President Donald Trump had hoped to celebrate his 100-day mark by boasting of his success in obliterating his loser predecessor's signature domestic accomplishment -- and in replacing it (naturally, since Trump is a winner) with something that delivers more and better health care for less money. Instead, one of his chief 100-day accomplishments may be that he's in the process of making Obamacare more popular.
A new Post-ABC News poll finds that 61 percent of Americans now favor keeping and improving the Affordable Care Act, while only 37 percent favor repealing and replacing it. Crucially, it also finds that huge majorities reject the ideas at the core of the latest version of the GOP replacement that Trump is championing.
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Only 33 percent support allowing states to decide whether to require insurers to cover Essential Health Benefits (EHBs), such as doctors' visits and emergency room visits, while 62 percent say it should be required in all states (as the ACA does). And only 26 percent support allowing states to decide whether insurers are banned from jacking up prices for people with preexisting conditions, compared with 70 percent who say it should be required in all states. Both of these state-waiver provisions are in the latest GOP plan.
What's even more striking, though, is that many voters who backed Trump are rejecting the GOP solutions. According to the poll's crosstabs, Trump voters are split on the Essential Health Benefits provision, with 45 percent saying all states should require them and 49 percent saying states should decide. Trump voters are also split on the ban on insurers hiking premiums on preexisting conditions: 51 percent of Trump voters support that ban, while 45 percent favor allowing states to decide (as Trumpcare would do). Republican respondents say this by a striking 55-39.
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While Trump voters do overwhelmingly favor repeal-and-replace in the abstract, there is not much support among them for the ideas at the core of the concrete replacement Trump is championing. This suggests that a key piece of conventional wisdom about this debate -- that Trump will badly disappoint his base if this plan doesn't go through -- perhaps deserves more skepticism.
The new poll also shows that Trump's bluster about sabotaging the ACA to force Democrats to the table is a non-starter with the public, including with his supporters. Americans overall say that during this debate, Trump and Republicans should make the law work as well as possible by 79 percent, while 13 percent want to make the current law fail as soon as possible. Even Trump voters say this, 58-28.
One of the big stories of the 2017 health-care debate has been this: When voters were finally presented with a choice between the unpopular ACA and a massively regressive GOP alternative that would slash spending and regulations and roll back the ACA's historic coverage expansion for the poor and sick, they decided they preferred the former, and rejected the latter. Perhaps because of this, a nontrivial number of moderate GOP lawmakers appear privately okay with the ACA's general spending and regulatory architecture, though they can't say it that way out loud.
To be sure, the future of the ACA exchanges is hardly assured, and it's still possible that the GOP could succeed in repealing and replacing the law. Trump and Republicans continue to try to push a solution that includes the above deregulatory provisions, to win over conservatives. But the unpopularity of those provisions suggests that continuing down this path invites a backlash in the 2018 elections. Indeed, our poll finds that independents oppose the EHB provision, 67-28; and they oppose the preexisting conditions provision, 71-27. Will vulnerable Republicans really want to vote for those?
Trump strongly suggested during the campaign that he represented an ideological break from Paul Ryan and House Republicans when it comes to government's role in covering poor and sick people. He then embraced Ryan's plan, because it turned out (shockingly) that he just wanted the "win" of crushing Obamcare, with zero concern for the details or human toll the Ryan replacement would impose on millions. The public has rejected the wildly regressive Ryan vision, and this route forward only carries further political peril.
Trump does, of course, have another option: He can drop repeal, revert to his promise of ideological heterodoxy and make a deal with Democrats to improve the ACA. This might plausibly make him more popular. Indeed, our poll finds that only 26 percent of Americans think Trump should continue working with conservative Republicans in trying to change the law -- people have perhaps figured out that the GOP has nothing on this issue -- while 43 percent say he should work with Democrats.
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