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Poll shows Americans deeply divided on
March 21, 2011—A year after President Obama
signed health reform into law, the public
remains deeply divided over the landmark
legislation, with a year of political debate
over its merits and the beginning stages of
its implementation doing little to alter
Americans’ opinions about the law.
In March, one year after enactment, 42
percent of Americans hold favorable views of
the law while 46 percent view it
unfavorably, a basic division that has
changed little during the last 12 months.
(In April 2010, 46 percent had favorable
views and 40 percent unfavorable ones, but
both figures have ticked up and down over
the last year.)
Opinion of the law continues to break
sharply along partisan lines, with 71
percent of Democrats backing the law and 82
percent of Republicans opposing it.
About half (51%) of Americans who like the
law cite expanded access to insurance and
health care as the reason.
Those who do not like it give a greater
variety reasons: 20 percent are concerned
about costs; 19 percent have concerns about
government’s role; and 18 percent mention
opposition to the individual mandate.
A majority of Americans do agree on
something: 53 percent are confused about the
law, the major provisions of which won’t
take effect until 2014. This is nearly
identical to the 55 percent who reported
being confused in April 2010.
Further, 52 percent this month say they do
not have enough information about health
reform to understand how it will impact them
personally, while 47 percent think they do.
Members of the groups most likely to benefit
from health reform — the uninsured and those
living in low-income households — are the
most likely to say they do not know enough
about the law’s potential impacts.
With Republicans quite critical of the law
and some state officials chafing at its
requirements, the issue of how much
flexibility states should be granted, and
with what conditions attached, has been a
subject of debate in Washington.
Two-thirds of Americans agree that states
should be able to substitute their own
health reform plans provided that they are
as comprehensive and affordable as the
national one created by the new law.
The idea wins majority support across the
political spectrum, backed by 75 percent of
Republicans, 72 percent of independents and
55 percent of Democrats. But public support
for state flexibility drops sharply if
people think states would use substitute
plans to save money by offering more limited
insurance to fewer people than the national
In that case, roughly two in three Americans
(65%) would oppose state substitution, while
26 percent would still favor it.
The requirement that nearly every American
obtain health insurance – known as the
individual mandate – remains unpopular, with
67 percent of the public supporting the
repeal of that provision.
That view is not an immovable one, however.
For instance, support for repealing the
mandate fell to 35 percent when those who
initially supported repeal were told that
“under the reform law, most Americans would
still get coverage through their employers
and so would automatically satisfy the
requirement without having to buy any new
There was a similar, if smaller, drop in
support for the mandate’s repeal to 48
percent when repeal supporters were told
that without such a requirement people might
wait until they were sick to buy insurance.
At the one year mark, seniors continue to be
more skeptical about health reform than
other Americans, with 52 percent holding an
unfavorable view of the law in March and 40
percent holding a favorable one.
This month, however, saw a break in the
trend of increasing negativity among seniors
toward health reform that began in December.
Unfavorable views of the law among seniors
dropped by 7 percentage points from February
to March, while favorable views increased by
8 percentage points.
Still, by a two-to-one margin, seniors are
more likely to believe that Medicare will be
worse off (39%) than better off (19%)
because of health reform.
This Kaiser Health Tracking Poll was
designed and analyzed by public opinion
researchers at the Kaiser Family Foundation.
The survey was conducted March 8 - 13, 2011,
among a nationally representative random
sample of 1,202 adults ages 18 and older.
Telephone interviews conducted by landline
(801) and cell phone (401, including 171 who
had no landline telephone) were carried out
in English and Spanish by Princeton Survey
The margin of sampling error is plus or
minus 3 percentage points. For results based
on other subgroups, the margin of sampling
error may be higher.