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Americans Want Health Care Reform More Than Anything Else

And most of them would prefer to keep some form of the Affordable Care Act—putting the GOP in a bind.

We’re waiting.   Photo: Dominican University

Donald Trump has begun his presidency with considerable speed, primarily through a series of executive orders and presidential memos—not quite as many as Barack Obama did in the first couple weeks of his first term, but considerably more than George W. Bush or Bill Clinton. Some of these have had immediate impact, like the infamous travel ban that had O’Hare’s international terminal staffed with immigration lawyers and surrounded by protesters.

Others, like his first one, have been more like statements of intent, symbolic but with limited power, like his very first: one to maybe, or maybe not, weaken the Affordable Care Act.

But it’s taking a lot longer than promised. The ACA was supposed to have been repealed already and replaced “very quickly or simultaneously, very shortly thereafter,” as Trump said, which put one Republican representative in the awkward position of trying to find a different definition for “simultaneous.”

Repealing and replacing the ACA is hard, and not just because it’s deeply entwined with the nation’s impossibly complex healthcare system. It’s because healthcare reform is, perhaps surprisingly, the most important issue for voters, and a plurality of them want what Hillary Clinton offered: the ACA, but with changes, rather than an entirely new approach to health care.

The numbers come from the collaboration between the Associated Press and NORC, the University of Chicago’s august public-opinion research group. At the very end of last year, they polled Americans on their biggest policy priorities for the new year, asking them “which policies would you like the government to be working on,” and found that there’d been a big change since the last year. Here’s how some of the major concerns moved around:

Health care was the top priority for everyone—even when parsed by political party. Health care, immigration, and unemployment/jobs were 1-2-3 for Republicans and Independents; for Democrats, it was health care, education, and environment/climate change.

So, it’s something we can agree on, or at least collectively share a plurality on. But that’s about as far as it goes. AP-NORC did a second survey, right after Trump’s first term began, to see what people actually wanted from their new leadership on health care. And it wasn’t quite what was campaigned on.

Half strongly or somewhat support the ACA. If you give the tie to the status quo, it’s 65 percent in support or ambivalent versus 35 percent opposed. But that’s not to say that people are wholly satisfied with the ACA, so they asked people what they actually wanted.

It turns out that a small majority, 52-47 favors keeping it in some form. (The results don’t total 100 percent due to rounding.) This means that on the issue most important to Americans, a small majority doesn’t want what the president dramatically campaigned on and is already finding difficult to do.

There might be gray area, or at least rhetorical space, between “repeal,” “replace,” and “keep with changes,” but if Republicans can’t find it, it could be catastrophic.

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