U.S. Health and Human Services Secretary Kathleen Sebelius’ trip to Austin this week to promote the Medicaid expansion and the federal government’s apparent willingness to negotiate with Texas on the terms of it under the Affordable Care Act met with sharp rebukes from the Texas GOP. In a widely quoted statement, Gov. Rick Perry responded, “With due respect, the secretary and our president are missing the point: It’s not that Americans don’t understand Obamacare, it’s that we understand it all too well.”
While most Americans do in fact have an opinion on the Affordable Care Act, to say that they understand it — at all, let alone “all too well” — runs contrary to the data currently available.
Perry knows there is an audience for his whack at the Obamacare piñata. In Texas, as in the nation, most polls show voters pretty evenly split on the issue. In the 2012 Texas Lyceum Poll, equal proportions (46 percent) of Texans expressed favorable and unfavorable attitudes towards Obamacare. Nationally, according to a June 2013 Gallup Poll, 44 percent of Americans expressed approval of the law while 52 percent expressed disapproval. But even here in Texas, when the opportunity came up for the Supreme Court to strike the law down, according to the May 2012 University of Texas / Texas Tribune Poll, 45 percent wanted the individual mandate overturned and the whole law thrown out, 36 percent either wanted the law ruled constitutional or wanted the individual mandate ruled unconstitutional while maintaining the constitutionality of the rest of the law, and 19 percent had no opinion — not overwhelming opposition.
While this data addresses Perry’s implicit contention that Americans know about the law, but don’t like it, it doesn’t address his explicit contention: that they do know about the law. This proposition seems unlikely when examined from at least two angles, the contradictions in opinions on the ACA and the public’s expressed lack of knowledge about the law’s basic components.
The close divisions in Texas and in the country on the ACA, as in so many other cases, are not without internal contradictions — the primary and repeatedly confirmed contradiction being between high levels of support for most individual elements of the ACA that surpass approval levels found when asking about the overall package. To take one of many surveys that found such contradictory opinions, the March 2012 Kaiser Foundation Health Tracking Poll asked whether respondents approved of 12 specific elements of the ACA and found that only one element of the ACA, the individual mandate, was supported by less than 50 percent of Americans; seven of the 12 elements were supported by 69 percent or more.
Available data on the public’s knowledge of the law’s basic components seems to contradict the governor’s contention as well. According to the April Kaiser Poll, 42 percent of Americans expressed uncertainty about whether the Affordable Care Act is still the law of the land and 78 percent said that they didn’t know whether their governor had decided to expand Medicaid in their state. More recently, in Kaiser’s June Poll, only 24 percent of respondents said that they had heard “a lot” or “some” about the health insurance exchanges, echoing the results of the March 2012 Kaiser survey suggesting that as time passes since the ACA’s passage, familiarity with the act’s provisions erodes.
Perry’s response to Sebelius’ visit to Texas didn’t surprise anyone who has watched the governor repeatedly call President Obama and the health care reform plan socialist. The same Kaiser tracking polling data do show that between 75 percent and 90 percent of Republicans have been opposed to the ACA since it was passed. You can bet that for his part, Perry understands those facts all too well.