Obamacare’s popularity is the Republicans’ problem

Speaking to the National Association of Counties in March of 2010, roughly two weeks before President Barack Obama signed the Affordable Care Act into law, then-House Speaker Nancy Pelosi (D-Calif.) offered a comment for which she would take much grief. “We have to pass the bill,” she said, “so that you can find out what is in it, away from the fog of the controversy.”

Pelosi’s critics treated the line as a “gotcha” moment, claiming (wrongly) that the speaker was asking Congress to pass the bill without knowing what its provisions were. Her point, even if she expressed it a trifle inartfully, was that the rocky, fractious road to the law’s enactment tainted what would prove to be the largest advance in health care access since Medicare; voters would know what was “in it”—and would potentially come to like it—only when they started receiving its benefits. 

This is exactly what happened, which is why Republicans have continued to live what the Wall Street Journal recently called their “Healthcare Nightmare” as they tried, again and again, to repeal or scale back Obamacare over the last 15 years.

The extent to which the Affordable Care Act haunts Republicans was brought home by the crackup in the GOP-controlled House on Dec. 17 over enhanced subsidies for Obamacare enacted during President Biden’s administration. After House Speaker Mike Johnson (R-La.) refused to hold a vote on extending the subsidies, which expire at the end of the year, four Republicans broke ranks by signing a Democratic discharge petition to force a three-year extension to the floor. Given the narrow Republican advantage in the House, their defections were enough to produce a majority for the petition.

The petition’s success should force a House vote on the three-year extension in January, right at the beginning of the election year. This could create pressure for negotiations on some sort of extension in the Republican-led Senate, which voted it down on Dec. 11. But if the GOP lets the extension expire, Democrats will have what they see as a powerful issue in November’s elections.

The rebels—Reps. Rob Bresnahan Jr. (R-Pa.), Brian Fitzpatrick (R-Pa.), and Ryan Mackenzie (R-Pa.), and Mike Lawler (R-N.Y.)—fear just that and made clear they were listening to their voters. “We report to our constituents,” Fitzpatrick told reporters. “We do not answer to any person or any party in this town.”

Democrats forced the issue to the fore by shutting the government down for 43 days in the fall, and the prospect of millions losing coverage or paying far more for insurance created dissidence in Republican ranks that extended well beyond the four insurgents. 

“We run on this every time,” Rep. Jen Kiggans (R-Va.), who represents a competitive district, told the Journal. “There’s not an election that comes up when we don’t get beat up on healthcare.”

The history of public opinion on Obamacare explains why. The ACA has become the latest example of how public benefits that voters come to appreciate are almost impossible to repeal or shrink. Social Security is called “the third rail” of American politics for a reason. The Affordable Care Act has entered third rail territory.

We can know this thanks to excellent work by KFF (formerly known as the Kaiser Family Fund). KFF has done extensive polling on the ACA from the beginning, and its standard question gives Republicans and Democrats the opportunity to express their support or opposition for the president who pushed it through by defining the ACA explicitly as Obamacare: “In general, do you have a favorable or unfavorable opinion of the health reform bill signed into law in 2010, known commonly as the Affordable Care Act or Obamacare?”

As Pelosi knew, the contentious process surrounding the bill’s passage significantly damaged the law’s public image: The ACA was conceived in unpopularity. In October 2010, the month before the midterm elections, only 42% of Americans had a favorable view of the ACA. Republicans hated it—only 11% held a positive view—and independents didn’t like it, either (only 34% were favorable toward the ACA). Even among Democrats, approval stood at just 69%, down nine points from six months earlier. One of the Democrats’ greatest policy triumphs was hurting the party politically. They lost control of the House, with Republicans gaining an astonishing 63 seats. The GOP also picked up six seats in the Senate, but the Democrats, having entered the election with a large majority, still maintained control.

Things would get worse as Obamacare’s image was dented further by a botched rollout on Oct. 1, 2013, when the ACA website crashed. By October 2014, before the final midterms of Obama’s presidency, approval had dropped to 36%, and even Democrats (with only 59% approval) had growing doubts. Once again, the midterm election was a catastrophe for Democrats. Republicans took control of the Senate with a net gain of eight seats (the biggest midterm Senate gains for either party since Ronald Reagan’s 1980 triumph) and padded their House majority with a pickup of 13.

But over time, two things happened: Americans who had lacked health insurance began getting it courtesy of Obamacare, and Republicans tried to repeal it in 2017 during the first year of Donald Trump’s presidency. The repeal effort backfired because it finally gave Democrats and other ACA supporters a chance to make a full-throated case for what they had achieved—and to make clear what voters (and hospitals and other health care providers) would lose if the GOP succeeded in scrapping it. No matter how hard the GOP tried to craft an alternative, the Republican proposals inevitably led to a sharp reduction in the number of Americans with health insurance. The Senate Republican bill to “repeal and replace” Obamacare turned out to be not much of a replacement. The nonpartisan Congressional Budget Office estimated that the Republican proposal would have left 22 million more people uninsured. The repeal effort was defeated when three Republican senators—Susan Collins of Maine, John McCain of Arizona and Lisa Murkowski of Alaska—joined the Democrats in voting no.

By October 2017, the ACA had finally secured majority approval with 51% holding a favorable view. Democratic approval was back up to 77%, and 53% of independents also had a positive view. It was even gaining ground among Republicans, with approval rising from a low of 7% in 2012 to 22%. Support hovered around the 50% range and then took another leap upward after the pandemic, which appears to have led to new appreciation for government health care guarantees. The expanded subsidies under President Biden’s 2021 American Rescue Plan made insurance more affordable, roughly doubling participation in the ACA marketplaces, and it became even more popular. By March 2023, 62% of Americans had a favorable view of Obamacare. The difficulties Republicans in Congress are having with the issue as 2025 ends can be explained by Obamacare’s 64% approval rating in KFF’s September polling. Democrats are now nearly unanimous (94%) in viewing it positively, along with 64% of independents. What is giving many Republican rank-and-filers in Congress pause is that approval among Americans who identify as Republicans now stands at 36%—five times more support than the ACA enjoyed with the party’s loyalists in 2012.

The bottom line: 74% of U.S. adults, KFF found, support extending the ACA’s enhanced tax credits. That would be a remarkable majority under any circumstances. It’s all the more notable in our polarized, partisan moment.

None of this should be shocking. The ACA now provides coverage to roughly 45 million Americans, including about 24 million in the marketplaces and most of the rest benefitting from the bill’s expansion of Medicaid access. As Jonathan Chait observed in the Atlantic: “It was easy enough for Republicans to block health-care reform when a program to expand coverage didn’t exist. Taking insurance away from people who have it, or jacking up the price they pay to get it, is a completely different matter.” Think of this as Pelosi’s Rule.

Support for the ACA goes well beyond those currently benefiting from it. Many who may now have health insurance know Obamacare is there if they lose their jobs, take jobs with no health coverage, or turn to the gig economy for employment. This helps explain a large shift since the ACA’s enactment in the country’s philosophical orientation toward government’s role in guaranteeing health coverage. As Obamacare was just beginning to come online in 2013, Gallup found that just 42% of Americans believed it was “the responsibility of the federal government to make sure all Americans have healthcare coverage.”

 By the end of 2024, the proportion endorsing this idea had risen to 62%. The Pew Research Center asked a similar question in November 2025—“Is it the federal government’s responsibility to make sure all Americans have health care coverage?”—and found that 66% of Americans responded in the affirmative.

Of particular importance in light of the Republican Party’s increasing support among working-class voters, Pew found that the proportion of Republicans and Republican-leaning independents who endorsed a government responsibility for health care coverage had risen from 31% in 2020 to 41% in 2025—and among lower-income Republicans and Republican-leaners, the figure stood at 60%. KFF found that 45% of those who purchase their own health insurance, “most of whom do so through the ACA marketplaces,” are Republicans.

Republican leaders know that letting the expanded tax credits expire is unpopular. They have tried again to offer alternatives. Their difficulty is that there is no getting around the fact that market-based solutions without substantial government support will leave many Americans without the resources to afford health insurance. (Obamacare, after all, is a far more market-oriented plan than, say, a single-payer health care system). Senate Republicans, for example, proposed putting up to $1,500 in Health Savings Accounts. But as Natalie Andrews noted in the Wall Street Journal, “the GOP plan for health savings accounts could help with out-of-pocket costs for people with eligible insurance plans, but it doesn’t address the fundamental problem for individuals who are unable to afford insurance.” There is a reason why conservative parties in virtually every other advanced democracy have accepted a substantial government role in ensuring universal health insurance coverage: There is no alternative.

Whatever happens in the short term over the Obamacare subsidies, passage of the ACA fundamentally altered the policy terrain, much as Social Security and Medicare did before it. In his definitive study of the passage of the ACA, “The Ten Year War,” Jonathan Cohn concluded that Obamacare “is not nearly good enough, yet so much better than what came before it.” Most Americans, including an increasing number of Republicans, have come to agree.