To Know Obamacare Is to Love It?
A Gallup poll released today confirms what anyone paying attention knows: The Affordable Care Act's successes aren't changing negative views on "Obamacare," including what people report about their personal experiences with health care. Yet the very characteristics that make Obamacare unpopular make the ACA safe from repeal.
As I've said before, the design of the law almost ensured a schizoid response from the public, given that the benefits that people like aren't labeled "Courtesy of Obamacare." No such confusion exists with the benefits delivered by, say, Social Security or Medicare, which is why most Americans are attached to those programs. Even though President Barack Obama's's mediocre approval ratings contribute to Obamacare's bad poll numbers, most of the blame can be attributed to this labeling flaw in the law, not the president.
Going to the numbers: 15 percent of Gallup's respondents agreed that Obamacare has "helped" them and their family; 27 percent said the law had "hurt." There's a sharp partisan split: 40 percent of Republicans said the law "hurt," and just 4 percent said it "helped." Among Democrats, however, 27 percent said it "helped" and 15 percent said it "hurt." To some extent that could reflect real disparities in health situations between Republicans and Democrats, but the bulk of the difference is almost certainly due to a combination of the general attitude toward Obama and information flows that make Democrats more likely to be exposed to good news (real and imagined) about the law and for Republicans to know about real and imagined problems with it.
That only gets at the partisan divide. It doesn't explain why relatively few people, regardless of political affiliation, feel the law has helped them, even though (as Jonathan Cohn points out again in a good piece today) there have almost certainly been more winners than losers.
The reason more people believe they've been hurt than helped is that peak awareness of the ACA's benefits is already in the past, and it wasn't very high in the first place.
For one thing, even though the ACA may have moderated the rise in the cost of health care, even smaller price increases will be seen as a harmful result of the law. Especially because there's always variation in costs, and Republicans are going to publicize any spikes and Democrats aren't going to trumpet increases, even when they are at or below trend. Indeed, Republicans will blame reform for every bad health care story, regardless of whether it's ACA-related.
Another reason for the bad feeling is that there's little reason for most consumers to connect health care benefits they like with a law passed more than four years ago.
How many young people who are able to to stay on their parents' insurance know they have Obamacare to thank?
How many people with (private!) insurance they like purchased through the exchanges ---through state exchanges such as Kynect or Covered California or even through Healthcare.gov -- know that those plans are part of "Obamacare"? How many people in expanded Medicaid know they are receiving Obamacare?
How many people know Obamacare is the reason they don't exceed annual or lifetime reimbursement caps?
I suspect that most people who enrolled this year but had previously been denied coverage because of a pre-existing condition know the ACA helped them. But a lot of people who are applying for health insurance for the first time probably don't realize that their pre-existing conditions would have barred them from coverage in the days before Obamacare. Fewer and fewer people are going to credit Obamacare for allowing them to get insurance, even when they know they have a serious health issue, because they will forget that there was a time when people could be denied coverage.
None of these observations settle the question of whether the ACA is good or bad policy. But it does mean that anyone contemplating repeal should ignore the poll numbers and think hard about what consumers would say if the benefits they enjoy were to disappear. People on expanded Medicaid may not credit Obamacare, but they sure are going to want to know why their coverage went away. The same is true of people who obtained insurance through the exchanges or benefit in other ways. And remember, just as Obama is now held responsible for any bad news on health care, even when there's no connection to the ACA, the blame would shift to Republicans if they successfully push repeal, with or without a replacement.
As for the electoral effect of the still-depressed ACA numbers, I continue to be skeptical that there are many people who would support Democrats but for health care reform. But I guess we'll have to wait until post-election analysis to know more about it.
And even if Obamacare turns out to be "good" policy -- by some objective measure such as the proportion of winners to losers -- that still doesn't mean it was the best thing to do. Some would argue that the government shouldn't be involved in this way, regardless of the outcome.
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