Obama Delivers “The Best Medicine” To Ted Cruz, John Boehner, and Michele Bachmann

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Barry Blitt said this about the above cover for The New Yorker: “This whole enterprise was just an elaborate excuse. I enjoyed drawing Ted Cruz, John Boehner, and Michele Bachmann as petulant children—and I especially wanted to draw an open-mouthed Mitch McConnell being spoon-fed his meds.”

Obama is certainly delivering the “medicine” as news comes in showing that enrollment in the Affordable Care Act exceeded projections of seven million, and the number of uninsured is falling to new lows. While good for the United States, this is certainly bitter medicine for Republicans. There is additional bitter medicine for Mitch McConnell as the number signing up in Kentucky exceeded 360,000 with 75 percent previously uninsured.

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Republicans Had To Hide Support For Fix To Affordable Care Act To Limit Attacks From The Right

The “doc fix”  has become a strange legislative tradition as Congress regularly votes to stop the automatic  cuts in physician payment called for under the flawed Sustainable Growth Rate formula. As I discussed in March, this time there were a couple of new twists which were known, but in addition it turns out that another item hidden in the bill reveals a lot about the Republican Party.

First I’ll recap what we had already known. The “doc fix” proposed to block the cuts which would have taken effect in April was for one year and included multiple other measures, including a delay in implementing change to ICD-10 diagnosis codes until at least October 2015. Physician groups actually opposed this bill because a permanent fix was also under consideration and it was feared that passing yet another temporary fix would lead to abandonment of the permanent fix (which does now appear dead).

The “doc fix” regularly passes with bipartisan support because Congress is not going to risk the backlash which would be created if many Medicare patients could no longer find physicians willing to accept them. This time the House passed the “doc fix” on a voice vote, which allows individual members to avoid being held accountable for the vote.

Over the weekend we learned why House Republicans wanted to pass this on a voice vote. Another item in the bill made some changes in the Affordable Care Act which was desired by small business and which Democrats were willing to make:

At the prodding of business organizations, House Republicans quietly secured a recent change in President Barack Obama’s health law to expand coverage choices, a striking, one-of-a-kind departure from dozens of high-decibel attempts to repeal or dismember it.

Democrats describe the change involving small-business coverage options as a straightforward improvement of the type they are eager to make, and Obama signed it into law. Republicans are loath to agree, given the strong sentiment among the rank and file that the only fix the law deserves is a burial.

“Maybe you say it helps (Obamacare), but it really helps the small businessman,” said Rep. Phil Roe, R-Tenn., one of several physician-lawmakers among Republicans and an advocate of repeal.

No member of the House GOP leadership has publicly hailed the fix, which was tucked, at Republicans’ request, into legislation preventing a cut in payments to doctors who treat Medicare patients.

It is unclear how many members of the House rank and file knew of it because the legislation was passed by a highly unusual voice vote without debate.

This shows how dysfunctional Congress has become. Normally both parties would see it as a victory for the system that they passed a measure to make requested changes in the Affordable Care Act. However, Republicans felt compelled to hide this vote because it contradicts their public policy of only supporting repeal (having voted for repeal over fifty times). Since this became public, the Republicans have faced criticism from the right, probably making it even harder for them to vote on improvements in the Affordable Care Act in the future.

The fix which passed allows small businesses to offer policies with higher deductibles. This allows for lower premiums, and the higher deductibles are often handled separately with Medical Savings Accounts. There are also added protections in new insurance policies under the Affordable Care Act such as annual limits on out of pocket expenses and the elimination of annual and lifetime caps on coverage which help offset the problems created by higher deductibles.

If Republicans should attack the Affordable Care Act based upon including high deductible plans, keep in mind that this is exactly the type of plan which Republicans frequently advocate, and that the Republicans voted to increase the allowable deductible levels in response to requests from small business.  Democrats had no objection to the change as the limit on deductions was originally placed in the bill because it was supported by Republican Senator Olympia Snowe. In response to this addition, Snowe voted for the Affordable Care Act when in the Senate Finance Committee but ultimately voted against the bill on the Senate floor, along with every other Republican Senator.

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Gallup Finds Number Of Uninsured Continues To Fall

Percent Uninsured

New figures from Gallup show a further decrease in the number saying they are uninsured. The number of uninsured decreased to 15.6 percent in the first quarter of this year, a 1.5 percent decrease from the fourth quarter of 2013. This is the lowest recorded level since late 2008 and suggests that the Affordable Care Act is successful in providing insurance to the previously uninsured. This also shows a further decrease from a similar survey conducted last month.

The uninsured rate has been falling since the fourth quarter of 2013, after hitting an all-time high of 18.0% in the third quarter — a sign that the Affordable Care Act, commonly referred to as “Obamacare,” appears to be accomplishing its goal of increasing the percentage of Americans with health insurance coverage. Even within this year’s first quarter, the uninsured rate fell consistently, from 16.2% in January to 15.6% in February to 15.0% in March. And within March, the rate dropped more than a point, from 15.8% in the first half of the month to 14.7% in the second half — indicating that enrollment through the healthcare exchanges increased as the March 31 deadline approached.

This report is consistent with The Urban Institute’s Health Reform Monitoring Survey (HRMS) which estimated that the number of uninsured adults had fallen by 5. 4 million before the surge in enrollment in March . Another study performed prior to the late March surge in enrollment showed that at least 9.5 million new people received insurance.

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Paul Ryan Admits Consequences Of Replacing Obamacare With Republican Alternative

Republicans who have been attacking the Affordable Care Act have been unable to provide a specific alternative to replace it with. One problem they face is that, while polls show large numbers of people say they oppose Obamacare, a majority also supports many of the individual components of the law. Paul Ryan admitted what repeal of Obamacare and replacing it with a Republican alternative would mean:

House Budget Committee Chairman Paul Ryan (R-Wis.) says in a new interview that it would be too costly for Republicans to reinstate some of the more popular provisions of Obamacare if and when the law is repealed, but that Republicans should look for alternatives.

The former GOP vice presidential nominee was asked on Bloomberg’s “Political Capital with Al Hunt” about whether Republicans would keep provisions like requiring coverage for pre-existing conditions, keeping kids on their parents’ insurance until they are 26 years old and barring insurance companies from having different rates for those whose jobs include physical labor.

The first two provisions are among the most popular parts of Obamacare, which as a whole is not popular. But Ryan says such provisions would also drive up the cost of insurance too much.

“If you look at these kinds of reforms, where they’ve been tried before — say the state of Kentucky, for example — you basically make it impossible to underwrite insurance,” Ryan said, according to an advance transcript. “You dramatically crank up the cost. And you make it hard for people to get affordable health care.”

Returning to underwriting insurance would mean that insurance companies could once again issue policies based upon who they find the most profitable to cover, denying coverage to those with pre-existing medical conditions and based upon age.

It is less expensive for health insurance companies to sell insurance only to young, healthy people and to revoke coverage when people get sick. However this is not what we need from health insurance, which to be meaningful must be available to everyone and cover people when they become sick. As I’ve pointed out many times in the past, most people going into bankruptcy from medical expenses were insured at the time they first got sick or injured.

Cross posted at The Moderate Voice

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Study Shows Number of Newly Insured Increased By 5.4 Million As Of Early March

Despite favorable numbers on Obamacare enrollment, many Republicans continue to try to deny the positive results. Two common questions brought up are the number paying their premiums and the number of newly insured. Yesterday I pointed out that those claiming that as many as twenty percent are not receiving coverage due to not paying their premiums are incorrect because often the estimates are made prior to premiums actually being billed or due and as many of the people who drop insurance obtained through the exchanges wind up receiving other coverage. In addition to previous estimates, The Urban Institute’s Health Reform Monitoring Survey (HRMS) estimates that the number of uninsured adults had fallen by 5. 4 million before the surge in enrollment in March . Their survey was concluded on March 6. NBC News reports:

More than 5 million Americans who didn’t have health insurance before have been able to get coverage since September, according to a new report released Thursday.

The report seeks to answer one of the big questions surrounding the government statistics surrounding the law known as Obamacare — how many people have gained health insurance under the new rules? Early statistics had suggested that many of the people who rushed to buy the plans available on the new health insurance exchanges were just swapping out of other coverage.

But the new report suggests the law is having its intended effect of getting people covered who weren’t before.

“This represents a major step forward for 5.4 million previously uninsured people who now have health coverage,” said Dr. Risa Lavizzo-Mourey, president and chief executive officer of the Robert Wood Johnson Foundation, which issued the report along with the Urban Institute.

The report shows that 15.2 percent of Americans were without health insurance as of the first week in March, a drop of 2.7 percentage points since September 2013.

The Obama administration says at least 7.1 million people signed up for private health insurance on the online, health insurance exchanges that opened up in October. Close to three million signed up in March alone, the last month for open enrollment, which is now closed.

Separately, the Obama administration says anyone who started to sign up and wasn’t able to finish by the March 31 deadline has until April 15 to finish.

The exchanges are the centerpiece of the 2010 Affordable Care Act, which seeks in part to get coverage to the 47 million Americans who lacked it as of 2013. The Congressional Budget Office projects that 26 million people will buy health insurance on the exchanges by 2022 and that 12 million people will become newly eligible for Medicaid in the states that choose to expand their offerings by 2022.

So far 26 states, plus the District of Columbia, have decided to offer Medicaid to more people as requested under the law. The report issued Thursday doesn’t include any separate estimates of how many people this might be, and also doesn’t include young adults added because of a provision allowing people to stay on their parents’ health insurance up to age 26.

“The survey does not capture the enrollment surge that occurred at the end of the open enrollment period,” the report adds — that would be the 3 million or more people who signed up in March.

This shows that the number of uninsured has already been falling before the March surge, when Republican critics of the ACA were claiming that most of those signing up for coverage were people who had previously been dropped from their health care plans. The percentage of uninsured will drop further as those enrolling in March and April are included, along with those obtaining expanded Medicaid coverage throughout the year.

Cross posted at The Moderate Voice

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Obamacare Enrollment Surpasses Seven Million

The number of people purchasing insurance under the Affordable Care Act has exceeded seven million. This slightly surpasses initial predictions. This also surpasses the reduced prediction of six million made by the Congressional Budget Office as a result of the initial IT problems, (with more expected to sign up in future years) and shows that conservative opponents of Obamacare were wrong in predicting lower numbers.

Millions more purchased health insurance directly from insurance companies. This also does not include the newly insured due to Medicaid expansion or due to students being able to remain on their parents’ policy until age 26. Even when estimates come in including those covered by Medicaid expansion, the number can continue to grow as there is no deadline for signing up for Medicaid. In Michigan the Medicaid program did not even begin taking enrollments until today. There are also some situations in which people can purchase insurance offered through the exchanges after the deadline, such as in case of loss of job or divorce.

There are not yet accurate numbers nationally regarding the number of people signing up who previously had insurance versus those newly insured.

Conservatives are raising questions regarding how many people have not paid premiums and ultimately will not keep this insurance. Estimates on this are premature as coverage for those signing up in late March does not begin until May and premiums will not even be due until mid April.

These numbers are already out of date in light of the surge of people signing up at the last moment, but The Los Angles Times reported on Monday that Obamacare has led to coverage for at least 9.5 million new people:

• At least 6 million people have signed up for health coverage on the new marketplaces, about one-third of whom were previously uninsured.

• A February survey by consulting firm McKinsey & Co. found 27% of new enrollees were previously uninsured, but newer survey data from the nonprofit Rand Corp. and reports from marketplace officials in several states suggest that share increased in March.

• At least 4.5 million previously uninsured adults have signed up for state Medicaid programs, according to Rand’s unpublished survey data, which were shared with The Times. That tracks with estimates from Avalere Health, a consulting firm that is closely following the law’s implementation.

• An additional 3 million young adults have gained coverage in recent years through a provision of the law that enables dependent children to remain on their parents’ health plans until they turn 26, according to national health insurance surveys from the federal Centers for Disease Control and Prevention.

• About 9 million people have bought health plans directly from insurers, instead of using the marketplaces, Rand found. The vast majority of these people were previously insured.

• Fewer than a million people who had health plans in 2013 are now uninsured because their plans were canceled for not meeting new standards set by the law, the Rand survey indicates.

Conservatives have falsely claimed that due to the cancellations of insurance there is a net decrease in the number insured. Most of those who received cancellation notices have received alternative insurance plans, often from the same insurance company. Those who qualify for subsidies are receiving coverage at a lower rate. Everyone who changed from the old plans to new plans on the individual market benefit from changes such as being safe from losing their insurance if they become ill and their insurance company would prefer to stop covering them to save money. The new policies also have annual limits on out of pocket expenses and do not have lifetime caps on coverage as old plans often did.The above data is consistent with Gallup polling showing a decrease in the number of uninsured:

The decrease parallels a similar drop recorded by Gallup, which found in its national polling that the uninsured rate among adults had declined from 18% in the final quarter of last year to 15.9% through the first two months of 2014. Gallup’s overall uninsured rate is lower than Rand’s because it includes seniors on Medicare.

Gallup Editor in Chief Frank Newport said that March polling, which has not been released yet, indicates the uninsured rate has declined further.

“While it is important to be cautious, the logical conclusion is that the law is having an effect,” he said.

Although estimates vary, about 45 million to 48 million people are believed to have been uninsured before the marketplaces opened last year.

The Courier-Journal estimates that about 75 percent of those signing up through the state-run exchange in Kentucky were previously uninsured.

The goal of the ACA was to help cover 48 million Americans, including 640,000 in Kentucky, who lack health insurance.

Although the state set no official first-year goal, its 360,000-plus sign-ups — 75 percent of whom were previously uninsured — represents a sizable chunk.

Although Obama said that the success of enrollments for the Affordable Care Act means “the debate over repealing this law is over,” Republicans are not likely to stop fighting and spreading misinformation. They know that this will help improve Republican turn out this fall. The Koch-financed Americans for Prosperity has put out additional dishonest ads.

Fox, the propaganda organ for the Republican Party, has generally spread their misinformation, including an attempt to distort interpretation of the number of people signing up. Even Fox has not been entirely consistent in backing the Republicans.  On Monday Jenna Lee asked Senator Lindsey Graham why the Republicans have not offered an alternative to the Affordable Care Act despite repeatedly voting to repeal it.

Cross posted at The Moderate Voice

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Democrats Need A Message

One reason that the Republicans get people to turn out to vote in off year elections, often to vote against their economic self-interest, is that they have a message. The message might be based upon dishonest claims and incorrect views as to how the economy and government work, but it is a message. In contrast, many Democratic voters feel less interested in turning out to vote, especially in off year elections. To some degree the Democrats have difficulty in defining a message as they are a big tent party which wins elections by appealing to a wide variety of voters, ranging from center-right to left wing. Issues which appeal to some Democratic voters might turn off others.

The Washington Post describes how Senate Democrats are struggling to define a message:

Senate Democrats’ latest effort in that regard is a 10-point plan for legislation they intend to bring to the floor over the spring and summer.

The issues are familiar ones for Democrats, and poll well among Americans generally.

Yet they are top priorities to narrower slices of the Democrats’ constituency — particularly those who showed up to vote for President Obama in 2012, but who do not have a history or voting in off-year contests.

The first items up for Senate debate will be increasing the minimum wage, from $7.25 an hour to $10.10 an hour, and a bill to assure paycheck equity between male and female workers.

Democratic pollster Celinda Lake said that those are measures that would have their greatest impact on young people, unmarried women, Latinos and African-Americans — all of whom can be difficult to turn out in years when there is no presidential election.

“This doesn’t replace a broader economic message. In the long run, we have to do that. But in the short run, this is very helpful,” said Lake, who has warned that the Democrats face a large turnout disadvantage in a year when Republican voters appear to be more motivated.

GOP pollster Neil Newhouse said the Senate Democrats’ targeted strategy echoes that of Obama’s 2012 reelection campaign, where he emphasized a number of “niche group” issues such as the Dream Act, mandatory contraception coverage under the Affordable Care Act, student loan expansion and support for same-sex marriage.

Why haven’t Democrats been pushing for legalization of same-sex marriage more strongly in the past? As Michigan and other states saw recent legal victories for marriage equality I thought that, although this is an issue far more associated with Democrats than Republicans, the victories are in the courts and not the result of actions by the Democratic Party.

Perhaps Democratic leaders did not want to be associated with bringing about marriage equality out of a fear of losing socially conservative Democratic voters. Maybe, but I also wonder how many socially liberal people who lean Democratic don’t bother to get out to vote because of not seeing a real commitment from Democratic leaders for liberal causes.

Republicans have learned that people tend to take on the other views of the party they associate with when there is a consistent message. They get social conservatives to back their economic policies by joining these as a common conservative philosophy. If the Democrats were to put out a more consistent message, perhaps those who vote for Democrats for other reasons would also “evolve,” as Barack Obama has, on issues such as same-sex marriage.

Democrats should frame this as a consistent platform of keeping government out of the private lives of individuals, along with support for reproductive rights and ideally an end to marijuana prohibition (or at least a stronger defense of medical marijuana). It is amazing that Democrats have allowed Republicans to take an advantage on issues which should be seen as reasons to vote Democratic, from size of government as it relates to private lives to support for Medicare.

Democrats also think too small on economic matters. Rather than just concentrating on issues such as increasing the minimum wage, Democrats need an economic message showing how Democratic ideas strengthen and grow the economy while Republican economic policies lead to economic stagnation and a concentration of wealth in a small minority. Income inequality is an important issue, but only when placed in an overall economic message of expanding the economy and how extreme income inequality destroys the middle class. An economic message seen as merely dislike for the rich (or the Koch brothers) will never sell.

Of course making a coherent economic message which will not only mobilize their own voters but bring in new voters will take time and cannot be done in only one election year. The Republicans have been working for years at indoctrinating the country in their type of Voodoo Economics. It will also take several years to get out the message on how the economy actually works, but the Democrats might as well start now.

Health care remains one of the strongest reasons to vote for Democrats. Even those who have a negative view of the Affordable Care Act based upon Republican misinformation still prefer to improve it over either repeal or turning to any Republican alternative. As I have written before, Democrats need to go on the offensive on health care reform, not run away from the issue. Joe Conason has the same message again, with numbers now out showing that enrollment through the exchanges has exceeded the projected number of six million:

Success for Obamacare might boost the turnout projections that Republicans have tried so hard to suppress and that Democrats have so far proved unable to resuscitate.

Dominant forces in the Republican Party — including the tea party and its billionaire financiers — have staked everything on the commonplace assumption that Obamacare will drag down Democrats across the country.

Indeed, they make almost no other argument. Bolstering that cynical bet is the Democratic hesitation to mount a powerful counteroffensive on health care, with the impulse to push the minimum wage, unemployment benefits, and other vital issues that still feel safer.

But as Clinton warns, they will find no shelter from this storm. They cannot hide from their own history; and the more they pretend to do so, the more they risk contempt. For decades, Democrats have insisted that all Americans must have health coverage — a momentous and admirable goal advanced by the Affordable Care Act.

With the numbers now on their side, they should lift their heads, raise their voices, and lean into the midterm debate. They have no better choice.

Cross Posted at The Moderate Voice

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Obamacare Delay Similar To Previous Medicare Delay Under George Bush

Republicans are obsessed with Obamacare delays. Some of the delays have been helpful to allow for orderly transition to the new rules. The latest, allowing people to complete the process if they started an application for insurance before the deadline, seems like common sense and basic fairness (which might be why Republicans have such a problem with it). NBC News pointed out that George  W. Bush also had a similar delay with the Medicare D program:

As Republicans complain about the Obama administration’s latest deadline extension for Americans to purchase health insurance, Democrats are countering with this reminder: The Bush administration did something similar in 2006.

Back then, as it was implementing the Medicare prescription-drug benefit Bush had signed into law, the GOP presidential administration announced it was waiving penalties for low-income seniors and those with disabilities who signed up late.

As one Knight Ridder report put it at the time:

The move follows a recent administration decision to allow the same impoverished beneficiaries to sign up for Medicare drug coverage until Dec. 31.

“In other words, you can apply after May 15th without penalty. And that’s important for low-income seniors to understand,” President Bush told a group of older Americans in Sun City Center, Fla., on Tuesday.

There’s one key difference between Bush’s Medicare prescription-drug benefit and Obama’s health-care law: Democrats didn’t try to scuttle the Medicare law’s implementation (especially since some of them had voted for it), while the same isn’t exactly true of GOP actions regarding the health-care law.

But the 2006 story is a reminder that when it comes to the implementation of complex new laws, both Democratic and Republican administration have changed the rules to encourage enrollment.

Republicans who complain about delays in the Affordable Care Act under Obama had no problem with a comparable delay under George Bush, showing once again that their positions are motivated by opposition to Obama and not any higher principles.

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Bill Calls For Adding ICD-10 Delay To Latest “Doc Fix”

I recently pointed out that the Republicans killed a recent attempt to repeal the Sustainable Growth Rate formula by attaching a measure to end the individual mandate in the Affordable Care Act. With failing to repeal the Sustainable Growth Rate it becomes necessary for Congress to pass yet another temporary “doc fix” to prevent Medicare reimbursement from automatically falling so low that doctors will not be able to afford to see Medicare patients.

Medical Economics reports that a proposal to delay the transition from ICD-9 to ICD-10 diagnoses codes from October 2013 to October 2014. The transition was originally passed under the Bush administration, so ignore the Republican claims which are out there which blame Obamacare for the change. While there are benefits to the newer system which is used by the rest of the world, the change would be very expensive for medical practices. Changes such as this also take up a lot of physician time, reducing the number of patients which can be seen each day.

Such decreases in productivity would come at a poor time in 2013 when millions of new people will receive health insurance due to the Affordable Care Act and will need to find physicians who are accepting new patients. In addition, the second phase of requirements for electronic medical records (EMR’s) also kicks in for many physicians this October and having two sets of major changes will further reduce physician productivity, making it more difficult to accept new patients. Personally I had to greatly restrict accepting new patients for several months after the first phase of requirements went into effect, and anticipate again having to limit accepting new patients this fall if both the new EMR requirements and change to ICD-10 take effect simultaneously.

The AMA and many other physician groups have been lobbying for a further delay in ICD-10 implementation, which has already been delayed in the past. Medical Economics reports:

The ICD-10 transition has been a major point of concern for physicians due to its scope and cost to implement. In recent months the American Medical Association (AMA) ramped up opposition to the ICD-10 transition, and petitioned CMS for a delay to the implementation of ICD-10.

According to the AMA, small practices can expect staggering costs ranging from $56,639 to $226,105 to implement the new code set. According to a February survey by the Medical Management Group Association, 79% of physicians report that they haven’t begun ICD-10 implementation, or were only “somewhat ready.”

Molly Cooke, MD, FACP, president of the American College of Physicians, said the college favors the delay. “The college has expressed concern at every opportunity about the implementation of ICD-10. I’m not sure the healthcare system loses a lot if we delay implementation for another year, and it certainly would give our members a bit of a breather.”Earlier this month, the Republican-led House passed a bill to repeal SGR and replace it with a formula that would calculate payments based on quality metrics. But the bill received widespread opposition from Democrats because it was paid for by a five-year delay in the individual mandate in the Affordable Care Act (ACA).

Cross posted at The Moderate Voice

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Lack Of Information And Misinformation Suppressing Enrollment In Insurance Plans

Recent polls are showing some of the obstacles to extending coverage among the uninsured. A study published Monday by the National Academy of Sciences showed that a substantial number of consumers lack basic knowledge of how insurance works which would be necessary to intelligently purchase coverage. A new Kaiser Health Tracking Poll shows lack of knowledge of the deadline for obtaining coverage and widespread belief in many of the false claims being spread by opponents of the Affordable Care Act.

Many are unaware of next week’s deadline to obtain coverage and avoid potential tax penalties:

A third of those who lack coverage as of mid-March are unaware that the law requires nearly all Americans to have health insurance or pay a fine. When it comes to the specifics, four in ten of the uninsured (39 percent) are aware that the deadline to sign up for coverage is at the end of March, leaving about six in ten unaware of the March deadline.

When reminded of the mandate and the deadline, half of those without coverage as of mid-March say they think they will remain uninsured, while four in ten expect to obtain coverage and one in ten are unsure.

Many plan to not obtain coverage due to cost concerns, unaware of financial assistance available:

While some report trying to get coverage from new options available under the ACA, large shares of the uninsured remain unaware of two of the law’s key provisions that could help them get coverage. About half the uninsured are unaware that the ACA gives states the option of expanding their Medicaid programs, and more than four in ten don’t know that it provides financial help to low- and moderate-income individuals to help them purchase coverage.

The Kaiser poll showed a reduction in the gap between those who see the law unfavorably as opposed to favorably. While more now have a favorable opinion than previously, the majority continue to have an unfavorable opinion. Much of the opposition is based upon misinformation spread by opponents:

“It’s too expensive for regular people.”
“it’s costing too much money. It’s supposed to help people with low incomes and it’s not.”
“Because it’s a financial hardship on the U.S.”

The first two are based upon lack of knowledge of the assistance available which does make coverage more affordable. The third has been shown by the recent non-partisan report from the Congressional Budget Office to be false. Among its other benefits, the Affordable Care Act will reduce the deficit, reduce unemployment, and help stimulate the economy by freeing people from the insurance trap, enabling more people to work for and start small businesses

Opposition also includes a belief that the individual mandate is unconstitutional despite a Supreme Court ruling upholding the law. Some expressed the false belief that the ACA gives government more control over personal health care choices, echoing further scare stories from the right wing as to what the law does.

Despite unfavorable views about the law, a majority still would prefer to see improvement to the law as opposed to repeal or a Republican alternative:

Perhaps reflecting this sense that the debate has gone on long enough, more of the public would like to see Congress keep the law in place and work to improve it (49 percent) or keep it as is (10 percent) rather than repeal it and replace it with a Republican-sponsored alternative (11 percent) or repeal it outright (18 percent).

The poll found that many aspects of the law are popular, even if many people are unaware of these and other benefits:

As previous Kaiser tracking polls have found, many of the ACA’s major provisions continue to be quite popular, including across party lines. For example, large shares of Americans – including at least seven in ten overall and at least six in ten Democrats, Republicans, and independents – have a favorable view of the fact that the law allows young adults to stay on their parents’ insurance plans up to age 26, closes the Medicare “doughnut hole” for prescription drug coverage, provides subsidies to low- and moderate-income Americans to help them purchase coverage, eliminates cost-sharing for preventive services, gives states the option of expanding Medicaid, and prohibits insurance companies from denying coverage based on pre-existing conditions. Nearly as many (including a majority across parties) have a favorable view of the “medical loss ratio” provision that requires insurance companies to give their customers a rebate if they spend too little money on services and too much on administration and profits. Somewhat more divisive is the law’s Medicare payroll tax on earnings for upper-income Americans, which is viewed favorably by about three-quarters of Democrats and just over half of independents, but just a third of Republicans.

The individual mandate remains highly unpopular. Anticipation of this is one of the reasons I opposed the individual mandate prior to passage of the Affordable Care Act, preferring an alternate system to provide incentives to purchase coverage and penalize those who try to game the system by waiting until sick to purchase insurance.

Much of the opposition to the ACA is based upon beliefs about the law which are untrue:

Misperceptions also persist about things the ACA does not actually do. For example, nearly half the public (46 percent) think the law allows undocumented immigrants to receive financial help from the government to buy health insurance, and another two in ten (22 percent) are unsure whether it does. A third of the public (34 percent, including 32 percent of seniors) believe the law establishes a government panel to make decisions about end-of-life care for people on Medicare, with another quarter saying they are unsure (23 percent of the public, 25 percent of seniors).

Unfortunately both lack of information and intentional misinformation being spread by opponents of the Affordable Care Act is likely to cause a substantial number of people to go without coverage this year. The deadline is fast approaching for purchasing coverage on the exchanges. There is no deadline for those who qualify for coverage due to Medicaid expansion, but Republicans in many states are also denying this benefit to residents of their states even though the federal government picks up almost all of the cost.

Cross posted at The Moderate Voice

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