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Trump is reading the GOP base wrong on the Affordable Care Act


Data: Kaiser Health Tracking poll conducted Nov. 14-19, 2018, among 1,201 U.S. adults. Total margin of error is ±3.0 percentage points. Poll methodology; Chart: Chris Canipe

The only plausible explanation for President Trump's renewed effort through the courts to do away with the Affordable Care Act, other than muscle memory, is a desire to play to his base despite widely reported misgivings in his own administration and among Republicans in Congress.

Reality check: But the Republican base has more complicated views about the ACA than the activists who show up at rallies and cheer when the president talks about repealing the law. The polling is clear: Republicans don't like the ACA, but just like everyone else, they like its benefits and will not want to lose them.

The big picture: About three-quarters of Republicans still have an unfavorable view of the ACA, and 7 in 10 say repealing the law is a top health priority for Congress — higher than other priorities such as dealing with prescription drug costs. And yes, 7 in 10 Republicans still want to see the Supreme Court overturn the law.

But as the chart shows, majorities of Republicans like many elements of the ACA —especially closing the "doughnut hole" in Medicare prescription drug coverage (80%), eliminating copayments for preventive services (68%), and keeping young adults under 26 on their parents' plans (66%) and subsidies for low- and middle-income households (63%).

  • Nearly half of Republicans want the Supreme Court to keep the protections for pre-existing conditions (49%), and even more show general support for the pre-existing conditions protections (58%).
  • During the repeal and replace debate in 2017, even Republicans were nervous to hear that these sorts of things would go away. The 2020 campaign would drive home to the public, and to Republicans, what they have to lose — and it would become especially real to them if the 5th Circuit Court of Appeals upholds the ruling striking down the ACA.  

Maybe Republicans would forget about these lost benefits if they could agree on a replacement plan they liked? But there isn't one, and many of the ideas thought to be elements of one — such as cutting and block granting both Medicaid and ACA subsidies — are non-starters with Democrats and moderate Republicans on Capitol Hill. They're unpopular with the public, too. 

The bottom line: It is widely accepted that a renewed debate about repeal hands Democrats a powerful new political opportunity. Deeper in the polling, it's also clear that’s it's more of a mixed bag for Republicans than President Trump may realize.