GREG SARGENT WASHINGTON POST
With Democrats continuing to grow more skittish about Obamacare’s awful rollout problems, the Kaiser Family Foundation is out with some important new polling that deserves a careful look from Dem Congressional officials — and political commentators.
The most important finding in the Kaiser poll — which is in some ways the gold standard of health care polling — is that significantly more Americans want the Affordable Care Act kept or expanded than want it repealed and replaced with a GOP alternative or with nothing at all. Here’s the key finding:
What would you like to see Congress do when it comes to the health care law?A total of 47 percent wants to keep or expand the law, versus 37 percent who want to replace it with a GOP health reform plan or scrap it completely.
Expand the law: 22
Keep the law as is: 25
Repeal the law and replace it with a Republican-sponsored alternative 13
Repeal the law and not replace it: 24
This poll was taken October 17-23, more than two weeks after the problem-plagued rollout began (though in fairness, before the “you can keep your plan” furor blew up).
How is it possible that more Americans want to stick with the law, when it’s obviously (as Republicans and some commentators say) such an epic disaster, both in policy and political terms alike?
The answer lies in the way the question was asked, and this has important larger implications. Kaiser’s line of questioning may be the best out there at shining light on what people really mean when they say they either support or oppose the law (a plurality of 44 percent view it unfavorably), and what they really mean when they say they want to get rid of it. If anything, the question is generous to Republicans, because it offers respondents the choice of an unspecified generic Republican alternative. Ultimately, what this finding suggests is that, whatever their dissatisfaction with Obamacare, people do not want to return to the previous system, and perhaps more crucially, do not believe Republicans are offering a serious alternative. Indeed, only 13 percent favor repeal and replace, GOP style.
...Among GOP voters, the Kaiser poll shows a split: Only 29 percent of Republicans want repeal and replace, versus 42 percent of Republicans who want to scrap the law and replace it with nothing.
In other words, the de facto GOP position is to go back to the old system. Rather than do that, more Americans want to stick with Obamacare.
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But Didn’t President Obama vow that Americans who like their insurance would get to keep it?
JONATHAN COHN NEW REPUBLIC:
The essential transformation that I wrote about yesterday continues to frustrate many people who have health insurance. Insurers are refusing to renew existing insurance policies for hundreds of thousands and maybe millions of Americans, usually because those new policies do not satisfy Obamacare regulations that take effect in 2014. The people losing insurance have a chance to get modified or new policies that typically offer better, more secure coverage. But the prices they are seeing tend to be higher than what they are paying now. These people are asking a lot of hard questions, which Republicans are amplifying today. Why can’t these people simply keep the policies they had before? Didn’t President Obama vow that Americans who like their insurance would get to keep it?
Yes, he did. And he was wrong to make that promise, at least in such clear-cut terms.
It applies perfectly well to the overwhelming majority of Americans who get insurance from an employer, Medicare, or Medicaid, since these plans and programs aren't really changing in ways that most consumers would notice. But people who buy coverage on their own, through brokers or directly from insurers, are in for some big changes. They constitute a tiny portion of the population but, because this is a large country, they are still a sizable group in raw numbers. (Somewhere between 10 and 20 million, depending whose estimates you believe.) Many of them are the ones hearing from insurers now.
It would have been perfectly fine for Obama to say most Americans get to keep their coverage or to qualify his statement in some other way. And administration officials offered such nuance when asked.
Health and Human Services Secretary Kathleen Sebelius has apologized to the nation for the botched launch of the Obamacare website, admitting that Americans 'deserve better
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But ultimately the more important question is about what’s actually happening to these people losing their current policies—and why. This transformation is not just a consequence of Obamacare. It's very much the intent. And for very good reason.
By nearly everybody's reckoning, the "non-group" market is the most dysfunctional part of the American health insurance system. The dysfunction takes two primary forms. First, insurers have been selective about whom they would cover and how—charging higher premiums, covering fewer services, or simply denying benefits outright to people with pre-existing medical conditions. About half of all Americans have at least one such condition, according to official estimates, so roughly speaking about half the population couldn't reliably find comprehensive, affordable coverage if they had to buy it on their own.
The second big problem with the non-group market has been the lack of protection it provides even those people who think they have good insurance. At worst, plans in the non-group market border on fraud. They are “mini-med” plans that cover no more than a few hundred dollars of bills, which will last you about ten minutes if you visit the emergency room. But even the better, more respectable plans can exclude whole categories of services, like maternity care, rehabilitation, mental health, or prescription drugs. Typically they also have high deductibles and co-payments.
These policies may seem alluring, because they don’t cost much upfront. But these premiums are notoriously unstable. From time to time, insurers will “close” blocks—in other words, they stop letting new people into the plan—and then jack up rates once a few of the insured get sick. The paperwork on the plans is also opaque. While some people have trustworthy insurance brokers to help them, many rely on less informed counselors or attempt to sort out the confusing insurance options on their own. When they end up in the hospital, they discover they still owe tens of thousands of dollars in medical bills—sometimes, enough to force them into bankruptcy.
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The major goal of Obamacare is to end these insurer practices and get those less protective policies off the market. The law prohibits insurers from withholding benefits, charging higher prices, or denying coverage altogether to consumers because they have pre-existing medical conditions. It sets a minimum standard for “essential benefits” that all policies must cover—including, yes, maternity care and mental health. It bans annual and lifetime limits on what policies will pay. And it limits the out-of-pocket costs consumers can pay in one year.
But if insurers are going to cover more, they’re also going to charge more. That's why premiums for the new plans are higher. Obamacare addresses that problem by offering subsidies, worth hundreds of dollars in some cases and thousands of dollars in others. The result is that many people will actually pay less every month for the new policies than they are paying now. They may also get assistance with out-of-pocket expenses. But some people really will pay more for replacement policies and some of them will not find it easy. Meanwhile, many people eligible for the subsidies frequently don’t know they are available, let alone how much they are worth, because of the website problems. The media isn’t helping here, since stories about cancellations and higher rates frequently say very little about the subsidies—or fail to mention them altogether.
Obamacare isn't the only or even the best way to address the problems of the non-group market. You could move everybody onto a single, public insurance plan. You could regulate insurance prices as if the industry was a utility. Or you could simply increase the value of the subsidies. (I'd gladly support any of those.) But all of those require some combination of more government and more money, which is not politically possible right now. Conservatives have their own alternatives, some of which would let more people keep their current policies and some of which would almost certainly lead to more people losing their current policies. But under either of those options, many fewer people would get insurance—and those who had insurance would have less protection.
Regulation always involves tradeoffs. Food is more expensive because government demands the processing companies take steps to avoid contamination. Houses cost more because government insists builders use sturdy materials. Plenty of people would be happy to take their chances with less stringent regulations, but the government bans the sale of such products, even if they might be cheaper for some, because they are hazardous to the public's health.
A similar choice is at the heart of this latest controversy. You can set higher standards for insurance, even though it means forcing some people to get better coverage. Or you can leave the standards as they are, even though those standards expose people to financial and medical calamity. Obama and his allies chose the former. Those who disagree should explain why they prefer the latter.
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THE BIG CHOICE ON OBAMACARE: Jonathan Chait goes deep into the basic tradeoff that the law’s overhaul of the health care market requires, explaining why “letting people keep their insurance” would undermine that tradeoff. This:
People accept this transfer from the healthy to the sick because it is the only way to make medical care affordable to the sick…If you believe the healthy are entitled to keep the financial benefits of their good health, then you must also believe the sick must be denied medical care. Should that principle be the foundation of our health-care system?As Chait suggests, this is the moral choice the law asks folks to make. The above polling suggests it’s possible people are prepared to make this trade. Republicans will argue that once more people clearly understand the true nature of this choice, they’ll want to get rid of it. Related to this is the question of how many people will pay more, and how many will benefit. We’ll just have to wait and see.
GREG SARGENT WASHINGTON POST
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There’s no minimizing the political problems the web site is currently creating for Dems, and it remains possible that the politics of Obamacare could get significantly worse. But one possibility that no one seems to be entertaining is that the current battle could end up seriously backfiring on Republicans. If the web site does get fixed — and if demand proves to be such that enough people enroll – what do Republicans say at that point?
Republicans will have spent weeks expressing outrage on behalf of Americans who have been unable to tap into the benefits of Obamacare because of administration incompetence, and on behalf of people who are “losing” coverage because of outrageous liberal Big Government overreach. At that point, though, the web site will be working, and untold numbers of people will be shopping for real, tangible plans. Many on the individual market will find plans that are better, and potentially even cheaper overall — whether because of subsidies, or because the plans don’t disguise their true long term cost, as the current, crappy ones do – than their previous ones. None of this is a given, obviously; again, it all turns on whether the law works.
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I don’t know how long public patience will last on Obamacare. Perhaps the fuse is very short. And the possibility that Obamacare will fail — creating a political disaster for Dems — remains real. But Republicans seem absolutely certain that this will inevitably be a long term political bonanza for them, and that there’s simply no chance the law could end up working. Of course, this is hardly surprising, given that they’ve largely organized the party around the guiding idea that Obamacare is nothing but an epic catastrophe that can only be redeemed by eviscerating it entirely, and that the public is with them all the way. That was partly what led Republicans to adopt the disastrous shutdown strategy. I wouldn’t discount the possibility that it could be leading them into another long term miscalculation right now.