Since its enactment in 2010, the Affordable Care Act, also known as “Obamacare,” has not been a runaway success. Public opinion has moved from disapproval to lukewarm support: monthly Kaiser Health tracking polls show that 40 percent of American adults viewed Obamacare unfavorably in July 2015, down from 53 percent in July of 2014, but high nonetheless. The law has taken center-stage in recent elections, with one CBS News poll indicating that 23 percent of respondents felt that the most important issue in the 2014 midterm elections would be health care, second only to the economy.
Obamacare is largely a form of social welfare spending, and as such, the negative, and more recently lukewarm, public perception of Obamacare has led to diminished welfare spending since the bill’s passage. In 2010, welfare spending as a percentage of GDP was 4.55 percent, excluding spending on the ACA. By 2012, this number had decreased to 3.49 percent of GDP, and by 2015 it had dropped to an estimated 2.09 percent, on par with welfare spending in 1970.
The Affordable Care Act’s stated goals include expanding healthcare coverage nationwide, providing tax breaks to small businesses, and stopping insurers from dropping the insured during periods of illness. Though Obamacare initially experienced issues with its website, it has lowered the rate of uninsured Americans by 8 percentage points from a high of 18 percent in 2013, and the cost of health care since the implementation of the Affordable Care Act has risen at a slightly slower rate than it had before the law’s passage. So why did a majority of Americans initially disapprove of the Affordable Care Act despite its many strengths?
Healthcare policy expert Anton Gunn, a member of the task force that worked with state lawmakers to shape the provisions of the Affordable Care Act, told the HPR that this initial disapproval arose because the Republican Party was better able to craft a message around healthcare reform. John Tantillo, a marketing expert and creator of the term “The O’Reilly Factor,” has written that one such packaging issue on the part of Democrats was the Obama administration’s inability to control the use of the term “Obamacare.” Tantillo argues that the term automatically “alienated a third of the [healthcare] market,” namely Republicans, and that those implementing the Affordable Care Act should have continually corrected use of the term.
Daily Beast writer Judith Grey has pointed to the administration’s inability to market to the millennials as a major flaw. Grey, along with Tantillo in a separate article, argues that young and single millenials don’t feel they need to purchase healthcare. Grey also highlights poorly-targeted advertisements that omit one of the Affordable Care Act’s possibly greatest selling points: polls have indicated that millennials are highly concerned with social justice, yet the administration has not advertised the fact that millennial enrollment in the program lowers healthcare costs for elderly participants.
Essentially, Democrats did not package the bill to the public properly, allowing Republicans to exploit the law’s intricacy—it is, in its accepted form, 906 pages long—to spread fear regarding the law and the changes that it legislates. For instance, House Republicans have complained of the increasing cost of Obamacare, and while it does in fact cost hundreds of billions of dollars, the projected price has actually decreased over time.
Partly because of the Republican Party’s effective use of the media, Americans overwhelmingly voted Republican. Following the election of 2008, before the passage of Obamacare, the Democratic Party held a majority in the House of Representatives, with 59 percent of the seats. Then, in the election of 2010, which came a few months after the passage of the Affordable Care Act, voters gave the Republicans control of the House with a net gain of 64 seats. The last time a change of this magnitude occurred in the House of Representatives was when Harry Truman was in office.
Strengthened by their new majority, the Republican Party worked to limited welfare spending. However, the results of the Election of 2010 may also have limited how much focus Democrats placed on welfare spending. According to Gunn, many of the 219 congressional Democrats—46 in fact—who voted for the Affordable Care Act lost their seats in Congress after November of 2010, while only 20 Democrats who did not vote for Obamacare lost their seats. These members, as opposed to their fellow Democrats who did not vote for the bill, were likely more welfare spending-oriented, as Obamacare does have a large price tag: President Obama had predicted it would cost around $900 billion over 10 years in 2009. Thus, not only the Republican Party’s return to control but also the removal of more spending-oriented Democrats decreased the potential for welfare spending.
The Affordable Care Act was hailed by Democrats as a great victory for the poor and minorities and a monumental change to the government-citizen relationship in the United States. The bill was so monumental, however, that its passage has had a large impact on welfare policy. The Republican Party’s effective media use and the Obama administration’s missteps have contributed to large reductions welfare spending in the last five years, and will likely continue to echo into 2016.
Image Credits: Flickr/ Peter Stevens