Obamacare fractured the country in 2010. Five years later, pretty much nothing has changed.
The other big government welfare programs, namely Social Security, Medicare and Medicaid, all faced some Republican opposition when they were passed, but quickly won relative popularity after going into effect.
Not so for the Affordable Care Act.
Its major components are now rolled out, and millions of previously uninsured Americans have obtained health coverage of one sort or another through Medicaid expansion or buying federally subsidized private plans. Yet the law still sharply splits Congress and the American public.
“I can’t think of other laws that have divided the public in the same way,” said Patrick Egan, a politics and public policy professor at New York University.
Three election cycles have passed since President Obama signed the Affordable Care Act into law, and Republicans have won dozens of seats in Congress campaigning against it. And while the law probably won’t be the central issue during the 2016 presidential elections, there’s little sign that its political controversy is fading.
The persistent divisions were perhaps best summed up last week by Sen. Orrin Hatch, chairman of the powerful Senate Finance Committee, at a hearing noting the law’s five-year anniversary.
“I think it’s going to be an awful mess as the future goes on,” the Utah Republican said.
Experts agree that the ongoing opposition to the health care law, both in its breadth and intensity, is unprecedented compared to the government’s other big safety net programs.
One well-documented reason is that the political environment is more polarized than ever. And from the get-go, the public didn’t oppose Social Security or Medicare the way it dislikes the health care law, past polls show.
When Congress passed the Social Security Act in 1935, 89 percent of Americans favored the government providing “old-age pensions for needy persons,” according to a Gallup poll at the time.
And in the months leading up to the passage of Medicare in 1965, about 60 percent of the public told Gallup they approve of a “compulsory medical insurance program covering hospital and nursing home care for the elderly” to be “financed out of increased Social Security taxes.”
But the context was different in many ways, experts point out. At the time, the majority of Americans thought differently about how the government should involve itself in delivering benefits such as health care to Americans, according to Karlyn Bowman, a senior fellow at the American Enterprise Institute.
There was a widespread idea that “a rich and powerful country like the USA should be able to provide protections for a more vulnerable population,” she said.
“Government was doing fewer things, so there was a lot less to criticize,” she said. “I wouldn’t say there was a deep partisan split that we’ve seen on the Affordable Care Act from the very beginning.”
Another difference between Medicare and Social Security versus the Affordable Care Act: They eventually deliver government benefits to nearly everyone, while the health care law provides subsidies only for those with lower incomes. That makes it less attractive to a wider swath of Americans.
“The beneficiaries were clear,” said Gary Jacobson, a political science professor at the University of San Diego. “The expectation that everyone would eventually get old generated a great deal of support.”
The public was also sharply divided, and remains divided, over laws such as the Patriot Act and No Child Left Behind, both enacted under President George W. Bush.
But health care is a deeply personal issue in a way that education and terrorism threats aren’t, Egan said.
“They don’t affect every single American it the same way the health care law does, so in that sense neither of those issue have ever had as much heat as the Affordable Care Act,” he said.
By now, Republicans’ criticisms of the health care law, and Democrats’ defenses of it, have been aired for years. But that’s not making them less useful to each side, as the parties continue warring over the law.
“These are not well-worn talking points,” said Sen. Pat Roberts, R-Kansas, at the finance hearing. “These are egregious complaints by my colleagues.”
