As you may have noticed, the prospect of Congress repealing the Affordable Care Act, as Republicans have long promised to do, has sparked a pretty furious political backlash. All around the country, citizens who are terrified of losing their health insurance are hounding their elected representatives, urging them not to vote for repeal. As the New York Times put it, “President-elect Donald J. Trump and congressional Republicans appear to have accomplished a feat that President Obama, with all the power at his disposal, could not in the past seven years: They have galvanized outspoken support for the Affordable Care Act.”
The reasons for this — or for any other type of political behavior — are complicated. But at root, what’s going on can be summed up with just two words: loss aversion.
Loss aversion, a concept introduced by the groundbreaking psychologists Amos Tversky and Daniel Kahneman, is a simple but powerful human tendency: All else being equal, we are more scared of losing stuff than excited by gaining it. In one of the simplest manifestations of this, most people won’t take a bet in which they are equally likely to win or lose $10 — to get them to take it, you need to amp up the reward relative to the loss. And the so-called endowment effect flows logically out of loss aversion: Having something, as opposed to not having it, causes us to suddenly view it as more valuable. We are less likely to sell something for $10 than to buy it for $10.
So what’s going on now is that people realize they, or people close to them, may be about to lose something profoundly important to them — it’s an actual life-and-death matter in all too many cases. This kickstarts the sorts of emotional reactions that are much harder to elicit if the debate in question is about giving people something they don’t already have.
Close followers of the Obamacare fight have known about the importance of taking loss aversion into account for a long time. In 2010, for example, the business-school professor Dean Eckles and the political scientist Brian Schaffner published an article which sought to explain an interesting divide apparent in polling conducted during the contentious public debate over the law: Most people, polls suggested, thought there was something wrong with the American health-care system that needed reforming, but, as Eckles and Schaffner wrote, “clear public support for any specific reform proposal was difficult to muster since most individuals also indicated satisfaction with their own health care.” The median American probably felt the American health-care system had major flaws, but also had health insurance themselves, and whatever the warts of their plan or the broader health-insurance ecosystem, above all they did not want to see their own coverage cancelled or lost in potentially damaging ways.
As the authors point out, Obama — no stranger to behavioral-econ findings — was well aware of these psychological effects, and therefore made sure to emphasize, every step of the way, that folks with health insurance would be able to keep it:
Here are the details that every American needs to know about this plan. First, if you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: Nothing in our plan requires you to change what you have.
This promise ended up biting Obama in the butt a little, as there were a small number of people enrolled in subpar plans who did have to change them once the ACA kicked in fully, but the point is that the law and its marketing strategy were specifically designed to avoid activating loss-aversion fears. “Loss aversion shaped the entire structure of the Affordable Care Act, which was designed to create the fewest possible losers while fulfilling the basic goals of health-care reform,” wrote Jonathan Chait in 2014. “Loss aversion is so deeply embedded into the psychology of our political system that reporters have internalized it thoroughly.”
Loss aversion didn’t really work as an argument for a bill that wasn’t law yet, argued Eckles and Schaffner back in 2010, but the story would likely be quite different if anyone tried to mess with the law post-passage. “We note that even as elites actively attempted to frame the issue to counteract loss averse tendencies by the public, these strategies met with little success in generating support for Obama’s reform plan,” they wrote. “However, we also argue that these very tendencies will now work against any Republican efforts to repeal the health reform legislation, as the public will place more value on the benefits of that legislation now that they represent the status quo.”
Seven years later, with the country engaged in a bruising fight over the most important piece of safety-net legislation passed in recent history, this looks like a prescient argument. For many people, Obamacare has shifted from being a vaguely scary threat to the status quo to the status quo. It’s much clearer exactly what the law provides and what it would mean if it went away. Hence the angry protests, hence all the news coverage. Loss aversion is a powerful motivator.