Americans Tilt More Negative Toward Affordable Care Act

WASHINGTON, D.C. -- A slight majority of Americans (52%) say they disapprove of 2010 healthcare law known as the Affordable Care Act or "Obamacare." Disapproval of the law, which has generated public opposition from its outset, is up four percentage points since July. Approval of the ACA now stands at 44%, down slightly from 47% this summer.

The ACA was signed into law a little over five years ago, and it has survived two legal challenges that could have invalidated or fundamentally altered large parts of the law had the Supreme Court ruled differently. But, as last week's gubernatorial election in Kentucky demonstrated -- where an avowed ACA critic was elected -- even if the legal challenges to the ACA are largely settled, the political ones are not.

Since 2013, the year before the law's much-debated mandate for individuals to obtain health insurance took effect, the ACA has been largely unpopular. Disapproval rose to 55% in late 2013 after the technology-troubled rollout of the federal government's health exchanges and the realization that millions of Americans had their insurance policies canceled because they did not meet the law's minimum coverage requirements. Those cancellations directly contradicted President Barack Obama's pledge that those who liked their insurance plan would be able to keep it under the law.

But over the course of 2014, even as the Obama administration presented solutions for these problems and the uninsured rate among U.S. adults fell dramatically, disapproval remained at or above majority levels. Scorn for the law rose as high as 56% in November 2014, shortly after Republicans won sole control of Congress, with many GOP candidates running promising to support legislation that would undo the law.

While the GOP-dominated Congress has so far been unable to advance a bill that would repeal the ACA wholesale, enthusiasm to repeal the law is hardly diminished among Republicans. Virtually all GOP presidential candidates promise to repeal the law if elected, and nearly nine in 10 rank-and-file Republicans (86%) disapprove of the ACA in the most recent survey. Gallup has previously found that identifying as Republican is the single biggest predictor in determining if a person will disapprove of the law.

ACA Approval Varies Little by Health Insurance Plan

The ACA expands healthcare coverage through various mechanisms, including by expanding eligibility for Medicare and Medicaid, at least for those living in states that have chosen to cooperate in the expansion of these government-run programs. An even greater number of Americans have obtained private health insurance of some variety under the law.

But whether Americans have a private insurance plan or are using Medicaid or Medicare exclusively, they are still more likely to disapprove than approve of the law, according to aggregated data from Gallup's 2014 and 2015 Healthcare polls. A majority of Americans with health coverage disapprove of the ACA, with 56% of Americans with private insurance plans disapproving and 50% of those using Medicaid or Medicare disapproving.

Individuals who say they have no insurance, however, tilt heavily toward disapproval of the healthcare law.

Bottom Line

The ACA, or Obamacare, remains the law of the land, overcoming numerous legal challenges -- including two that reached the Supreme Court -- and unrelenting political opposition. But the law's continued survival and its empirical success in lowering the uninsured rate has not made much difference in how Americans feel about the law. As such, it seems doubtful that the law will be broadly accepted in the U.S. political system in the near future. It will likely remain the target of efforts to repeal or significantly modify it, which could finally prevail if Americans elect a wholly Republican federal government in 2016.

Historical data are available in Gallup Analytics.

Survey Methods

Results for this Gallup poll are based on telephone interviews conducted Nov. 4-8, 2015, on the Gallup U.S. Daily survey, with a random sample of 1,021 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level. All reported margins of sampling error include computed design effects for weighting.

Each sample of national adults includes a minimum quota of 60% cellphone respondents and 40% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

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