Will Barack Obama Receive The Credit He Deserves On Health Care Reform?

Support for Obamacare has fallen to new lows but, as has been the case all along with such polling, it is largely based upon misconceptions as to what Obamacare is and how it will affect people. There has generally been far greater support for the major components of the Affordable Care Act when polls have concentrated on this. Opposition to Obamacare has generally been based upon opposition to either items which are not really in the law (such as death panels and forced change from private insurance to a government run plan) or based upon predictions which have questionable basis in the actual law.

This is not to say that there have not been problems. The first month of the online exchanges started out poorly, but this was a problem easily circumvented by either waiting a month or by purchasing insurance directly from the insurance company’s web site (as I did). The issue of cancellations of some health plans (even if the insurance companies had the option of grandfathering people in) was been greatly exaggerated, with most people receiving more comprehensive coverage at a lower out-of-pocket cost. A relatively small number of older and more affluent people will pay more. However, even though I have to pay more, I consider it worthwhile to have a policy which could never be canceled due to developing medical problems and due to having caps on total out-of-pocket costs.

There are predictions that people will lose their current doctors but so far no evidence that this is a meaningful problem. Before the Affordable Care Act, every year there were many patients who I could no longer see because their employers changed them into plans I do not accept. This will remain the same, but unfortunately many people will blame Obama for this, just as they mistakingly are blaming Obama for many other health care issues which have nothing to do with the Affordable Care Act. Many also fail to realize that, thanks to Obama, we will no longer see the previously common occurrence of people who stop seeking medical care because they have lost their insurance and are unable to get a replacement.

There are frequent stories in the right wing media claiming that doctors will not accept patients with plans purchased through the exchanges. This will be clearer after January when we see if there are any shocks in how insurance companies reimburse for plans purchased through the exchange, but so far I see no evidence to support this fear. The plans which were available locally were almost all from the two biggest insurance plans active in the area. The  majority of doctors participate in these plans, and will such participation will continue uninterrupted in January. Maybe my Blue Cross plan will suddenly start paying out less than it did in the past, leading colleagues to decide to stop accepting it, but that is not likely. Insurance companies are interested in having a share of the currently enlarged individual market and are unlikely to engage in acts which will lead to people dropping their plan at the next open enrollment period.

In other words, market forces will help prevent the problem which conservatives are using to scare people with. Funny how conservatives only believe in market forces when it is convenient for their arguments. Plus the higher premiums (before subsidies) which conservatives complain about are a factor which would allow insurance companies to maintain fee schedules comparable to plans sold through employers.

A big question is what will happen over the next few months as people see what really happens under Obamacare, and most people with insurance find that things are not all that different from last year. Christopher Flavelle argues at Bloomberg Business that somebody has to be wrong about Obamacare:

A CNN poll taken last week showed that many Americans are exaggerating the effect of Obamacare on their own lives. As I wrote on Tuesday, this suggests the law will get a bump in public support over the next few months, as the widely anticipated negative consequences don’t materialize for most people outside the health-care insurance exchanges.

The poll is interesting for another reason: It suggests that the public’s divergent views on Obamacare don’t reflect different opinions about the proper role of government, so much as wildly different understandings about what the law will mean for the average American. Here’s the thing: They can’t both be right.

Start with this question: “Do you think you and members of your family will or will not be able to receive care from the same doctors you see now?” That isn’t a question about political preferences; it’s asking respondents to make a prediction of fact.

So the difference is startling: 79 percent of Democrats said they’ll be able to keep their doctor, compared with just 44 percent of Republicans — almost a 2-to-1 gap. Unless doctors start dropping patients according to their party affiliation, those two groups can’t both be right.

The same is true for a question about whether people expect to pay for medical care. Here the gap is even larger: 86 percent of Republicans said yes, compared with just 47 percent of Democrats. Again, unless insurers structure co-payments and deductibles by party, they can’t both be right.

Based on those numbers, one of two things will happen in 2014. The first is that access to doctors will fall and the cost of care will go up for most Americans; Democrats will (gradually) realize they’ve been misled, and support for the law will collapse.

The second possibility is that access to doctors and the cost of care won’t change for most Americans; Republicans will (gradually) realize they’ve been misled, and the case against Obamacare will disintegrate for the average voter. Fear of that outcome may explain why Republican leaders have been so frantic in trying to undermine the law now — they’re afraid that once their base realizes the warnings about Obamacare were wrong, they will stop paying attention.

It seems almost unnecessary to note, a week before the law’s coverage provisions take effect, that the vast majority of Americans who get their insurance outside the exchanges won’t see any big difference in cost or in their ability to see their own doctor. Unnecessary, because whether you agree with me or not, we’re about to find out. All we know for sure is that somebody is wrong.

To some degree the polls should shift as people see what really happens under Obamacare, and the scare stories do not come true. On the other hand, if my predictions are wrong and doctors will not accept people with insurance purchased through the exchanges, we will have a very serious problem which would undermine the success of Obamacare.

Unfortunately matters are not so simple as to expect that support for Obamacare will immediately climb when people see what the Affordable Care Act really does. I fear that, driven by ongoing conservative misinformation campaigns, people will continue to blame every problem in health care on Obama, regardless of whether the Affordable Care Act is responsible. Health care costs will continue to go up, and insurance companies might continue to use limited networks of physicians to attempt to control costs, as has been occurring for years. The trend towards higher out-of-pocket costs in health insurance also began before Obamacare and is likely to continue.

Later this year there will probably be stories about doctors having to spend large amounts of time and money due to a conversion from ICD-9 to ICD-10 diagnosis codes. I have already seen some Republicans blame this on Obamacare. Actually this is a change which came about under George Bush, with implementation later delayed until 2014.

Another problem which Obamacare will face is that people will enjoy the benefits of Obamacare without realizing it. I bet people are already taking it for granted that their health insurance now covers many preventative tests with no copay or deductible, or that they can keep dependent children on their plans until age 26. But how many realize that this is a result of Obamacare? If someone developed a serious medical condition and their insurance continues, will they realize that if not for Obamacare they might have lost their insurance and have been forced into bankruptcy in the past? Benefiting from Obamacare will not translate into support in the polls if people fail to realize all the ways they are now better off.

Obamacare is not perfect and some changes should be made, but all available evidence shows that it has brought about a major improvement in health care, bringing the United States closer to the standards of the rest of the industrialized world. This was done without a government takeover of health care and, for better or for worse, we have continued the American system of market-based health care coverage. The question is not as to the success of Obamacare, but as to whether Barack Obama will receive the credit he deserves for its success.


  1. 1
    JimZ says:

    Good column.  Politically, Obama has all the characteristics of a “survivor.”  Also, he is up against some of the most unpopular politicians in particular and the GOP in general, whose long term viability one can contemplate, at the very least.  So, to that extent he is lucky (his opponents are incompetent and mean-spirited).  Obama almost never loses his cool before cameras, his intelligence and basic good heartedness seems to come through almost regardless of the subject matter.  [This is a sort of Reaganesque trait, to his advantage]  I think his political “legacy” will be more adversely affected by issues unrelated to the ACA, such as the drone murders and domestic surveillance.  And finally his “actual” legacy will (tragically) be based on his gutless turn from proper economics to joining the GOP’s and Wall Street’s obsession with “debt” and “the deficits,” which will assure that the US continues in not just a lost economic decade but possibly multiple decades of terrible economic performance and literally generations of real human pain and suffering due to our failure to apply what we have known for almost 80 years about how to fight depression.  The ACA will live on and be absorbed into the American culture.  The economic disaster that Obama now owns will be, too.

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    Ron Chusid says:

    I think you are projecting your views on how the majority will see Obama. I don’t think that enough people care about issues such as drones and domestic surveillance to significantly affect his legacy.

    The conventional wisdom is that deficits are bad and cutting the deficit takes priority. (See previous post here).  If considering how Obama will be viewed (not whether he was right on the issues), Obama will probably be better off in going along with the conventional wisdom.

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