Obama signs Affordable Care Act

President Obama signs the Health Care and Education Reconciliation Act of 2010.

Now that the federal exchange is functioning less terribly it seems supporters of the Affordable Care Act are again trying to convince themselves popularity is just around the corner. While I could be wrong I simply can’t see the law every becoming truly popular.

The simple fact is the law was unpopular while it was being drafted. It was unpopular when it was passed. It was unpopular for three years before it was implemented. While when Democrats were given their one chance to make a second first impression they completely fumbled the roll out.

If the administration can finally fix the technical problems and start actually providing insurance to new people that should bring the law’s popularity back from its new lows, but I doubt that will be enough to make it truly popular. Opinions about the law are pretty firm and the law will not directly touch most people at first.

In the first few years the law was meant to only affect about 10 percent of population. Of this group, arguably about 1 in 4 will legitimately consider themselves worse off because they are made to pay higher premiums or face more limited networks. Even among the people who are “winners”, they might not feel better off when they get hit with unexpected taxes due to incorrect subsidy calculations or find out a $12,000 annual cap doesn’t really protect them from a medical bankruptcy.

A big PR problem for the law is that the “winners” in this 10 percent will tend to be poor and the “losers” will tend to be middle class. The media has a habit of paying much more attention to the latter.

In addition, most of the people truly helped by the law will be individuals covered by the Medicaid expansion, but they wouldn’t be given something call “Obamacare Medicaid.” There is only Medicaid. This could make it hard for people to realize if they were helped by the law or not.

I think the best hope for the ACA is reluctant acceptance, not popularity. There is good chance it can become merely accepted and when it comes to politics that might be even more important. The country does have a strong status quo bias and very soon the ACA will be the new status quo.  Even when people disapprove of the status quo they can be very reluctant to change it. After all, our current health care system is pretty terrible, yet we mostly put up with it.

Currently, the ACA is the devil you don’t know, but in a two years it will become the devil you do know. At that point even if it is not popular it will be very tough to change, especially by Republicans who can’t offer a real plan alternative. Already the polling make it clear the law is very unpopular but so is the idea of simply repealing it.