An overwhelming majority of people disapprove of Republican lawmakers' plan to repeal the Affordable Care Act without having a ready replacement for the health care law, according to a poll released Friday.
And judging by the letter-writing and lobbying in the first week of the new congressional session, many health care and business groups agree.
A poll released Friday by the Kaiser Family Foundation finds that 75 percent of Americans say they either want lawmakers to leave Obamacare alone, or repeal it only when they can replace it with a new health care law. Twenty percent of those polled say they want to see the law killed immediately.
But Drew Altman, CEO of the Kaiser Family Foundation, says the poll shows lawmakers don't have a strong mandate to repeal Obamacare.
"Most of the American people said they're either against repealing it or they're against repealing it unless Republicans put a replacement plan on the table," Altman says. "They want to see what comes next before they seen the ACA repealed."
Americans are about equally divided over whether Congress should repeal Obamacare, the poll shows. But of the 48 percent who want the law rolled back, about 60 percent want lawmakers to wait until they have an alternative plan.
And Obamacare isn't even people's top health care concern. The vast majority — 67 percent — say their top priority is finding a way to lower their health care costs.
The poll findings come just days after Republicans in the Senate took the first step toward repealing President Obama's signature health care law. They voted on Wednesday to move ahead with a budget resolution that will allow them to take funding away from Obamacare, which will effectively gut the law because the subsidies to buy insurance, and the penalties for not doing so, will disappear.
Republicans say they intend to vote on repeal, but give the law time to sunset while they come up with a replacement that will give the millions of people covered under Obamacare access to insurance through some other vehicle.
On Thursday, House Speaker Paul Ryan, R-Wis., said the replacement legislation would pass by the end of the year.
But doctors, hospital groups, insurers and analysts are skeptical of that strategy. In letters, press releases and advertising campaigns, many organizations have made it clear that they want to see a replacement for the Affordable Care Act in place, or at least outlined, before Congress repeals the current law.
A report released Dec. 6 by the American Hospital Association and Federation of American Hospitals warned that a repeal could cost hospitals hundreds of billions and said "any reconsideration of the ACA should be accompanied at the same time by provisions that guarantee similar coverage to those who would lose it."
A letter sent Tuesday from the American Medical Association urged lawmakers to release details of their Obamacare replacement before repealing the current law.
"Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform," the letter said.
Dr. Andrew Gurman, president of the American Medical Association, says people should be able to evaluate the proposed Obamacare replacement before the current law is thrown out.
"People in this country need to understand what it is they're being asked to substitute for what's there now so they can have an informed opinion about whether it's better or not," Gurman says.
And repeal and delay?
"We have a concern that that creates uncertainty in insurance markets and uncertainty in people about whether they're going to have continuity of coverage," Gurman adds.
He says he and his members talk with lawmakers regularly.
A separate study released Thursday projects that a straight repeal of the law could kill 3 million jobs across the country by 2021.
That study, by the Milken Institute School of Public Health at George Washington University, finds that about a third of those lost jobs would come from health care, and the rest would be in other industries such as retail, construction, finance and insurance. Total business output could be cut by as much as $2.6 billion over four years, the report says. California, Florida and Texas would be most affected.
Leighton Ku, the report's lead author, says the debate over ACA repeal has focused almost completely on insurance coverage and has ignored the broader economic impact.
"The payments you make to health care then become income for workers and income for other businesses. And this spreads out," Ku says. "Health care is almost a fifth of the US economy, so as you begin to change health care, there are repercussions that go across all sectors."
Ku says he can't estimate what economic impact Obamcare replacement would have because Republicans have yet to lay out their plans.
"It's a mystery," he says.
Editor's note: The Kaiser Family Foundation supports Kaiser Health News, an editorially independent program that produces news reports heard on NPR and published on NPR.org.
DAVID GREENE, HOST:
So Republicans in Congress are moving ahead with efforts to repeal the Affordable Care Act. They've said that's a priority. But there's a new poll suggesting that their constituents might not be as eager as they are to see the law go. The survey comes from the nonpartisan Kaiser Family Foundation. It shows that if lawmakers don't have something ready to replace Obamacare, only 20 percent of Americans want it repealed immediately. Here's NPR's Alison Kodjak.
ALISON KODJAK, BYLINE: The poll shows that Americans are about equally divided over the Affordable Care Act. Forty-seven percent like the ACA, and 48 percent want it to go. But of that second group, more than half say Congress should have a replacement ready before they vote to repeal. Kaiser CEO Drew Altman says the poll shows lawmakers don't really have a mandate to kill the law.
DREW ALTMAN: Most of the American people said they're either against repealing it or they're against repealing it unless Republicans put a replacement plan on the table. They want to see what comes next before they see the ACA repealed.
KODJAK: Senate Republicans this week made the first move to repeal the health-care law. They began debating a budget proposal that will serve as the legislative vehicle to repeal the taxes and subsidies that make Obamacare work. Their plan as of now - vote immediately to kill the law and come up with something to put in its place later.
ALTMAN: Republicans in Washington are feeling much more bullish about repealing the ACA without a replacement plan than the American people are.
KODJAK: One big reason - about 20 million people have health insurance thanks to Obamacare. The Republican plan to repeal now, replace later leaves them wondering what comes next. Doctors, hospitals and patient groups aren't big fans of the repeal-and-delay strategy either. And they're making sure lawmakers know it.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED WOMAN: The cancer has returned.
UNIDENTIFIED MAN #1: Your son's infection has spread.
UNIDENTIFIED WOMAN: You have insurance, right?
KODJAK: That's from an ad campaign by the patient-advocacy group Families USA. It's asking people to demand an Obamacare replacement that ensures the same number of people will be covered.
(SOUNDBITE OF ARCHIVED RECORDING)
UNIDENTIFIED MAN #2: Repealing health care with no plan is a partisan attack by Congress that will hurt us all.
KODJAK: The American Hospital Association and the American Medical Association are among many organizations that are asking lawmakers to slow down. Andrew Gurman is president of the AMA.
ANDREW GURMAN: Our position on repeal and replace is that we need to see what the replace part is. We think that all people in this country need to understand what it is that you're being asked to substitute for what's there now so that they can have an informed opinion about whether it's better or not.
KODJAK: Another study released today shows that repealing the Affordable Care Act could also cost the economy as many as three million jobs. That study's lead author, Leighton Ku of George Washington University, says about a third of those jobs are in health care.
LEIGHTON KU: Health care is almost a fifth that the U.S. economy. So as you begin to change this health care, there are repercussions that go across all states and all sectors.
KODJAK: That's because your insurance premium is someone else's paycheck down the line.
KU: The payments that you make to health care then become income for workers and income for other businesses. And the income they receive they pay out to their workers. And they buy more goods.
KODJAK: With jobs on the line and public opinion mixed, Republicans in Congress may find they're better off speeding their work on Obamacare's replacement and putting the brakes on its repeal. Alison Kodjak, NPR News, Washington.
[POST-BROADCAST CLARIFICATION: The audio version of this story refers to an ad campaign by Families USA. In fact, the campaign is being conducted by a broad coalition of 21 doctor, nurse and patient advocacy groups, including Families USA.] Transcript provided by NPR, Copyright NPR.