Surveys Show Benefits Of Obamacare For Individuals And Hospitals

Two polls were released today regarding opinion of the effects of the Affordable Care Act, one from consumers and one from hospital administrators. The first is reported by CNN:

More than half the public says Obamacare has helped either their families or others across the country, although less than one in five Americans say they have personally benefited from the health care law, according to a new national poll.

A CNN/ORC International survey also indicates that a majority of Americans oppose the Affordable Care Act, but that some of that opposition is from people who don’t think the measure goes far enough…

According to the poll, only 18% of the public say they or their families are better off now that the major provisions of the health care law have been implemented. Another 35% report that, while their lives have not improved, the Affordable Care Act has benefited other people in the U.S. Add those two numbers together, and that means 53% say that Obamacare has helped either their families or others across the country.

Forty-four percent tell us that the health care law has not helped anyone in the country.

Any poll regarding whether the law has helped people has to be interpreted cautiously. First there are those who follow the Republican line and deny benefits which have been well-documented, such as an increase in the number of insured. Even those answering with an open mind might not realize ways in which they are benefiting.  Before the Affordable Care Act came into effect many people often did not realize the problems in the old system as they had not encountered them personally. In the past I often saw patients with very limited coverage who had no idea how limited their coverage was. Some policies would only cover inpatient or outpatient services. Some policies had severe limitations on how many office calls they would cover or how much they would pay for lab per year. I have seen patients with newly diagnosed diabetes who suddenly needed far more services than in the past but found that they had used up their coverage for the year by around March. Many people also do not realize the risk they previously faced of being dropped by their insurance plan should they develop expensive medical problems. Insurance companies can no longer drop people for medical problems or deny coverage for pre-existing conditions, along with being required to provide comprehensive coverage, including preventative care.

FierceHealthCare reported on a survey of hospital executives which showed that average inpatient admissions were increased by 0.4 percent in the second quarter of this year, following several years of deceases, as a consequence of the Affordable Care Act and other factors. They also found that “The ACA has made a positve impact on hospital performance, according to the survey, with hospitals in states that expanded Medicaid under the healthcare law expressing significantly more positive views about improvements in payer mix and diversity in the second half of the year.”

Hospital inpatient volumes trended positive for the first time in several years–albeit by only a slight margin–according to a new survey from Jefferies. The investment bank and securities firm also released data about hospital performance and payer mix.

Inpatient volume has trended negative for the last few years, due largely to the economic downturn and plan design changes, but average inpatient admissions were up 0.4 percent in the second quarter of 2014, according to the survey results. Researchers attribute the uptick to a combination of the improving economy, the implementation of the Affordable Care Act and patients waiting as long as possible for procedures, compounding demand.

Polling on provider optimism was also positive, according to the survey. Of the executives from 50 hospitals Jefferies polled, seven in 10 expected inpatient volume to be either flat or up in the third quarter, which is remarkable considering the multiyear trend of negative volumes, according to the survey results. Executives at hospitals with more than 250 beds were particularly optimistic, with all such respondents expecting volume increases in the third quarter.

The ACA has made a positve impact on hospital performance, according to the survey, with hospitals in states that expanded Medicaid under the healthcare law expressing significantly more positive views about improvements in payer mix and diversity in the second half of the year.

“That said, 54 percent of our surveyed hospitals indicated that the ACA has not impacted volume trends yet; it is worth noting though that half of hospitals with 500 or more beds noted improved admission trends as a result of the ACA,” the results stated. Jefferies will continue monitoring developments in states that have not yet expanded the program but are “key for the publicly traded hospitals,” including Tennessee, Pennsylvania and Florida.

Thirty-four percent of respondents overall said emergency department (ED) admissions had increased, but the numbers were higher in expansion states (42 percent) than non-expansion states (29 percent). This lines up with the results of a study which found Medicaid expansion in Oregon increased ED volumes, FierceHealthcare previously reported.

The benefits for hospitals in this survey was consistent with previous reports that Medicaid expansion has led to both increased care for the poor and improved revenues for hospitals. The same post also reported on a recent survey conducted by the American College of Emergency Physicians which found that 37 percent of ER physicians reported that patient volume had increased slightly, 9 percent reported that it had increased greatly, and 27 percent reported that the number of ER visits had remained the same.

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Michigan Democratic Candidates Improving Position In Latest Poll

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There is good news in the latest EPIC-MRA poll out of Michigan. The biggest race from a national perspective is replacing retiring Senator Carl Levin. In addition to having an impact on control of the Senate, the Republican candidate, Terry Lynn Land, is a Teabagger who so far has come across as only slightly less bat-shit crazy than Michele Bachmann. Democratic candidate Gary Peters (pictured above) leads Land by 9 points, 45 percent to 36 percent.

Republican Governor Rick Snyder is fortunately not an extremist like Land. Many Democrats supported Snyder four years ago in the Republican primary, during a year when it was clear the GOP candidate would win, to prevent more extreme candidates such as Pete Hoekstra from getting the nomination. Snyder has sometimes stood up to the Republican legislature and  might even be tolerable if working with a Democratic legislature. Unfortunately at other times he has given in to the Republicans.

Snyder started out with a big advantage, such as that an incumbent governor has not lost in Michigan since 1990. In May Snyder led his Democratic opponent, Mark Schauer, by nine points. Now the lead has narrowed to three points, with Snyder leading 46 percent to 43 percent. As Schauer is still not well known, it is encouraging that he is making it a close race with a long time to go until November. The results are within the margin of error, and shows Schauer increasing support from the Democratic base and shows independents now breaking towards Schauer.

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The Secret To Success In The Senate

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Congress has a record low approval rating, which perhaps is why the most successful Senators appear to be those who haven’t spent much time there. Barack Obama sure didn’t waste much time in the Senate before successfully running for president. Hillary Clinton is a special case as her time in the Senate is only a small part of her resume, but she didn’t spend very much time there either. The most popular Senator from each party today very well might be a freshman. Both have ignored the old tradition for new Senators to be fairly quiet.

On the Democratic side, Elizabeth Warren has received the most enthusiastic support. There is even a Ready For Warren web site, despite her statements that she has no plans to run for president. She has spoken out the most on economic issues, but is now wading into social issues as well with her comments on the Hobby Lobby case:

I’ll be honest – I cannot believe that we are even having a debate about whether employers can deny women access to birth control. Guys, this is 2014, not 1914 . Most Americans thought this was settled long, long ago. But for some reason, Republicans keep dragging us back here – over and over and over again.

On the Republican side, Rand Paul has generated the most excitement. As his foreign policy views are out of step with those of his party, there are real questions as to whether he has a chance to win a Republican presidential nomination. Gallup found that he falls just slightly behind Mike Huckabee among potential Republican candidates at this time. Aaron Blake looked at other polls to show that Paul is in a strong position to possibly win in both Iowa and New Hampshire, which certainly would give him strong momentum towards winning the nomination. Should Paul manage to win the nomination, a Quinnipiac poll shows that Paul is the strongest Republican candidate against Clinton in Iowa. Of course that might not hold nation wide.

A Huckabee versus Paul race for the Republican nomination would certainly offer a choice of different views. A presidential race between Paul and Warren would do the same, and most likley excite many on both the left and right far more than, say, another campaign between a Bush and a Clinton. Of course a race between Clinton, as opposed to Warren, and Paul is far more likley considering the state of the Democratic race. As I discussed previously, this would lead to a reversal in partisan foreign policy perspective, with the Democrats having the hawk as a candidate. As Peter Beinart pointed out, she sounded more like George Bush than a Democrat on foreign policy on her recent appearance on The Daily Show.

Updates: Digby also questions Clinton’s statement. Politico reports that Warren rallies the base. John Dickerson thinks a Warren run would be a good thing–but primarily to provide a worthy conversation and to “force Clinton to draw clear lines about what she believes, why she’s running, and why her message is something more than ‘It’s my turn.’” I would be more interested in a challenge to Clinton from the left which could actually beat her for the nomination, but that doesn’t look likely.

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Norman Ornstein Writes Once Again That The Republicans Are The Problem

Norman Ornstein once again sets the record straight, resonding to those who say both parties are responsible for the degree of polarization and gridlock we are now experiencing:

Tom Mann and I, among others, have said that the polarization in the capital is asymmetric, much more on the conservative and Republican side than on the liberal and Democratic side. An army of journalists—including Ron Fournier, Paul Kane, and others—have said both sides are to blame. And journalists led by Jim Fallows have decried what he first called “false equivalence.” This malady itself has two components. The first, which in many ways is a larger ingrained journalistic habit that tries mightily to avoid any hint of reporting bias, is the reflexive “we report both sides of every story,” even to the point that one side is given equal weight not supported by reality. The second, often called the Green Lantern approach and typified by Bob Woodward, is that presidential leadership—demanding change, sweet-talking, and threatening lawmakers—could readily overcome any dysfunction caused by polarization, thus allocating responsibility in a different way that deflects any sign of asymmetry.

As the Pew study makes clear, in the mid- to late-1990s, we did not have anywhere near the level of public polarization or ideological or partisan animosity that we have now. In the public, this phenomenon has been much more recent (and is accelerating). But in the Gingrich era in Congress, starting in 1993, where Republicans united in both houses to oppose major Clinton initiatives and moved vigorously from the start of his presidency to delegitimize him, the era of tribalism started much earlier, while the ante was upped dramatically in the Obama years. The fact is that it was not public divisions on issues that drove elite polarization, but the opposite: Cynical politicians and political consultants in the age of the permanent campaign, bolstered by radio talk-show hosts and cable-news producers and amplified by blogs and social media, did a number on the public.

The elite tribalism was not all one-sided. To be sure, there was plenty of vitriol hurled by Democrats at George W. Bush. But Democrats worked hand-in-glove with Bush at the early, vulnerable stage of his controversial presidency to enact No Child Left Behind, which gave his presidency precious credibility and provided the votes and support needed for his tax cuts. Contrast that with the early stages of the Obama presidency.

Merry uses immigration to dispute our characterization of the contemporary Republican Party as an insurgent outlier, dismissive of science; no surprise that he does not mention climate change. As for Ron Fournier, I have one point of contention and one response to his question, “Who cares?” First is the characterization of those who believe that the polarization is asymmetric as partisans. There are partisans who have seized on the ideas, but it is very unfair to characterize the scholars and most journalists who have written about this as biased—just as it would be deeply unfair to characterize Fournier, a straight-up journalist of the old school, as an instrument of Republicans or the Right.

More important is the question he raised. Does it matter whether the polarization, and the deep dysfunction that follows from it, is equal or not, including to the average voter? The answer is a resounding yes. If bad behavior—using the nation’s full faith and credit as a hostage to political demands, shutting down the government, attempting to undermine policies that have been lawfully enacted, blocking nominees not on the basis of their qualifications but to nullify the policies they would pursue, using filibusters as weapons of mass obstruction—is to be discouraged or abandoned, those who engage in it have to be held accountable. Saying both sides are equally responsible, insisting on equivalence as the mantra of mainstream journalism, leaves the average voter at sea, unable to identify and vote against those perpetrating the problem. The public is left with a deeper disdain for all politics and all politicians, and voters become more receptive to demagogues and those whose main qualification for office is that they have never served, won’t compromise, and see everything in stark black-and-white terms.

Besides, this excerpt, read the full article, along with his writings with Thomas Mann, including this op-ed and their book, It’s Even Worse Than It Looks. For a look at the unprecedented obstructionism towards Obama practiced by the Republicans, see this Frontline documentary,The Republicans’ Plan For The New President:

On the night of Barack Obama’s inauguration, a group of top GOP luminaries quietly gathered in a Washington steakhouse to lick their wounds and ultimately create the outline of a plan for how to deal with the incoming administration.

“The room was filled. It was a who’s who of ranking members who had at one point been committee chairmen, or in the majority, who now wondered out loud whether they were in the permanent minority,” Frank Luntz, who organized the event, told FRONTLINE.

Among them were Senate power brokers Jim DeMint, Jon Kyl and Tom Coburn, and conservative congressmen Eric Cantor, Kevin McCarthy and Paul Ryan.

After three hours of strategizing, they decided they needed to fight Obama on everything. The new president had no idea what the Republicans were planning.

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Twenty-Eight Percent Of Americans Believe Bible Is The Literal Word Of God

Gallup Bible Word of God

I recently cited a Gallup poll which showed that 42 percent of Americans believe in creationism. With that in mind, I imagine it is a good thing that a lower number, 28 percent, believe that the Bible is the literal word of God. Gallup reports that this is below the 38 percent to 40 percent seen in the late 1970s, and near the all-time lows of 27 percent seen in 2001 and 2009. However, “half of Americans continue to say the Bible is the inspired word of God, not to be taken literally — meaning a combined 75% believe the Bible is in some way connected to God.” Gallup also found that 21 percent see the Bible as  “ancient fables, legends, history, and precepts written by man.” While discouragingly low, at least this is up from only 13 percent in 1976.

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Study Shows People Less Likely To Take Storm Seriously If It Has A Female Name

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People are really stupid

A study published in the Proceedings of the National Academy of Sciences (via The Washington Post) found that people are more likely to be killed by storms with a woman’s name than a man’s name because they don’t take them as seriously:

Researchers at the University of Illinois and Arizona State University examined six decades of hurricane death rates according to gender, spanning  1950 and 2012.  Of the 47 most damaging hurricanes, the female-named hurricanes produced an average of 45 deaths compared to 23 deaths in male-named storms, or almost double the number of fatalities.  (The study excluded Katrina and Audrey, outlier storms that would skew the model).

The difference in death rates between genders was even more pronounced when comparing strongly masculine names versus strongly feminine ones.

“[Our] model suggests that changing a severe hurricane’s name from Charley … to Eloise … could nearly triple its death toll,” the study says.

They also found that people would be less likely to take precautions if told a storm with a female name is coming as opposed to one with a male name:

“People imagining a ‘female’ hurricane were not as willing to seek shelter,” Shavitt said. “The stereotypes that underlie these judgments are subtle and not necessarily hostile toward women – they may involve viewing women as warmer and less aggressive than men.”

It sounds hard to believe that people would be so stupid as to fail to take shelter because of being told that Hurricane Charlotte is approaching as opposed to Hurricane Charlie. What if they were told Hurricane  Natasha Romanoff was coming after them?

National Geographic has more, including some criticism of the study.

In somewhat related news on the stupidity of Americans, Gallup found today that 42 percent  believe in creationism, consistent with previous polls. Previous polls have shown a greater likelihood for Republicans to believe in creationism. I wonder how much overlap there is between these people and those who would downplay the severity of a storm if it has a female name. There could be some evolutionary implications towards weeding out stupidity going on here which the victims wouldn’t even understand or believe in.

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A Fact Checker Responds To Mitch McConnell’s Dishonesty On Obamacare

In response to the issue discussed yesterday where Mitch McConnell simultaneously opposed the Affordable Care Act and supported Kynect, the computer exchange set up in Kentucky as part of the Affordable Care Act, Glenn Kessler exchanged email with Jesse Benton, McConnell’s campaign manager. Benton made some absurd statements such as that,  “When Obamacare is repealed, Kentucky can choose to continue Kynect or alter it in a way that makes the best sense for Kentuckians.” As discussed yesterday, Kynect cannot exist without Obamacare.

Benton also tried to separate the benefits of the expanded Medicaid program from the Affordable Care Act:

Medicaid existed before Obamacare and will continue to exist after repeal. Kynect is not Medicaid. It is a state administered exchange that provides a marketplace for private insurance plans.  While some 300,000 Kentuckians discovered they were eligible for Medicaid through Kynect, they do not purchase private insurance through the exchange; they are enrolled in the state-administered program.

The expansion of Medicaid is another aspect of the Affordable Care Act, with the federal government paying the bulk of the cost of this expansion. If Obamacare is repealed, there would not be either Kynect or the expanded Medicaid program which many in Kentucky have benefited from.

Benton also claimed that people in Kentucky “would move back to HSA’s and other higher deductible plans they had pre-Obamacare to receive a higher quality of care.” However there were no previous plans for most of these people as 75 percent of the newly insured in both Medicaid and the exchange were previously uninsured. High deductible plans and HSA’s work well for upper income individuals, but they are not a good solution for those with lower incomes who cannot afford to pay high deductibles or place money in HSA’s.

Kessler concluded:

McConnell appears to have accepted the Medicaid expansion that has been so embraced by his state’s residents, while drawing a distinction with the Obamacare health plans sold on the statewide exchange. Given that three out of four of the newly insured in Kentucky ended up on Medicaid, that probably makes political sense—and also is newsworthy.

But the history of individual state exchanges shows it is not credible for McConnell to suggest that the state exchange would survive without the broad health-care system constructed by the Affordable Care Act, such as an individual mandate and subsidies to buy insurance. Given the popularity of the state exchange, McConnell appears to want to offer out hope it would continue even in the unlikely case the law was actually repealed. That’s likely not a tenable position, and we will pay close attention to McConnell’s phrasing on this issue in the future. The senator is clearly trying to straddle a political fence; when doing so, it’s easy to lose your balance.

I do find it strange that Kessler decided to review the exchange with the above conclusion “rather than a traditional fact check.” These statements from McConnell and his campaign manager are clearly dishonest. Kessler has declared statements which were far more ambiguous to be dishonest in the past. I do applaud his decision to concentrate on reviewing the facts as opposed to jumping to awarding Pinocchios, but hope that this new policy applies to both parties.

In related news, a new Wenzel Strategies poll (a Republican pollster with a reputation for a strong pro-Republican “house effect”) has Mitch McConnell leading Democratic challenger Alison Lundergan Grimes by 47 percent to 44 percent. The closeness of the race is encouraging but it is hard to see Kentucky voting in a Democratic senator.

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Two Polls Give (Limited) Hope For A Democratic Upset In November

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There are two recent poll findings which you might think should help the Democrats in November but most likely will not. Gallup found that the Democratic Party had a favorable rating of 44 percent while the Republicans have a with 34 percent favorable rating.

Unfortunately this type of lead has not necessarily translated into election victories in the past. It also doesn’t help the Democrats that, while leading the Republicans, they are still under 50 percent.

Republicans also have an advantage in House elections due to gerrymandering, and due to the concentration of Democrats in urban areas, leading to a larger margin of victory in a smaller number of districts. Democrats are defending several Senate seats in red states where they would not enjoy this lead over Republicans.

Brendan Nyhan looked at a recent Washington Post-ABC News poll which showed that more people agree with the Democrats on the issues:

More Americans say they trust Democrats than Republicans on the “main problems the nation faces over the next few years” as well as a number of key policy issues, including the economy, health care and immigration. Members of the public also typically indicate that Democrats are closer to their opinion than Republicans on specific issues like abortion, same-sex marriage and raising the minimum wage.

This apparent political advantage is less important than it might seem, however. For instance, Democrats had greater advantages on several major issues at comparable points in the 1994 and 2010 electoral cycles, which both resulted in Republican landslides…

Why haven’t these issue advantages translated into electoral success? First, the midterm electorate is not representative of the American public. The public’s preferences for Democrats on the issues may diminish or disappear once you look at registered voters or those who claim they are “absolutely certain” to vote, as Jaime Fuller of The Washington Post has noted. The Democrats’ edge on the issues is likely to dissipate further among the older, whiter group of Americans most likely to vote in November.

In addition, the importance of the issues in congressional elections is typically overstated. Structural factors like presidential approval, the state of the economy, the type of election (midterm or presidential year) and the composition of the seats that are up for election tend to matter more.

Most likely, based upon fundamentals in a midterm election the Republicans should do better than the Democrats. However, if the Democrats are seeking to significantly beat historical expectations, they sure have a better chance at the upset if they are the party which a majority support than if they did not have this support. How they do will depend a lot on whether the Democrats can get more of their supporters out to vote than is typical in midterm election years.

While the Democrats face a difficult task in holding onto Senate seats in the red states, there is an advantage to incumbency which should allow some to win. This might be enough to allow the Democrats to maintain control of the Senate until 2016 when the fundamentals are in their favor, including having an election year electorate and it is the Republicans who will be defending Senate seats in several blue states.

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Percentage of Uninsured Continues To Decrease–Tennessee Republican Compares Obamacare To The Holocaust

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Gallup reports a further drop in the percent who report being uninsured to 13.4 percent, representing a new low since they started polling on this topic in 2008. The decrease shows the effects of the Affordable Care Act despite claims by many Republicans that the number of uninsured has increased rather than decease.

As data repeatedly comes out which is contrary to Republican claims it is getting harder for Republican to deny that more people have insurance coverage due to the Affordable Care Act. Instead they have to find new ways to spin the numbers. Tennessee State Senator Stacey Campfield posted this: “Democrats bragging about the number of mandatory sign ups for Obamacare is like Germans bragging about the number of manditory sign ups for ‘train rides’ for Jews in the 40s.”

Opposition to the individual mandate is a plausible position to take, ignoring the fact that it was a position commonly proposed by Republicans until Obama adopted it as part of the Affordable Care Act. Regardless of how one feels about the mandate it is hardly comparable to the Holocaust. It is also possible that the mandate has influenced the number who obtained coverage, but this is what the law was designed to do. It is questionable how many people did sign up due to the mandate, as opposed to simply wanting to obtain health care coverage, considering that for the first year the penalty is both small and easily avoidable. On the other hand, the number covered would be higher if many Republican-controlled states weren’t blocking Medicaid expansion despite this program being paid for primarily by the federal government.

The Affordable Care Act has made it possible for many people who could not obtain insurance in the past to now do so. I have posted examples of people who have benefited from the law in previous posts. The Commonwealth Fund has this page with additional examples. One of the cases they looked at previously paid $600 a month for a plan with a $50000 deductible. Their current plan purchased in the new exchanges cost $192 with a $500 deductible and broader coverage after the tax credits were factored in. Other people could not purchase insurance at all due to having pre-existing medical conditions.

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Success Of Obamacare Might Translate Into Political Success

The number of people signing up for private insurance coverage under the Affordable Care Act has now reached eight million. While primarily symbolic, it does represent a victory after initial projections of seven million were reduced to six million due to the problems when the exchanges opened. We know that if they failed to meet these projections, Republicans would be making a big deal of them. In addition, late enrollees included a high percentage of young people.

Good news means more positive head lines, such as National Journal writing that Obamacare is on a Winning Streak. The political climate is changing, with some Democrats now being more willing to run on its success.  I think it is essential that they do this to reduce the risk of the loss of a large number of seats this November. The evidence shows that Obamacare is a success but if Democrats don’t defend it, voters will only hear Republican attacks. Hiding from Obamacare will only make Democrats look weaker, and will not protect them from voters who vote against Democrats based upon Republican misinformation.

Ezra Klein writes that the right suffers from Obamacare Derangement Syndrome, being unable to admit that it is working:

Republicans used to talk about Bush Derangement Syndrome. Washington Post columnist Charles Krauthammer defined it as “the acute onset of paranoia in otherwise normal people in reaction to the policies, the presidency — nay — the very existence of George W. Bush.” Republicans like Krauthammer understood that BDS helped the Bush administration in two ways: it fired up their supporters and it distracted liberals from more modest, but effective, critiques.

Today, the right struggles with Obamacare Derangement Syndrome: the acute inability to see Obamacare as anything but a catastrophic failure that the American people will soon reject. For those suffering from ODS, all bad Obamacare news is good news, and all good Obamacare news is spin. In this world, delays of minor provisions in the law prove that the entire structure is collapsing, while surges of millions of people enrolling in insurance don’t prove anything at all…

But it’s coming at a moment when Obamacare’s successes are getting tougher and tougher to deny. The law signed up more than 7.5 million people in the exchanges, more than 3.5 million people in Medicaid, and it led millions more to get health care through their employers or directly through insurers. Premiums are lower than the Congressional Budget Office predicted when the law passed, and insurers are already thinking about how to compete for applicants in 2015. The White House has a much better story to tell than anyone — including me — thought possible in December.

For Republican pundits it might not matter that Obamacare is a success. Republicans show more intensity in their views, and very little concern for the truth. Campaigning against Obamacare might still motivate Republicans to get out and vote.

Andrew Sullivan might be a bit overly optimistic about the political effects of the success of Obamacare, but I hope he is right:

There’s simply no denying that the law has been rescued by an impressive post-fiasco operation that did to ACA-opponents what the Obama campaign did to the Clintons in 2008 and to Romney in 2012. Obama out-muscled the nay-sayers on the ground. I have a feeling that this has yet to fully sink in with the public, and when it does, the politics of this might change. (Since the law was pummeled at the get-go as something beyond the skills of the federal government to implement, its subsequent successful implementation would seem to me to do a lot to reverse the damage.) There are some signs that this is happening. A new Reuters/Ipsos poll finds the following:

Nearly one-third of respondents in the online survey released on Tuesday said they prefer Democrats’ plan, policy or approach to healthcare, compared to just 18 percent for Republicans. This marks both an uptick in support for Democrats and a slide for Republicans since a similar poll in February.

That’s mainly because of renewed confidence and support from previously demoralized Democrats. But it’s also a reflection, it seems to me, of the political vulnerability of Republicans who have failed to present a viable alternative to the law, and indeed seem set, in the eyes of most voters, merely to repeal ACA provisions that are individually popular. And this bad position is very likely to endure because of the intensity of the loathing for Obama/Obamacare among the Medicare recipients in the GOP base. It seems to me that right now, the GOP cannot offer an alternative that keeps the more popular parts of Obamacare without the air fast leaking out of their mid-term election balloon. And so by the fall, the political dynamics of this may shift some more in Obama’s direction. By 2016, that could be even more dramatic. One party – the GOP – will be offering unnerving change back to the status quo ante, and the other will be proposing incremental reform of the ACA. The only thing more likely to propel Hillary Clinton’s candidacy would be a Republican House and Senate next January.

It’s that long game thing again, isn’t it? Like the civil rights revolution of the Obama years, it seemed a close-to-impossible effort to start with, and then was gradually, skillfully ground out. It also seems true to me that the non-event of the ACA for many, many people will likely undermine some of the hysteria on the right. The ACA-opponents may be in danger of seeming to cry wolf over something that isn’t that big a deal. Yes, they may have premium hikes to tout as evidence of the alleged disaster. And every single piece of bad news on the healthcare front will be attributed to the ACA, fairly or not. But the public will still want to know how premiums can go down without people with pre-existing conditions being kicked out of the system, or without kids being kicked off their parents’ plan, and so on. I think, in other words, that the GOP’s position made a lot of short-term political sense in 2010 and even 2012. But it’s a much tougher sell in 2014, let alone 2016. Once again, they have substituted tactics for strategy. Every time they have done that with Obama, they have failed.

Sullivan described how he has benefited from the Affordable Care Act and concluded, “Yes, I am just one tiny, and rare example. But for me, at least, Obamacare has over-delivered and over-performed. If my experience is replicated more widely, then I suspect the polling and politics will shift yet again.”

Cross posted at The Moderate Voice

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