Poll: 7 in 10 Want the Trump Administration to Make the Affordable Care Act Work Rather Than Make it Fail

Large Majorities of Democrats, Republicans and Independents Favor Continuing Cost-Sharing Reduction Payments as Part of Bipartisan Deal in Congress To Give States More Flexibility

As the Trump administration begins implementing Thursday’s executive order aimed at providing alternatives to the Affordable Care Act’s marketplace plans, a new Kaiser Health Tracking Poll finds a large majority of the public (71%) want President Trump and his administration to do what they can to make the current law work.

Fielded just prior to Thursday’s executive order, the poll finds fewer Americans (21%) say that the president and his administration should do what they can to make the law fail so they can replace it later.

The vast majority of Democrats (93%) and three quarters of independents (74%) say the Trump administration should do what they can to make the law work. Republicans are more divided, with about half (48%) saying they should do what they can to make the law work and about four in 10 (43%) saying the administration should do what they can to make the law fail.

The poll also finds two thirds of the public (66%) say it is more important for President Trump and Congress to work on legislation to stabilize the Affordable Care Act’s marketplaces than continue efforts to repeal and replace it. That is more than twice the share (30%) who say it is more important for the administration and Congress to continue repeal and replace efforts than to stabilize the markets.

Large majorities of Democrats (85%) and independents (67%) say stabilizing the marketplaces to minimize premium increases and encourage competition is more important. Republicans, however, are more divided between continuing repeal and replace efforts (51%) and stabilizing the marketplaces (43%).

Late Thursday, the Trump administration announced it would end cost-sharing reduction payments to insurers intended to lower the deductibles and copayments that low-income marketplace enrollees face. The poll finds that a majority of the public (60%) favor Congress guaranteeing those payments to insurers while a third (33%) say they are a bailout of insurance companies and should be stopped.

Partisans view the cost-sharing subsidies very differently. While majorities of Democrats (82%) and independents (62%) want Congress to continue them, most Republicans (55%) say that the payments should stop.

However, these partisan differences fade when framed as part of a bipartisan deal to stabilize the ACA marketplaces similar to the one being negotiated by Senators Lamar Alexander and Patty Murray. When asked whether they support Congress guaranteeing the funds to continue the cost-sharing reduction payments as part of a bipartisan compromise that also would give states more flexibility in the types of plan sold in their state’s marketplace, a majority of the public (69%) – including roughly equal shares of Democrats (69%), independents (70%), and Republicans (68%) – say they support such a compromise.

Despite support for a bipartisan approach, a large majority (69%) of the public say that they are either “not too confident” or “not at all” confident that President Trump and Congress will be able to work together to improve the ACA marketplaces. Fewer (30%) say they are either “very” or “somewhat” confident that they will be able to work together.

In the past few months, President Trump’s administration has made a number of changes related to the ACA and the marketplaces. In general, about twice as many say the actions taken by President Trump and his administration are “hurting” (40%) the way the ACA marketplaces are working than say the actions are “helping” (19%). One-third (34%) say their actions are not having much impact on the way the marketplaces are working.

When asked about four specific actions the Trump administration has taken related to ACA marketplaces, the public is largely divided. Half approve of the Trump administration decreasing federal spending on advertisements encouraging people to sign up for health insurance and suggesting the federal government may stop enforcing the individual requirement to have health insurance or else pay a fine. On the other hand, most (61%) disapprove of the Trump administration decreasing federal funding to organizations that help people enroll in health insurance, and half disapprove of limiting federal involvement in community events held by states to encourage enrollment.

Not surprisingly, approval of the actions taken by President Trump’s administration are largely driven by party identification with the majority of Republicans expressing approval for each of the four actions while few Democrats approve of any of the actions.

Other findings include:

• This month, half (51%) of the public express favorable views of the ACA, while 40 percent express unfavorable views of the 2010 law. This is a five percentage points increase in the share of the public who held favorable attitudes in September (46%) and similar to August, when more expressed a favorable opinion than an unfavorable one (52% favorable, 39% unfavorable).
  
  
• About half of the public overall (54%), and majorities across parties – Republicans (52%), independents (56%), and Democrats (55%) – say it is important for the country to continue the debate over the health care law. Smaller shares – about four in ten – say that they are tired of the debate and think the country should focus more on other issues.

METHODOLOGY

Designed and analyzed by public opinion researchers at the Kaiser Family Foundation, the poll was conducted from October 5 – 10 among a nationally representative random digit dial telephone sample of 1,215 adults. Interviews were conducted in English and Spanish by landline (429) and cell phone (786). The margin of sampling error is plus or minus 3 percentage points for the full sample. For results based on subgroups, the margin of sampling error may be higher.

Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.