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Saturday, December 10, 2016

Oct. 8 (Bloomberg View) — A Gallup poll released Wednesday confirms what anyone paying attention knows: The Affordable Care Act’s successes aren’t changing negative views on “Obamacare,” including what people report about their personal experiences with health care. Yet the very characteristics that make Obamacare unpopular make the ACA safe from repeal.

The design of the law almost ensured a negative response from the public, given that the benefits that people like aren’t labeled “Courtesy of Obamacare.” No such confusion exists with the benefits delivered by, say, Social Security or Medicare, which is why most Americans are attached to those programs. Even though President Barack Obama’s’s mediocre approval ratings contribute to Obamacare’s bad poll numbers, most of the blame can be attributed to this structural aspect of the law, not the president.

Going to the numbers: 16 percent of Gallup’s respondents agreed that Obamacare has “helped” them and their family; 27 percent said the law had “hurt.” There’s a sharp partisan split: 40 percent of Republicans said the law “hurt,” and just 4 percent said it “helped.” Among Democrats, however, 27 percent said it “helped” and 15 percent said it “hurt.” To some extent that could reflect real disparities in health situations between Republicans and Democrats. But the bulk of the difference is almost certainly due to a combination of the general attitude toward Obama and information flows that make Democrats more likely to be exposed to good news (real and imagined) about the law and for Republicans to know about real and imagined problems with it.

The partisan divide doesn’t explain why relatively few people, regardless of political affiliation, feel the law has helped them, even though (as Jonathan Cohn points out in a good piece) there have almost certainly been more winners than losers.

The reason more people believe they’ve been hurt than helped is that peak awareness of the ACA’s benefits is already in the past, and it wasn’t very broad in the first place.

Why?

For one thing, even though the ACA may have moderated the rise in the cost of health care, even smaller price increases will be perceived as a harmful result of the law. There’s always variation in costs, and Republicans are going to publicize any spikes and Democrats aren’t going to trumpet increases, even when they are at or below trend. Indeed, Republicans will blame reform for every bad health care story, regardless of whether it’s ACA-related.

Another reason for the bad feeling is that there’s little reason for most consumers to connect health care benefits that they like with a law passed more than four years ago.

For example:

• How many young people who are able to to stay on their parents’ insurance know they have Obamacare to thank?

• How many people with (private!) insurance purchased through an exchange — either state exchanges such as Kynect or Covered California or the federal HealthCare.gov — know that those plans are part of “Obamacare”?

• How many people in expanded Medicaid know they are receiving Obamacare?

• How many people know Obamacare is the reason they don’t exceed annual or lifetime reimbursement caps?

I suspect that most people who enrolled this year after previously having been denied coverage due to a pre-existing condition know the ACA helped them. But many applying for health insurance for the first time probably don’t realize that their pre-existing conditions would have barred them from coverage before Obamacare. Fewer people are likely to credit Obamacare in the future because they won’t know there was a time when people were denied coverage.

None of these observations settles the question of whether the ACA is good or bad policy. But they do mean that anyone contemplating repeal should ignore the poll numbers and think hard about what consumers would say if the benefits they enjoy were to disappear. People on expanded Medicaid may not credit Obamacare, but they sure are going to want to know why their coverage went away. The same is true of people who obtained insurance through the exchanges or have benefited in other ways. Remember, just as Obama is now held responsible for any bad news on health care — even if there’s no connection to the ACA — the blame would shift to Republicans if they successfully push repeal, with or without a replacement.

AFP Photo/Karen Bleier

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