Do People Really Like the Affordable Care Act?


There was an interesting article, which was reported by Christopher Flavelle in his blog regarding the Supreme Court’s review of the Affordable Care Act. After the oral argument at the U.S. Supreme Court two weeks ago, the odds that Obamacare will survive its latest legal challenge appear slightly better than even. But instead of relief, the law’s supporters should take a moment to reflect on the deeper problem for the Affordable Care Act: its persistent and widespread unpopularity. Reversing that will do more to protect the law than any court decision.

A Pew Research Center poll last month reported that almost five years after it was signed, 53 percent of people disapprove of Obamacare — close to an all-time high. That reflects more than just partisanship; even independents dislike the law by almost 2 to 1.


That’s a bigger problem than Obamacare’s supporters seem to realize. Liberals’ hope is that if the law can just survive this legal challenge and succeed on the merits — insuring more people at a reasonable cost — it will eventually gain acceptance, or at least benign indifference. By that view, the low level of public support for the law is either minimally important or beyond fixing.

But if Democrats don’t find a way to address the public distaste, Obamacare will stay vulnerable to the next ploy that comes along to undercut it. The disapproval fuels not just the court challenges but also the obstructionism of Republican executives and lawmakers that makes those challenges so potent. After all, if every state were willing to establish its own exchange, the court’s ruling on King v. Burwell would be moot.

To which Obamacare’s supporters might ask, what do you expect us to do? President Obama’s administration couldn’t do more to trumpet the number of people who are getting coverage through the law’s exchanges. If you want to know how many Colorado residents signed up for a silver plan for 2015, the Department of Health and Human Services can’t wait to tell you.

By focusing on the expansion in coverage, however, the law’s defenders are fighting the wrong argument. The opposition doesn’t center on the notion that the government shouldn’t be trying to cover more people. It revolves around two other claims, neither of which Democrats have done a good job dealing with. And both of those arguments are mostly bogus.

First is the idea that Obamacare imposes mandates on insurance that needlessly drive up the cost of coverage and restrict choice, a core Republican argument. “Republicans understand that what works in Utah is different from what works in Tennessee or Wyoming,” a trio of Republican senators wrote a few Sundays ago in the Washington Post. Under their alternative, “every state would have the ability to create better markets suited to the needs of their citizens.”

What Republicans are arguing against is the law’s requirement that insurance cover 10 types of care: outpatient care, emergency room visits, hospitalization, prescription drugs, laboratory services, preventive care, rehabilitative care, pediatric care, maternity care including obstetrics and gynecology (think of single men), and mental health and addiction treatment. Which of those is unnecessary in Utah?

Republicans are really saying that people should be free to avoid carrying insurance for problems they don’t expect to have (a bout of depression, maybe, or a stroke that requires rehabilitation) or don’t want to help pay for (pediatric and maternity care for men with no children, say). The former view shifts costs onto the unlucky; the latter shifts costs onto women and parents. Both undercut the purpose of insurance, which is pooling risk. Neither saves money. Yet in the abstract the argument sounds compelling. And it’s going mostly unchallenged.

A second reason Obamacare remains unpopular is that many people who get coverage through their job (still slightly more than half the country) believe the law is causing their employer to cut benefits. Because that’s often what their employer is telling them.

In a survey last fall by the consulting firm Towers Watson, more than half of large companies said they expect to pay the so-called Cadillac tax, which falls on high-value insurance plans, by 2020 if they don’t cut costs. And two-thirds of large companies said the tax will have a moderate to large influence on their health-care strategy, driving them to cut coverage for family members, reduce provider networks, limit benefits and restrict drug coverage. No wonder more people told Pew that the law hurt them and their families than said it helped.

The problem is that only a fraction of companies that say they would face the Cadillac tax by 2020 are in fact likely to do so. Starting in 2018, the tax will apply to plans that cost at least $10,200 for an individual or $27,500 for a family. Yet in 2014, less than 4 percent of covered workers with individual coverage were in plans that cost that much, and less than 6 percent of those on family plans. And even if those costs grew at 5 percent a year — about double the growth from 2013 to 2014 — the share of covered workers on plans that trigger the Cadillac tax in 2020 would still be less than 1 in 5.

So employers are citing an Obamacare tax that probably won’t affect them for years to justify benefit cuts now. Meanwhile, Republicans are claiming that the law’s insurance mandates are making coverage more expensive, when all it’s doing is pooling the cost of that coverage across more people (which is why medical debt troubles are down). Those are both compelling arguments. Yet Democrats have focused on touting the number of people who have gained coverage — which is important, but doesn’t feel as personal to most Americans.

Of course, anybody can criticize Democrats for not doing enough to sell Obamacare. And you can probably point to more arguments that the law’s opponents cite to undercut it, and which the administration has done a lousy job rebutting.

The broader point remains that even if the most optimistic interpretations of Wednesday’s argument are true, liberals can’t count on the Supreme Court to save Obamacare. Sure, it would be nice if the justices uphold the tax credits for every state. But King v. Burwell is a symptom of a bigger problem, one that no ruling will fix. Ultimately, the only way to protect Obamacare is to convince more people that it’s a good law. On that count, the government is still failing.

The other option is to offer an alternative or modify the present law.


I also wanted to point out, as April 15th approaches and we all try to figure out our taxes and worry about the possible penalties regarding the Affordable Care Act that scammers are waiting for their opportunity to rip off more and more innocent people.

Consider the announcement by the IRS published March 13, 2015 in the Associated Press.:

IRS warns of tax scams involving health care law.

Unscrupulous tax preparers are using President Obama’s health care law as a ploy to pocket bogus fines from unsuspecting taxpayers, including some immigrants not bound by the law’s requirements, the IRS warned Friday.

In an advisory, the tax agency said consumers can be sure something is wrong when a tax preparer says they collect the health law fines that may be due the government. The law requires virtually everybody in the country to have coverage or risk fines.

“The payment should never be made directly to an individual or return preparer,” the IRS said. “Most people don’t owe the (fine) at all because they have health coverage or qualify for a coverage exemption.”

Sometimes the con artists promise to lower the purported fine if the consumer pays them directly.

The IRS said it has received reports from around the country that fraudsters are targeting immigrants, particularly Spanish speakers with a limited understanding of English.

In some cases, people who don’t owe a fine because they have Medicaid or some other form of health insurance have been told they need to pay anyway, because supposedly they don’t have the right kind of coverage.

In other cases, immigrants who are not bound by the law’s coverage requirements are being told they must pay a fine.

Young immigrants protected from deportation by the Obama administration fall into a legal gray area that may be prime territory for exploitation.

While they do have authorization to work and therefore pay taxes, they are not considered “lawfully present” for purposes of the health care law. They are not entitled to coverage under the law, and the mandate to get coverage does not apply to them.

The health care law uses the income tax system to subsidize coverage and also to collect fines from people who remain uninsured. This is the first tax-filing season that the connections between health insurance and income taxes are becoming visible to average consumers. Two of the most complicated areas for consumers — taxes and health care — are now intertwined.

So, be wary and be careful!



1 thought on “Do People Really Like the Affordable Care Act?

  1. Michael Fisher, M.D.

    Thanks Roger, for clarifying the issue that is coming to a head this week. Having lived with the threatened SGR cuts for so many years, as a private practitioner, I weigh the risks and benefits of the 10 year “level” payment. While I feel responsible for those Medicare patients whom I serve, at least I will know (to a degree) what percentage of Medicare patients my practice can withstand over the 10 years if this is passed. Ideally, I also would like to include in the bills some provision that the Medical Schools are increasingly supplemented with these funds so we can make certain the future physician supply is not even more threatened–this is the socially responsible thing to do, and I would be happier accepting the “level” payment if I knew this was to occur.


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