Public opinion of the health care law

Since it was enacted over two years ago, the Patient Protection and Affordable Care Act, President Obama's signature piece of legislation, has never been especially popular with the American public. Just 34 percent approve of the health care law, according to a CBS News/New York Times Poll released earlier this month, while 48 percent disapprove. Other recent polls also show more oppose the law than support it.

As might be expected, views on the health care law are colored by partisanship. Eight in 10 Republicans disapprove, while most Democrats (56 percent) approve. More than half of independents (52 percent) oppose the law.

Overall opinions of the health care law have barely wavered since its passage in March 2010, and support for it has never reached 50 percent in CBS News Polls. Back in May 2010, two months after it was passed, 43 percent of Americans approved of the law - that's the highest percentage to date.

But is this an indication that Americans are not ready for health care reform? Not necessarily. Throughout the debate over health care in 2009, CBS News Polls showed a majority of Americans wanted either fundamental changes made or a completely rebuilt health care system. A recent AP-Gfk survey asked what should happen if the health care law is ruled unconstitutional by the Supreme Court; 77 say the President and Congress should start work on new health care legislation. Only 19 percent of Americans want the health care system should be left as is.

In fact, despite Americans' mostly negative views of the health care law generally, there is broad public support for some specific elements of the law. A March CBS News/New York Times Poll found 85 percent favor the requirement that insurance companies cover people with pre-existing conditions, nearly seven in 10 support allowing children under 26 to say on their parents' health plan, and 77 percent back the part of the law that offers discounts to reduce the Medicare prescription drug coverage gap, commonly known as the donut hole.

Even a majority of those who express disapproval of the health care law overall say they approve of these three elements.

Still, the most controversial component of the law - the requirement that nearly all Americans obtain health insurance -- does not sit well with the American public. In that same March poll, 45 percent approve of that provision, but 51 percent do not. According to an April Kaiser Family Foundation survey, seven in ten find that element of the law unfavorable

Also, among those who oppose the law overall in the March CBS News/New York Times Poll, seven in 10 disapprove of the mandate that people buy health insurance.

Even though the public is familiar with some elements of the health care law, particularly the individual mandate, there is some evidence that many may not have a good understanding of it. Soon after the law was enacted, 41 percent of Americans felt they had a good understanding of what the law would mean for them, but two years later and even after some provisions were implemented, that number increased just six points to 47 percent. Just as many -- 48 percent -- now find the law confusing. And while a CBS News/New York Times Poll released earlier this month found that most know at least some details about the 2010 health care law, only 28 percent of Americans say they know a lot about it. Of that 28 percent, more than six in 10 disapprove of the law.

Throughout the health care debate and after the law's passage, it seemed Americans never really saw any benefit in the law for them. More Americans consistently said the health care changes would to do more harm than good to them personally. In March of this year, only 19 percent thought the law would mostly help them; most either said they would be hurt by it (31 percent) or not have much of an effect (43 percent).

The cost of health care is an ongoing concern and Americans do not expect their health care costs to decline under the law. In that March poll, just 15 percent though their costs would go down because of the law; virtually the same as the 14 percent who said that two years ago as the law was being enacted. More than half (52 percent) expect the Affordable Care Act to increase their own health care costs.

Ultimately, Americans didn't see health care reform as the top priority for the country. While people wanted a better health care system, they wanted a better economy more. Since 2008, the economy has been the dominant concern for Americans, according to CBS News Polls. Throughout 2009 when health care reform was being hotly debated, health care claimed the second spot behind the economy and jobs among the public's concerns; however, it was always a distant second. In October 2009, 20 percent volunteered health care as the most important issue facing the country, but 45 percent said the economy and jobs. Two years later, health care is even less of a concern. In an April CBS News/New York Times Poll, just 5 percent of Americans cite health care as the most important issue facing the country- but nearly ten times as many people choose the economy and jobs with 48 percent.