Mark Blumenthal highlights one of the more remarkable aspect of the new Kaiser Family Foundation poll I wrote about earlier. In addition to the remarkably consistent and intense opposition among Republicans to the reform, people remain very confused about the law.
First, roughly half of Americans (53 percent on their most recent survey) continue to say that they are "confused" about the health reform law. A similar percentage (47 percent this month) say they lack sufficient information about the law to know how it will impact them personally.
The Kaiser analysis also reports that the greater intensity of feeling among Republicans remains "essentially unchanged," with 59 percent now expressing a very unfavorable opinion.
So why no change?
The main provisions of the bill have not gone into effect and so Americans are neither experiencing its benefits nor dissuaded from the fears raised by opponents of the law.
In fact, "confused" is the most prevalent reaction, beating out “angry,” “anxious” and “enthusiastic," which Blumenthal says should be expected, given previous reforms. He describes the polling among seniors after the last health reform effort, the prescription drug benefit now known as Medicare Part D. That new law had high levels of negative impressions for months after it was signed—55% of seniors had an unfavorable opinion three months after it was enacted, and dominated for a couple of years until seniors actually experienced the program and saw benefits. An AARP survey conducted in 2008 found 67% approval for the program.
Taking that lesson, Blumenthal expects attitudes on the Affordable Care Act to remain fairly negative until the program really starts to kick in in 2014.
Back in 2009, I asked Bob Blendon, the Harvard professor of health policy who has studied Kaiser's opinion data for decades, what this experience might predict about attitudes toward health reform should it pass. "If you give benefits out right away," he said at the time, "and the benefits affect a lot of people, then…there will be support and people will like the bill."
But the major provisions do not go into effect until 2014 and relatively few benefit from those enacted so far, such as the high-risk pools for those without insurance due to pre-existing conditions.
Interviewed late last week, Blendon expressed little surprise over the lack of change in health reform attitudes, although he believes the delay before full enactment of health reform has an important impact on the politics of the issue as well. Americans that oppose the bill, he says are most "worried about the impact on Medicare or government interfering with medicine or the costs [or] the deficit." Those fears will remain hypothetical until at least 2014.
The next election, however, could change all that should Obama lose the White House. In that case, the law would likely never be fully implemented and what could be undone among the measures that have been implemented would be. This was always a danger pushing off full implementation of the law until after 2012. While some of the more popular elements of it have gone into effect—ending exclusion of children for pre-existing conditions, allowing adult children to stay on their parents policies until age 26—the parts of it that will affect the most people are still hanging out there as unknowns, easy targets for opponents.