There is no denying it: Americans are split over health carereform – the Patient Protection and Affordable Care Act. The latest pollconfirms this.

A Harris Interactive/HealthDay poll of 2,019 adults taken lastNovember found that 28 percent of adults want to repeal thelegislation, 31 percent want to keep all or most of the reforms,and 29 percent aren't sure.

Two-thirds of the respondents said they like the fact that thereform package prevents insurers from denying coverage to peoplewith pre-existing medical conditions. Another 60 percent want tokeep the provision for tax credits, so small businesses can affordcoverage for employees. Fifty-five percent like the idea that thelaw allows children to stay on their parents' insurance plans untilthey are 26.

And a little more than half support the idea of new insuranceexchanges where people can shop for insurance. Only one part of thelaw remains widely unpopular. Fifty-seven percent of respondentsoppose the requirement that people without health insurance buy itor face a penalty, while only 19 percent support it.

Those who want all or most of the law repealed say they thinkit's an unwarranted expansion of big government that will lead tohigher taxes, rationing of health care, and possibly evensocialism. Eighty-two percent of those wanting to repeal all or most believe it's “too expensive” and “will meanhigher taxes.” Seventy-seven percent believe it'll reduce thequality of individuals' health care. Seventy-four percent believeit'll lead to “rationing of health care.”

Seventy-one percent see it as a form of “socialism.” However, alarge percentage of the people who want most of the law repealedare happy with many of its provisions. Of those who want thelegislation repealed, forty-four percent say they would like tokeep the provision that bars insurers from denying coverage topeople with pre-existing medical conditions. Thirty-eight percentfavor offering tax credits to small businesses to help pay foremployee's insurance.

Sara Collins, vice president for affordable health insurancewith The Commonwealth Fund, notes public polls on health carereform over the last several months, including this most recentpoll, have been relatively consistent.

“They continue to show a split in the public's view of the lawfrom an overall perspective,” she states.
“However, when you start asking people about particular provisions,the majority tend to like certain ones. These include allowingpeople under 26 to stay on their parents' policies, guaranteedcoverage for pre-existing conditions, and bans on lifetime benefitlimits.”

Fred Hunt, president of the Society of Professional BenefitAdministrators, sees similar sentiment.
“When you're given candy, you like it, and you want to keep it,” hestates. “I know a number of people who were stern opponents ofhealth care reform, and they're still stern opponents. But, oh, bythe way, it sure is nice being able to have my daughter in collegecovered until she turns 26. And I have a friend with a pre-existingcondition, so it's nice that reform can help him.”

Part of the reason for the split, according to Dr. DevonHerrick, a senior fellow with the National Center for PolicyAnalysis, has been the difficulty of understanding all of the law'simplications.

“During the presidential campaign and during the health carereform debate, the American people were told, 'If you like what youhave, you can keep it,'” he says. “Part of the issue now is that,as people begin to hear more and more about the 2,600 or 2,700pages of the bill, they begin to hear about some things they like,as well as some things they don't like.”

Before the election, Herrick says, polls showed that 84 percentto 86 percent of the population liked what they had already interms of health care coverage.

“They knew that some things needed to be fixed, but how thatshould be accomplished was generally determined by one's politicalparty affiliation.”

It has always been Herrick's belief that, when people say theywant health reform, it's more of a theoretical construct in manycases.

“They favor it for someone else, but they don't want to losewhat they have,” he explains. “And these days, some people areworried they might lose what they have.” Another reason for publicconcern relates to cost.

“While we believe health care reform was the right thing to do,it imposes real costs on the system,” admits Mark C. Blum,executive director of America's Agenda: Health Care for All.

“Many people didn't anticipate this, because there was a largeexpectation that reform would focus on cost containment much morecoherently and aggressively than it did.”

That is, according to Blum, about 85 percent of Americansalready have coverage. Reform focused more on providing coveragefor the 15 percent whodon't.

“However, not enough attention was paid to the extra costs thatwill have to be borne by those with coverage. So, what really needsto be addressed now is cost containment and improved health careefficiency,” Blum says.

Implications
What impact will public perception of the new law have oncongressional and White House action in the months to come?

“We expect to see a lot of posturing over the next two yearsleading to the next presidential election,” Blum replies. “However,realistically, we don't think repeal will occur, with a DemocraticSenate and Obama as president. What happens after 2012, though, isanother thing.”

NCPA's Herrick believes shifting public perspective will have a“sobering effect” on the next Congress.
“During the debate, the bill was hard to digest into 'sound bites,'so the Democrats tended to attack health insurers, promote the morepopular aspects of the bill, and play down the negative aspects andthe costs,” he explains.

“However, they thought that, once it passed, it would tend togrow on people. That hasn't happened yet, and it cost them heavilyin the recent election. However, a lot of Democrats still believethat health care reform will grow on people.”

There are a lot of challenges that will have to be dealt with,Herrick adds. One is the individual mandate.
“Health insurance costs are rising at twice the rate of income, sosooner or later this is going to be a problem because people willbe forced to purchase something that is rising twice as fast astheir wages are rising,” he explains.

Another challenge is that people will have the ability to “game”the system. “The penalty for not buying coverage is pretty weak,and we are not sure it will even be enforced,” he notes. “Yet,insurance companies are being told that they must sell to anyonewho applies at rates that are tightly banded together. So, ifpeople can wait to buy coverage until they are sick, this doesn'thelp an insurance pool very much.”

SPBA's Hunt doesn't believe that total repeal will occur.However, the recent election's focus on reducing the deficit adds awhole new twist. “Areas where health care reform is going toincrease the deficit will be looked at carefully,” he states.

Overall, though, Hunt believes some people are over-reacting tothe implications of the new law.
“In my over-30 years in this business, I recall a lot oflegislation that was viewed as the 'end of the world' for employeebenefits,” he recalls. “For example, I remember when ERISA passed,and 95 percent of the employee benefits community was absolutelysure this would be the death knell for employee benefits.

They felt that no one would be crazy enough to maintain anexisting employee benefits plan or start a new one, because thecrazy ERISA law and all of its reporting requirements andliabilities did not make any sense. Of course, this is not whathappened.”

A new wrinkle
On Dec. 13, the reform health care reform law hit its first majorroadblock, when U.S. District Judge Henry E. Hudson in Virginiaruled thata central requirement of the law, requiring almost all Americans tocarry health insurance, is unconstitutional. The ruling isexpected to eventually make its way to the U.S. Supreme Court,which could take two years.

In the meantime, though, Hudson denied a request by Virginia'sattorney general, Ken Cuccinelli, to strike down the law in itsentirety or block it from being implemented while the ruling isappealed by the Obama administration.

An Associated Press article on the ruling noted, “Whatever theeventual outcome, Monday's ruling could create uncertainty aroundthe administration's efforts to gradually put into effect thelandmark legislation extending health coverage to 32 millionuninsured Americans. And it can only increase the public'sskepticism, which has not significantly receded in the months sincethe law's enactment, defying Obama's prediction that it wouldbecome more popular as the public got to know it.”

Get more: Coverage of theindividual mandate under PPACA