The fight over the Affordable Care Act in Washington is as fierce as ever, with a Republican budget plan that would repeal the health care law Democrats passed five years ago. In the rest of the country, opposition to the law appears to be easing.

The gap between favorable and unfavorable views of the ACA is the narrowest in more than two years, according to a poll released Thursday by the Henry J. Kaiser Family Foundation.

The poll of 1,503 U.S. adults found 43% opposed to the ACA and 41% in favor. With a margin of sampling error of plus and minus 3 percentage points, the result was essentially an even split. Those in favor most often cited expanded access to insurance, while opponents cited cost. 

“It looks like the pro and con narrowed a good bit during the recent open enrollment period,” says Katherine Hempstead, director at the Robert Wood Johnson Foundation. “It could be that relatively smooth roll out reduced the negative, and as enrollment increased it would make sense that more people either benefitted or know someone who did.”

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Negative views of the law increased in the months after October 2013, when the sign-up website Healthcare.gov and some state insurance marketplaces were crippled by technology failures. Now, the government reports that some 16.4 million Americans have gained insurance coverage under the law.

Looking at future surveys, Hempstead notes there were some interesting stats in the demographics. “Those with insurance who are under age 65 are more likely to be pro than con, so if that persists and the share of that population with insurance continues to increase, that bodes well for the ACA,” she says. “It also appears now that the population 18-64 is evenly split so going forward that is a good sign, too, assuming that their views don't change as they age. Seniors are still negative, which stands to reason due to the Medicare cuts.”

Future of the ACA

The future of the law is in the hands of the Supreme Court. The justices are considering whether to strike down the federal subsidies that make private health care plans affordable to millions of new enrollees, with a decision expected by summer. A majority of those polled by Kaiser thought a ruling against the subsidies would be harmful, a view shared by majorities of Democrats, Republicans, and independents.

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About two-thirds of the poll's respondents said they wanted Congress to come up with a way to preserve subsidies if the court rules against the Obama administration. But their expectations for that are dim. Less than 20% said they were even "somewhat confident" that lawmakers in Washington could work together to find such a solution, and a majority said they were "not at all confident" Congress would fix the problem.

Hempstead previously told EBA that she predicts there will be something to mitigate the impact should the court rule in favor of the plaintiff. “Everybody is playing chicken. I can’t really imagine this is going to come to pass,” she says. “I do think the non-group market is too big to fail and I don’t think the worst-case scenario is going to be allowed to come to pass. There will be some kind of workaround.”

Tozzi writes for Bloomberg News. Additional reporting by Brian M. Kalish of Employee Benefit Adviser.

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