American Conundrum, plus Discoveries

From Minnesota Alumni Magazine Fall 2016

How Larry Jacobs is teasing out Americans' mixed feelings about health care reform

By Stephanie Soucheray, Illustration by Miguel Gallardo

Seven years after former vice presidential candidate Sarah Palin made famous the term "death panels," a researcher from the University of Minnesota's Humphrey School has documented that the Affordable Care Act (ACA), commonly known as Obamacare, is still a polarizing topic among Americans-even those who say they've benefited from it. Political scientist Larry Jacobs, director of the Center for the Study of Politics and Governance at the Humphrey School, published his findings about popular opinion and the ACA in the journal Health Affairs. Americans, Jacobs says, are experiencing cognitive dissonance when it comes to health care reform.

The findings come out of an ongoing panel study of 1,200 participants Jacobs is conducting with Suzanne Mettler, a political scientist at Cornell University. A panel study, unlike other political opinion polls, measures the opinions of the same individuals over a long period of time to determine how their thoughts and attitudes change. Jacobs polled participants in 2010, 2012, and 2014.

During the period of the study, there was a 19 percent increase in the number of participants who said the law is providing tangible benefits to Americans. The most often cited benefits were: subsidies to pay for insurance, better drug coverage for seniors, and allowing children to stay on parents' policies until age 26. Respondents who said the law had little or no impact on access to health insurance decreased by 18 percent.

Though Americans are more appreciative of its tangible benefits, popular opinion of the law is still stubbornly divided: 45.6 percent of respondents had a negative view of the law, while 36.2 percent favored it. And even more confusing, among individuals who have had an unfavorable view of the ACA since 2010, the number who support a repeal of the law decreased by 9 percentage points, to 72 percent, by 2014.

"Health care reform is a huge puzzle in America," says Jacobs. "If you look at media polling, there are more people who dislike than like the ACA, yet over 20 million people benefit from the health insurance and new regulations."

Jacobs says a panel study is the only way to understand the complex and conflicting emotions surrounding health care reform. "Panel studies are the gold standard in social science, but they're challenging and expensive," he says. "Everyone else does snapshot polls of separate groups of people, but a panel gives us enormous power in explaining this mystery of why Americans are appreciative but so negative about the law."

Jacobs says the fraught partisan politics that have been the hallmark of the Obama presidency are to blame for this confusion. "The positive feelings about the law are overtaken by the toxic environment," Jacobs says. "If you're a Republican and you hate Obama, there's a 'circle the wagons' mentality when it comes to the ACA. And the constant efforts to repeal the law undermine it and influence public opinion."

Besides extreme partisanship, Jacobs says the other main reason for the law's unpopularity is a general distrust of government programs, and the sense that the government is inept at handling health insurance. "The health care exchange website was bad in 2013, and there continued to be technical snafus," says Jacobs. "Premiums have also risen."

Humphrey School Dean Eric Schwartz says Jacobs's work is vital in today's divisive political climate. "Larry does what good scholars in public affairs should do," says Schwartz. "He cuts through unsupported instincts and impressions to identify political and social phenomena based on careful analysis."

The mixed attitudes about health care reform are remarkable in the context of American social policy, Jacobs says. "Look at Social Security. When people get benefits they usually like the program, but not the ACA." Jacobs also says the passing of Medicare in 1965 also provides an interesting history lesson.

"When Medicare was first introduced it was called socialism in the doctor's office," he says. "Ronald Reagan [then an actor] was hired by the California medical board to speak out against the law." In other words, the nation was divided on Medicare, just as it is on Obamacare. But once the law passed, Jacobs says, there was a general sense of acceptance. "After Medicare was passed it was 'Let's get this thing working.' There was no talk of repeal."

Jacobs and Mettler will conduct another survey of their participants this fall and in 2018. He says he's interested in seeing what will happen to public opinion when a new president is in office.


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