Americans Generally Satisfied With Healthcare Costs But Those On Medicare Are Happier Than Those With Private Insurance

A Friday afternoon news dump is not always bad news. Gallup released a poll under this headline on Friday: As ACA Takes Effect, Majority OK With Personal Health Costs. Gallup reported, “Nearly six in 10 Americans (57%) say they are satisfied with the total cost they pay for healthcare, on par with other readings over the last five years. So far, there is little indication that the Affordable Care Act (ACA), also known as ‘Obamacare,’ has affected the way Americans view their healthcare costs, either positively or negatively.”

Gallup Insurance Satisfaction

Note that the graph above shows very little change over time, with the current numbers very close to when Obama took office. Satisfaction did increase slightly in 2014, presumably because of more people having coverage thanks to the Affordable Care Act.

Satisfaction increased by age, essentially correlating with reaching age 65 and having Medicare. The assumption that those who are older are more satisfied because they have Medicare is verified when the results are broken down by type of insurance. Satisfaction with costs  is at 74 percent among those with Medicare or Medicaid, compared to 58 percent with those on private insurance. Note that another recent study did show that overall satisfaction was much closer than this poll on satisfaction with costs. Out of pocket payments for those on Medicare are typically significantly lower than those covered by private insurance, except for those with the most generous employer-paid plans.

Gallup Insurance Satisfaction by Age

Other findings were that people were generally satisfied with the quality of health care but less satisfied with healthcare coverage as a whole in the United States compared to other countries. Gallup concluded:

U.S. adults holding health insurance via a private insurance plan are about as likely to rate their coverage positively (77%) as Americans holding either Medicare or Medicaid (75%), suggesting both groups are about equally happy with their plans. But, as noted earlier, Medicare and Medicaid holders are far more satisfied with the cost of their plan.

As Gallup has found in the past, Americans are far less effusive with their praise for healthcare coverage in the U.S. as a whole. This year is not an exception: Fewer than four in 10 Americans now rate healthcare coverage in the U.S. as excellent or good.

Before passing the ACA, the large majority of Americans who had health insurance were broadly satisfied with their medical care and coverage and their healthcare costs. Thus, a major test of the ACA will be whether it succeeds in expanding affordable healthcare to the previously uninsured while doing “no harm” to the large majority of Americans who are already highly satisfied with their healthcare coverage. So far, the verdict is positive. Gallup finds no decrease in insured Americans’ satisfaction with their healthcare services and their costs. At the same time, the uninsured are as negative as ever, but their numbers have dwindled. Gallup’s annual November updates of these trends will monitor whether this positive outcome persists as implementation of the ACA progresses.

Republicans have backed high deductible plans as a way to restrain health care costs for quite a long time. Now that they got what they want with plans sold on the exchanges (like plans previously sold in the individual market) generally having high deductibles, they have been using this as a line to attack Obamacare. If this is the main objection, rather than cowering in the face of attacks on the ACA, Democrats might be better off taking advantage of this as a reason to push for the type of single payer plan that most liberals supported before Obama compromised and promoted what was previously a Republican health care plan.

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Republicans Have Slight, But Not Insurmountable, Lead Prior To Midterms

The final weekend before the midterm elections the race to control the Senate remains close enough that either party can still win. The Republicans have an edge, but certainly not an insurmountable one. Looking at the most recent polls. electoral-vote.com has the Republicans with 51 seats. This means that the Democrats would only have to win in one state where they are behind provided that they hold onto the seats where they have a slight lead and that Greg Orman caucuses with the Democrats if he wins.

There is far less quality polling in Senate races in a midterm election than in presidential elections, and a slight lead in the polls is far less predictive than a slight lead in a presidential election. If either party out-performs the latest polls by just a couple points the final result could be much more favorable than these predictions, for either party. Sam Wang pointed out the significance of so many races being close:

As I wrote last week, everyone’s calculations are, to an extent, built on sand. Historically, in any given year midterm polls have been off in the same direction by a median of 2 or 3 percentage points. Depending on the year, either Democrats or Republicans end up outperforming polls. In current poll medians, six races are within less than 2 percentage points: Alaska, Colorado, Georgia, Iowa, Kansas, and North Carolina. Therefore all six of these races could be won by Republicans…or all six could be won by Democrats.

The other races total 48 Republicans and 46 Democrats/Independents. Republicans are slightly favored to take control, since an even split of the six close races would give them the 51 seats they need*. However, the likely possibilities range anywhere from a Republican majority of 54-46 to a Democratic majority of 52-48. As of today, cranking through the math and the uncertainties gives a probability of 55% for a Republican takeover.

Nate Silver sees the Republicans as having a significantly higher chance at taking control of the Senate at 68.5  percent.

Among the reasons that the Republicans now have the edge is narrow leads in two states where the Democrats should be competitive, Iowa and Colorado. It is especially disturbing that a candidate as extreme as Joni Ernst can have the momentum in her favor in Iowa, moving to a seven point lead. There remains hope that the Democrats could still win one or both of these states, with early voters possibly favoring Democrats in Iowa. Campaigning by both Clintons and Elizabeth Warren might also help.

The Democrats still have a reasonable shot of maintaining control of the Senate due to unexpectedly competitive races in Kansas, Georgia, and Kentucky. The race in Kentucky is heating up with Democrat Alison Lundergan Grimes filing a suit to attempt to prevent Mitch McConnell  distributing a mailer that it says amounts to illegal voter intimidation tactics.

One reason that the polls could be off by a few points is that the polls are weighted by who the pollster predicts will actually turn out to vote. Democrats hope that their ground game will tilt this in their favor, and are especially counting on their edge among women voters.

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Democrats Beating Expectations In Congressional Races

The fundamentals are certainly against the Democrats this year. Democrats are expected to do poorly in the sixth year of an unpopular presidency, in a midterm election where young and minority voters are less likely to turn out. The conventional wisdom has the Republicans picking up seats in the House and many are predicting that the Republicans will take over the Senate. Both could still happen, but so far the Republicans are not doing as well as expected.

Politico looked at House races today and found that it is likely that the Republicans will pick up only about half of their goal of eleven seats. It is probably overly optimistic to hope for the Democrats to actually retake control of the House, as some are predicting, but beating expectations this year might make this more feasible in 2016.

The Senate race remains more interesting as control is up for grabs. Sam Wang pointed out last week that, looking at the polls, the Democrats are outperforming expectations. Many web sites which include factors such as history of a state are predicting that the Republicans will take over the Senate. As polling is limited in some states, it is certainly possible that their historical-based predictions might be right. Still, it is a positive for the Democrats to see them doing better than would be expected in the polls. Today electoral-vote.com, which is based purely on polls, has both Democrats and Republicans winning fifty seats. This would leave the Democrats in control, with Vice President Biden casting the deciding vote. Many states are very close, but each party has seats which can easily go either way.

As I’ve said many times before, the Democrats have a chance to hold on to the Senate due to benefits of incumbency. The vulnerable Democrats in red states have won before, although it might have only been in 2008, which was a much more favorable year for Democrats. PBS looked at this topic:

Why Democrats can still win: Republicans are only favored, though, to win between four and eight seats. And Democrats still have a chance of retaining the Senate. But how can that be with the fundamentals described above and a president with among his lowest approval ratings, and even lower in these 12 states on average? Because candidates matter. Incumbents traditionally have an advantage because voters in those states have already elected them statewide, giving them natural bases — and fundraising networks and turnout operations — to get 50 percent. What’s more, the candidates Democrats have in some of these red states are legacy candidates. In other words, not only are they personally well known, their families are too. The Landrieus, Pryors, Begiches, and Udalls are near political royalty in their respective states. But will their personal dynasties pay the dividends needed this fall and be enough to overcome the national environment? It could be for some but not for others. How many survive could be the difference between a Democratic and Republican Senate for the last two years of Obama’s presidency.

Despite many predictions for the Republicans to take control of the Senate, between the overall unpopularity of the GOP and the advantages of incumbency, I still think this is a toss up.

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Kansas Independent Might Be Key To Control Of Senate

With control of the Senate so close, anything which might alter a race in a state felt to be dominated by one party could have huge ramifications. Sam Wang offers a plausible scenario which could make Kansas competitive:

In national politics, Kansas is considered as Republican as they come: Mitt Romney carried the state in 2012 by twenty-two percentage points, and the last Democratic Presidential candidate to carry Kansas was Lyndon Johnson, in 1964. But this year, the reliability of Sunflower State politics seems to have been upended. With control of the Senate in a tight, uneasy race, Kansas may be a game changer on a national level, thanks to an unusually strong independent candidate.

The Republican incumbent, Pat Roberts, is heartily disliked by Kansas voters: his approval rate is only twenty-seven per cent, even lower than the thirty-three per cent who approve of President Obama’s performance. Roberts, who is in his third term, recently survived a primary challenge by the radiologist Milton Wolf. Dr. Wolf ran under the Tea Party banner and gained attention for posting gruesome X-ray images of gunshot victims on his Facebook page that were accompanied by macabre banter with his friends. Still, Roberts’s margin over Wolf was only forty-eight per cent to forty-one per cent. It seems that Kansas voters will seriously consider just about anyone but Roberts.

Except, maybe, a Democrat. Shawnee County’s district attorney, Chad Taylor, cruised to a relatively easy victory in the state’s Democratic primary, but in recent general-election surveys, Taylor trails Roberts by a median of six percentage points. Kansas has not sent a Democrat to the Senate since Franklin D. Roosevelt was President, and it’s unlikely that it will this year.

The third candidate in the race is the businessman Greg Orman. Orman, who comes from Olathe, a city in the eastern part of the state with about a hundred twenty-five thousand people, has been crisscrossing Kansas by bus, meeting voters and preaching a message of fiscal restraint and social tolerance. A former Democrat, he decried the gridlock and lack of action in Washington, and now declines to identify himself as a member of either major party.

Orman’s formula seems to be working with Kansas voters. Despite the fact that thirty per cent of voters still have not heard of him, a recent Public Policy Polling survey shows that in a one-on-one matchup, Roberts would lose by ten percentage points, forty-three to thirty-three. In contrast, Roberts would survive a one-on-one matchup with Taylor by a margin of four points. So if you’re Roberts, you either want Taylor and Orman to split the vote, or to run against Taylor alone.

This means that, paradoxically, Pat Roberts’s political future may depend on his Democratic opponent staying in the race. And that, in turn, affects the balance of power in the closely contested Senate—by converting a Republican seat into an independent one.

Control of the Senate appears to be so close that one seat could certainly make the difference. It would be ironic if the key race turns out to be in Kansas due to backlash against how far right the Republicans have moved.

The first question is whether the Democratic candidate would really get out of the race and if Orman would really win. Polls show that there is an excellent chance of this happening should Taylor agree to drop out. The Democratic Party has plenty of incentive to offer Chad Taylor a lot in return for agreeing to this, and he certainly might accept a decent offer considering that he is not going to win if he remains in the race.

The next question is whether Orman would then caucus with the Democrats if he won. Chances are better that a former Democrat than a former Republican would do so, but he might also look ahead to having a better chance of holding on to the seat long term in Kansas if he becomes a Republican.

If Orman wins there will be intense pressure from both sides, and it might also impact the leadership of either party. Orman has said that both Harry Reid and Mitch McConnell “have been too partisan for far too long” to gain his vote of confidence. Would members of either party initiate a revolt against their leader if they thought it would mean retaining control?

Update: Taylor drops out of race

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Early Projections On Control Of The Senate

If you want another source besides Nate Silver’s site at FiveThirtyEight for information to make an educated guess about control of the Senate, check out Electoral-vote.com. The page has a map of all the states which links to the latest polls from each state. As an example of how close things are, today’s projection shows the Democrats with 49 seats, the Republicans with 50, and one tied. The Democrats retain control if they can maintain fifty seats due to Vice President Biden casting the deciding vote in a tie.

The tie is in Iowa, which does seem to give the Democrats a fighting chance of winning the 50th seat based upon this projection. FiveThirtyEight gives Democratic candidate Bruce Braley a 55 percent chance of winning that race.

Some of the states are classified as barely leaning towards one party and there is no doubt that some of these (and perhaps other) states will change. For example, Electoral-vote.com has Mary Landrieu barely leading in Louisiana. FiveThirtyEight gives her a 45 percent chance of winning, and predicts that this race will come down to a run-off in December. With control of the Senate very possibly coming down to a single seat, we can easily have a situation where we are waiting until the December run-off, which would then turn into an extremely high profile race.

The Democrats also face a tough challenge in North Carolina despite this state being listed as barely Democratic. FiveThirtyEight sees it as even tighter, giving Kay Hagan a 50 percent chance of winning.

Other races could also provide the Democrats with the 50th seat should the other races go as Electoral-vote.com predicts. They currently have Colorado listed as barely Republican, while FiveThirtyEight gives Mark Udall a 60 percent chance of winning. At this point I would place more credence in a human projection than in Electoral-vote.com’s projections based purely on the polls.

These sites certainly do not provide an answer as to who will win. The next question would be the impact of winning with Ezra Klein joining many other political writers in seeing a Republican controlled Senate as further increasing the chances that the Democratic presidential candidate will win in 2016. Will this keep Hillary Clinton from campaigning for Democrats this fall despite the risk of ill will from some Democrats?

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No Signs Of A Wave Election So Far

Nate Cohn looked at the small amount of generic Congressional polling there is available and concluded, consistent with other indicators, that there is no sign of a wave election this year. The polls he looked at showed an average 1.9 percent advantage for the Democrats over Republicans. Cohn wrote:

These findings bear no resemblance to the one-sided results at this point in 2010, when Republicans held a clear 4.7-point advantage, or in 2006, when Democrats were ahead by 10.1 points. The current slight Democratic edge is fairly similar to what generic ballot surveys showed in the days ahead of the 2012 presidential election.

It’s important to emphasize that these polls are of registered voters, not likely voters. Previous years’ surveys were also of registered voters. The Republicans probably have a slight advantage among the older and whiter electorate that’s likely to participate this November. But that’s a separate matter from national political conditions.

While some have predicted a Republican wave based upon Obama’s unpopularity in the polls, the fact that both Congress and the Republican Party have even worse favorability ratings must count for something. The actual result seems to be a decreased turn out at the polls in primary elections so far this year, possibly indicating that voters are fed up with everybody. There is still quite a while until the election, and an unforeseen event still might tilt things towards either party.

The lack of a Republican wave, assuming things stay as they are, should limit the expected loses by Democrats which we would normally see in the sixth year of a presidency. Unfortunately the Republicans are in a good position to take control of the Senate without a wave as the Democrats are forced to defend several Senate seats in red states which they picked up in 2008.

As it now stands, the Republicans have a very slight edge to take the Senate, but there are a number of reasons that Democratic incumbents might still hold onto enough seats to narrowly maintain control. The Hobby Lobby might get more single women to turn out to vote for the Democrats.  Republicans still could find ways to lose elections which are now close, such as with a call for nullification of federal laws by the states by the Republican Senate candidate in Iowa:

Joni Ernst, the Republican nominee for U.S. Senate in Iowa, appears to believe states can nullify federal laws. In a video obtained by The Daily Beast, Ernst said on September 13, 2013 at a form held by the Iowa Faith & Freedom Coalition that Congress should not pass any laws “that the states would consider nullifying.”

“You know we have talked about this at the state legislature before, nullification. But, bottom line is, as U.S. Senator why should we be passing laws that the states are considering nullifying? Bottom line: our legislators at the federal level should not be passing those laws. We’re right…we’ve gone 200-plus years of federal legislators going against the Tenth Amendment’s states’ rights. We are way overstepping bounds as federal legislators. So, bottom line, no we should not be passing laws as federal legislators—as senators or congressman—that the states would even consider nullifying. Bottom line.”

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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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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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Insurance Companies Plan To Increase Policies Offered On Exchanges Following 2014 Success, And Other Health Care News

The first year of enrollment for insurance under the exchanges is largely for first getting our feet wet, with more people projected to sign up in the future. It certainly exposed problems in the computer system and allowed for them to be fixed (although further testing before October was clearly needed). Insurance companies got to see whether this was a profitable market they would want to enter. In the past one or two insurance companies dominated in most areas on the individual market. One of the benefits of selling coverage through the exchanges was the hope that multiple companies would now begin to offer coverage.

Even conservatives who oppose the Affordable Care Act should agree with the benefits of having more companies offer insurance, including the likelihood of competition leading to lower prices. Actually exchanges, along with mandates, were originally supported by Republicans until they opposed the plan when supported by Barack Obama.

So far we are receiving good news following the initial IT problems. The Affordable Care Act now looks like a good policy which just got off to a rocky start. Enrollment is estimated at 7.5 million, exceeding predictions made even before they were adjusted downward with the early computer problems, with more healthy young people signing up at the last minute. Politico reports that insurance companies are happy with what they are seeing and want to get in:

Health insurers got their first taste of Obamacare this year. And they want seconds.

Insurers saw disaster in the fall when Obamacare’s rollout flopped and HealthCare.gov was a mess. But a strong March enrollment surge, along with indications that younger and healthier people had begun signing up, has changed their attitude. Around the country, insurers are considering expanding their stake in the Obamacare exchanges next year, bringing their business to more states and counties. Some health plans that skipped the new marketplaces altogether this year are ready to dive in next year.

At least two major national insurers intend to expand their offerings, although a handful of big players like Aetna, Humana and Cigna, are keeping their cards close for now. None of the big-name insurers have signaled plans to shrink their presence or bail altogether after the first rocky year. And a slew of smaller health plans are already making moves to join more states or get into the Obamacare business for the first time.

“[W]e see 2014 as just the beginning for exchanges,” said Tyler Mason, a spokesman for UnitedHealth Group, one of the nations’ largest insurers. “As the economics, sustainability and dynamics of exchanges continue to become clearer, we believe exchanges have the potential to be a growth market with much to offer UnitedHealthcare and other insurers and consumers.”

Nurturing this growth and health plan participation will be one of the first tasks of Sylvia Mathews Burwell, assuming she is confirmed to succeed Kathleen Sebelius as secretary of Health and Human Services.

The article reviewed plans by many of the larger insurance companies and also noted that several smaller companies now want to start selling insurance. Being able to offer their plans on the same computer site as the larger companies will allow small companies to compete for sales more easily than in the past, further increasing choice for consumers.

It is not only insurance companies which see the Affordable Care Act as succeeding. The latest Reuters/Ipsos poll shows the number of people who prefer Democrats over Republicans on health care has increased:

Americans increasingly think Democrats have a better plan for healthcare than Republicans, according to a Reuters/Ipsos poll conducted after the White House announced that more people than expected had signed up for the “Obamacare” health plan.

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.

Not surprisingly, Gallup has found a greater decrease in the uninsured in states which have embraced the Affordable Care Act, such as by setting up their own exchanges and taking advantage of the expanded Medicaid program.

Having Gallup survey the number of uninsured is of value as the Census Bureau is changing how it is surveying the uninsured, with Gallup providing a second set of numbers for comparison. Many Republicans see a conspiracy to make Obamacare look good. Actually this looks like a change to get more accurate results, which might actually show a greater number of uninsured. The changes also started with 2013 so we will still be able to compare the year prior to the exchanges to subsequent years. Sarah Kliff explained further at Vox.

Cross posted at The Moderate Voice

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