declined 22% since 2014, by 3.6 million people.

The Kaiser polls suggest that a debate over repealing the ACA could bring shifts in public opinion, since the polls have consistently found that the public changes its views when hearing detailed arguments about the law. Also, reaction to the term “Obamacare” has always been more negative than responses to individual components of the law itself. Sizeable majorities support elements like keeping adult children on family health plans through age 26, or keeping the ban on denying coverage for preexisting conditions.

Americans’ views of healthcare center less on ideological positions—such as who should control the system—and more on practical matters like lowering their own spending. The poll found top priorities were lowering out-of-pocket costs (67%) and lowering the cost of prescription drugs (61%). Also, 45% of Americans say dealing with the nation’s opioid and heroin epidemic should be a top priority, which is a higher share than those who want Congress to focus on repealing the ACA itself.

As has been so since 2010, views of the ACA divide sharply along partisan lines. Among Republicans, 53% support limiting the federal government’s role in healthcare and returning more control to states. But Democrats (79%) and independents (65%) want the federal government to guarantee a certain minimum level of coverage for seniors and the poor.

Most Americans say repealing the ACA would not change their healthcare situation much, with 55% saying they would keep their current coverage and 57% saying the quality of their care would be unchanged. The rest are divided: 27% say repealing the ACA will improve their own healthcare, while 28% say things would get worse.

In the past week, major physicians’ groups have called on Congress to not repeal with ACA without working to keep uninsured rates in check. This summer, the uninsured rate reached its lowest level in recent history at 8.6%, and weekly reports from HHS show that enrollment on the exchanges for 2017 is outpacing the 2016 period.