Only 40% want the law to be repealed completely or replaced with an alternative. Poll: Keep health reform, no mandate

If you were President Barack Obama or a member of Congress, what would you do with seemingly contradictory message from the public: Congress shouldn’t repeal the health care law. But the Supreme Court should strike down the individual mandate?

The public sentiment: Keep the law, but figure out a way to make it work without the mandate.


Easier said than done, according to the health policy experts. But that’s the clear message from the latest tracking poll released Thursday by the Kaiser Family Foundation, according to Drew Altman, the foundation’s president and chief executive officer.

The survey found that 54 percent of Americans want the Supreme Court to get rid of the requirement that nearly all Americans buy health insurance. But only 40 percent want the law to be repealed completely or replaced with a Republican alternative.

In fact, not only do half of Americans want the law kept in place or expanded, but the share that wants it expanded (31 percent) is larger than the group that wants to leave it as is (19 percent).

That’s not a big surprise, Altman said, because other polls have consistently shown that some parts of the law are popular with the public — especially the coverage for people with pre-existing conditions, which kicks in for adults in 2014. It's the mandate that has been wildly unpopular.

But what about the Obama administration’s argument that you can’t separate the two — that if the individual mandate goes, there won’t be a good way to get enough healthy people on the insurance rolls to cover the costs of all those new people with pre-existing conditions, so everyone’s premiums will shoot into the stratosphere?

The answer is, normal people don’t think about that. Only health policy experts think about it.

“I think the public just doesn’t connect the dots,” Altman said. “They don’t say, ‘Well, gee, if we throw out the mandate, how are we going to get enough healthy people into the system?’”

So the challenge for the future president (whether it's Obama or one of his Republican challengers) and Congress — if the Supreme Court does rule that the mandate is unconstitutional — would be to find an alternative that would bring in enough people to allow insurers to cover pre-existing conditions without raising rates for everyone else. There’s not much evidence that any of the ideas that have already been suggested — like letting people sign up for coverage whenever they want, but penalizing them if they wait until they’re sick — would work as well.

But only a minority of the public actually wants to get rid of the whole law, despite the pledges of all of the Republican presidential candidates to do just that.

“The challenge for elected officials … is just to come up with something else that works and could get through whatever Congress we have at the time,” Altman said.

This article first appeared on POLITICO Pro at 1:29 p.m. on January 26, 2012.