Few topics have been as divisive as health care reform. One attempt to change the American health insurance system in the 1990s met with failure. However, in 2010, the Obama administration succeeded in passing the Affordable Care Act (ACA), also known as ObamaCare. This reform has been met with both praise and widespread criticism.

A president’s approval ratings can tell a lot about how the American public feels about the president’s policies and behavior. Harry Truman recorded the lowest approval rating in modern history at 22%, on February 9, 1952. This was after a number of scandals in his first term. As a result, he did not seek a second term re-election. By contrast, these figures differed greatly from Truman’s high 87% approval ratings at the end of WWII as he took over efforts of the late FDR

Obama’s Approval Rating and the ACA

As Obama’s administration continues to implement the ACA, public approval has been low. The President’s highest approval rating of 69% came in January of 2009, at the beginning of his first term. His current approval rating is 39% according to Gallup, barely above his lowest of 38% from October of 2011. Obama’s average approval rating to date is 48%, below that of former Presidents, Richard Nixon and George W. Bush.

Polls that ask specifically about the ACA pinpoint Americans’ concerns. CBS reported in November that support for ObamaCare was at an all-time low. This had a great deal to do with the rocky start that open enrollment had, with technical issues in nearly every Marketplace, both state and federal. While the federal issues have largely resolved, some states continue to have ongoing problems with their enrollment process.

More recent polls, such as a Gallup poll released in early February, continue to show that Americans still largely disapprove of the law. However, acceptance is improving, with the February poll showing that 51% of Americans disapproved and 41% expressing approval for the ACA.

How Approval Ratings Affect the President

As a recent Reuters story points out, low approval ratings can strain the President’s relationship with Congress – even if the majority are in the President’s own party. Lack of support for ObamaCare can mean that Congressional representatives face trouble getting re-elected, especially in districts where a challenger uses the ACA as a major talking point. Any perceived weakness in the President becomes a weakness for everyone associated with him and Republicans are hoping to seize on the President’s low popularity and Americans’ frustration with the ACA to win control of the Senate in the 2014 elections.

Obama has tried to calm the fears of Congress by pointing out that the problems that occurred with ObamaCare’s early rollout have largely been fixed and that millions of Americans now have health insurance who have never had it before. Democrats are hoping to circulate first-hand stories of those whose lives have been positively affected by the law to boost support and help win re-election.

How the ACA affects America over the next few years and decades remains to be seen. However, with opinions strongly divided and presidential approval ratings at an almost all-time low, Democrats who are up for re-election in 2014 are nervous. Presidential ratings and approval for major legislation can change frequently. While approval ratings certainly aren’t the sole deciding factor in a President’s ability to work with Congress, they may still play a role in Congress’ willingness to enact change – especially in an election year.