Americans don’t actually want to repeal the Affordable Healthcare Act even if they say they do

According to a new Gallup poll Americans are pretty much split evenly on whether or not we should repeal the new healthcare law. But as with any other government program, Americans are only against it in the abstract. Americans hate the mandate, largely because it’s called a mandate, but love parts of the bill that end pre-existing condition clauses. Of course, you can’t really have a system of private insurance that allows anybody to get a plan at any time without a mandate, so we’re stuck with the good and the bad.

The healthcare law is a mixed bag. It doesn’t go as far as many wanted it to go – something like single payer, preferably. It changes rather than expands the role of government in providing access to healthcare. It’s inefficient in some ways; in other ways it improves upon the status quo. One thing that sort of irks me about it is how politics forces us to make do with something as ad hoc as all of this. We have Medicaid – administered by the states – and Medicare – administered by the federal government – and now the ACA – administered by the states – and rather than just save tons of money and increase efficiencies enormously by combining all these programs into one federal healthcare program, we have to leave this expensive patchwork in place and then just build upon it (and the patchwork is much worse once you think about how the private insurance system is designed, and the entrenched inefficiencies baked into healthcare writ large including hideously opaque prices…)

In any case, take away the parts that people dislike about the bill and of course people suddenly love it. Talk about it being struck down, and most Americans still imagine that their favorite parts will remain.

If you took away all the fearmongering surrounding the bill, they’d probably be fine with it also. But a steady diet of death panels and threats about tax-hikes has everyone much more frightened than they would otherwise be about a bill that basically just opens up non-employer-based insurance exchanges so that people have just a tiny bit more access to reliable healthcare than they did before. It’s neither a panacea or a government take over. It’s just sort of a step in the right direction and a step in the wrong direction all at the same time, and better – certainly – than doing nothing.

The ACA hurts Obama in swing states, even if people like the bill in pieces; but as James Joyner notes, if Romney gets the GOP nod it may be a moot point anyways.

(cross-posted)

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29 replies
  1. 1
    Jennifer says:

    Funny how all the concerns about how the ACA is going to raise costs and taxes go right out the window when there’s an opportunity to pass a slut-shaming law that will increase the cost of a fairly routine and completely legal medical procedure by $200 or more, for no medical reason.

  2. 2
    Enhanced Voting Techniques says:

    if Romney gets the GOP nod it may be a moot point anyways

    Why? Romeny will just point out he has no principles and Romney Care was just politically expedient at the time.

  3. 3
    makewi says:

    Why not just mandate the end of pre-existing conditions clauses and put a cap on premiums? Then let the marketplace figure out how to work that.

  4. 4
    Violet says:

    @Jennifer:
    You can’t put a price on controlling women. No cost is too high.

  5. 5
    pseudonymous in nc says:

    rather than just save tons of money and increase efficiencies enormously by combining all these programs into one federal healthcare program

    Or a relatively frictionless state system, akin to Canada’s provincial system operating under the auspices of the Canada Health Act. But that would require state governments to be a) populated by legislators who are not craven idiots; b) elected by people who give slightly more of a shit about state government.

    It’s a ‘can’t get there from here’ problem, which is what happens when there’s relatively little political space to challenge the people who profit under the existing clusterfuck.

  6. 6
    Rick Massimo says:

    I will never forget the blood-pressure spike I got the day after the ACA was signed when Our Media Stars FINALLY started telling people that while two-thirds of the country didn’t like the ACA, one-third of the country didn’t like it because it didn’t go far enough.

    Our Liberal Media certainly kept that under wraps as long as they could …

  7. 7
    Quicksand says:

    FYI, Erik is Ed’s brother.

  8. 8
    Jennifer says:

    @Violet: Yeah, but…I can see some ways to make it so painful financially to do so that it might discourage it. Say some rules adopted to ACA that state that if an employer doesn’t want to pay for contraception because of his religious objections, then instead he pays a $300 higher per month premium for each female employee – the cost of a pregnancy rider, more or less. That’s where his religious objections lead, and it’s not fair for him to offload the higher health care costs of his female employees onto the rest of us – since he’s the one calling the shots on their reproductive care, he should pay the costs of his convictions.

    Also, too, it would be nice to see an ACA rule that simply stipulates that any procedure mandated by state law that is not medically necessary cannot be billed to patients, insurers, or Medicaid/Medicare. Again, if you’re passionate about the idea of shaming the sluts to the tune of $200 or more per pop, then go explain to your constituents why you’re raising their taxes to underwrite the costs of something that’s not medically necessary but that you just thought would be a good idea.

    We’d see a lot of this shit die down in a hurry if we just played a little hardball on it. And not even really hardball, unless making people put THEIR money where their mouths are, rather than someone else’s money, is considered hardball.

  9. 9
    khead says:

    Box cat hates your freedom.

    Yeah, it’s the same box cat as last weekend.

    I have been lazy – so have the cats. Sue me. And the kittehs.

  10. 10
    Bago says:

    The ChiCaps would never do that, especially out at Foxconn.

    I love the fact that the iPad autocompletes for Foxconn.

  11. 11
    Violet says:

    @Jennifer:

    Say some rules adopted to ACA that state that if an employer doesn’t want to pay for contraception because of his religious objections, then instead he pays a $300 higher per month premium for each female employee – the cost of a pregnancy rider, more or less.

    Those costs would get passed onto every employee at the company. The company wouldn’t be out any more money. A big downside is it would discourage hiring female employees. And what about women who are on their husband’s or partner’s insurance? Would they not be penalized?

    If there’s going to be a surcharge, it needs to be applicable to every employee, not just women.

  12. 12
    Erik Kain says:

    Re: the Canadians system…sure.

  13. 13
    Canuckistani Tom says:

    @khead:

    You’re gonna be hearing from Maru’s lawyer

    http://www.youtube.com/user/mugumogu

  14. 14
    Benjamin Franklin says:

    with the +-variable it is unchanged since July 2011.

    A Kaiser poll says 42 percent of Americans holding a favorable view and 43 percent an unfavorable view.

    It doesn’t kick in until 2013. It takes time before people personally experience
    the benefit. The same scenario held for Social Security and Medicare.

    Now people want the gubmint to keep their hands off Medicare and SS.

  15. 15
    Jennifer says:

    @Violet: Assuming the company has group coverage, it pretty much would get spread around to all the employees. Insurers have a real knack for actuarial tables, and they could pretty quickly determine how much more they should charge for plans guaranteed to produce higher costs.

    Why should the costs be spread beyond that employer, though?

    Would be great if the rule also stipulated that the insurer “reach out” to those women affected just as in Obama’s concession to the beanie-heads, to let them know they could access no cost contraceptive care directly from the insurer. Perhaps rebate most of the higher premium paid by the employer to every female employee who opts for contraceptive services, and allow the insurer to keep a small portion as a PITA charge.

    Not gonna happen, I know. But it would be nice to see the discussion go in this direction rather than in bills requiring rectal exams and so forth for Viagara coverage. The public is not going to be nearly as sympathetic to god-botherers screeching about bein’ oppressed if they understand that they’ll be paying more so that the nutbars can force their religious beliefs on others.

  16. 16
    samara morgan says:

    @Erik Kain:

    But as with any other government program, Americans are only against it in the abstract.

    wallah, Captain Obvious rides again.
    DIAF, plz.

  17. 17
    fledermaus says:

    I opposed the ACA in its current form. Sure the things like coverage for kids under 26 and no pre -existing condition are nice, but the dems are still stuck explaining that health care insurance was messed up so were fixing it but requiring you to buy insurance from the same people who have been ripping you off for the last 20 years. Here are some of the problems I have with it (info taken from http://www.healthcare.gov):

    1. rate increase “review” – this sounds nice, but it actually does nothing to prevent insurance companies from raising rates to what ever they want. These are going on right now. Here is how it actually works: “The HHS review has found that Everence’s 12 percent rate increase for small businesses in Pennsylvania was excessive. . . . We have called on the insurer to immediately withdraw these rates, stop charging consumers unreasonable rates, and provide a refund or credit to any policyholders which have already paid unreasonable rates. Should the company choose not to do so, they must post a justification on their website in 10 days, explaining why they will continue charging their customers excessive rates.”

    So basically if a rate is found to be “unreasonable” are they kicked off the exchange or incur tax penalities? No, they have to post a statment on their website about it. shivers oh the humanity, what a draconian penalty!

    2. The “subsidy” – OK everyone making less than 133% federal poverty line gets Medicade (~14K/yr for a single adult). So far so good. But wait, everyone between 133-150% also gets a subsidy. Wonderful, except on closer examination this subsidy is a tax credit gained after the year is passed. So everyone in this level will have to pay full freight for a year before they get any help. Have an fiscal emergency and unable to make your monthly payment? Kicked off and you have to pay the penality as well. Plus no tax credit for the next year.

    3. medical loss ratio requiring 80-85% of premiums be spent on “care and quality improvement.” Great, except it is all based on self reporting and we see how that works in bank regulation. How could they even enforce this?

    4. Cost of coverage – finally the big ticket item. Look as I did, I did not see any hard limits on what insurers may charge on co-pays, deductables. The result of this is insurance companies will push cheap junk insurance that people will sign up for just to be compliant. The only explanation is that increased competition will reduce costs, asserted without evidence in typical neo-liberal fashion (although why our current individual coverage free market has failed to do so already is not explained)

    How is any of this supposed to work in the increasing world of multiple part time jobs (thus not covered by the employer requirements), the 1099 “gig economy” temporary contracts with no benefits and a 15% self employment tax?
    Who knows, maybe it will all work out just as planned and everybody will be happy with the exchanges and the mandate. But to expect people to be greatful that something called “health care reform” passed congress, with happy neo-liberal tales of the free market and a mandate to buy from the same people whose greed created the problem is not a winning message.

  18. 18
    samara morgan says:

    @Erik Kain: FYI, i been cc’ing Andrew your stupider comments. Like the one about Thomas Jefferson.
    ;)

  19. 19
    samara morgan says:

    @fledermaus: did you know Kain is a BEEG fan of the “freed” market?

  20. 20
    Lurker says:

    @fledermaus:

    But to expect people to be greatful that something called “health care reform” passed congress, with happy neo-liberal tales of the free market and a mandate to buy from the same people whose greed created the problem is not a winning message.

    Let me guess. You already have health insurance, and you feel secure about your own health coverage.

    I’m a cancer survivor who’s been rejected three times by three different insurers for private individual health coverage. I had to form a general partnership with my own husband just so that I could purchase guaranteed-issue group coverage in California. It’s a flimsy workaround, because if anything happened to one of us, the survivor would lose his or her health coverage.

    I am not “greatful” for the Affordable Care Act. I am GRATEFUL that I will have a chance to buy my own private individual coverage in 2014. Please don’t take the Affordable Care Act away from me.

  21. 21
    Fitzwili says:

    @fledermous I too am a cancer survivor; I have serious life threatening health problems and I lived in fear that my childhood cancer would be the basis of not being able to have insurance because of pre-existing conditions. I had to form a sole proprietorship to get my insurance. I am deeply, profoundly grateful for the ACA because I no longer have the fear of denial because of pre-existing conditions hanging over me.

  22. 22
    GARY CAMPBELL says:

    @pseudonymous in nc: How VERY WELL said!

  23. 23
    Ed in NJ says:

    It seems these surveys love to poll people who will never be mandated to purchase insurance. As someone who has to pay full freight for insurance as an independent contractor whose wife has her own small private counseling practice, I say mandate me please.

    I get sick of hearing the opinions of people who are not going to be affected by this law in any way. That includes some of the resident experts and wannabe blog comment celebrities here. And don’t give me shit about your taxes paying to subsidize me.

  24. 24
    Mart says:

    Think you forgot another of the nations biggest healthcare systems, the Veterans Administration.

  25. 25
    Billy Beane says:

    “The ACA hurts Obama in swing states”

    Proof? Links? I say you are just talking our of your ass on that one.

  26. 26
    Robert Waldmann says:

    “basically just opens up non-employer-based insurance exchanges so that people have just a tiny bit more access to reliable healthcare than they did before.” is not true at all. You didn’t mention the subsidies. More importantly, you didn’t mention the expansion of Medicaid. Of the people who will get health insurance because of the bill, about half will get Medicaid. For free. This is a huge huge change quite different from the mandate, the regulatory reforms, the exchanges or the subsidies to people and small firms who buy insurance on the exchanges (which you didn’t mention).

    I expect the expansion of Medicaid to go unmentioned over at Firedoglake. Hamsher’s whole case is based on pretending it doesn’t exist.

    Thjem’s fighting words around here no ?

  27. 27
    Bruce S says:

    Milton Friedman supposedly made the observation that there is no free lunch. But it seems that folks who gravitate toward the Right are the foremost exponents of the “free lunch” theory – i.e. everyone should have the right to sign up for health insurance regardless of pre-existing conditions, but without a mandate that everyone signs on to an insurance plan so the costs are, in fact, shared. Or the notion that tax cuts are always a good thing, but keep the governments hand off of the social insurance or revenue-sharing program that benefits “ME!” There is hardly a vestige left of conservatism in this country. Only ignoramuses promoting aggressive ignorance, selfishness and cultural/generational narcissism. Probably the closest thing you’ll find to an authentic conservative is certain of the Blue Dog Dems. And, frankly, I wish the opposition party represented folks like them – as opposed to the brain-dead and morally challenged – so real Democrats could get on with the necessary agenda of real reforms and forward-looking social policy. The GOP and their base is shot through with disingenuous “free lunch” schemes – and that’s not the worst of it. The state-sponsored rape stuff is leaving me scratching my head, it’s so retrograde and insane.

  28. 28
    slightly-peeved says:

    @17: You’re wrong on 1, 2, and 4. They can kick insurers off the exchange, the secretary of HHS determines what they could claim as medical treatment under the 85 percent rule, and the limits on co-pays are in Sec. 1302 part (c).

    Also note that the OPM will be contracting a national insurance provider to cover all exchanges in lieu of a public option. Well, with the exception of Vermont, which is going for a waiver under the law so they can institute single-payer. And there’s the massive medicaid expansion that is responsible for half the expected increase in coverage.

    people who want to complain about it should spend a bit of time reading it first.

  29. 29
    jlh says:

    @fledermaus:
    With regard to your comments on the subsidies, I just covered the ACA in a university course that I teach, and see a couple of problems with your description. First, the subsidies will be available to individuals/families with income between 133-400% of the federal poverty level (not 133-150%). Secondly, the subsidies will be in the form of tax credits that are not only refundable, but “advanceable”, meaning that they can be used immediately to purchase insurance on the exchanges. No one will have to wait until filing a tax return to receive the credit.

    Also, I support the ACA, but is it really true that it doesn’t expand the role of government, as the original post suggests? For example, Medicaid will be expanded to all individuals under age 65 with incomes up to 133% of the federal poverty level. Perhaps this can be characterized as expansion of an existing government program as opposed to an expansion of the “role of government”. But I’m not sure that argument really works.

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