In early November, in the midst of the worst of the disastrous rollout of HealthCare.gov, Terry McAuliffe beat Virginia attorney general Ken Cuccinelli, who defined himself as one of the nation’s foremost opponents of the president’s health care reform, to become the state’s next governor.
“We tested Cuccinelli’s brag that he was the first attorney general to sue to stop Obamacare,” McAuliffe pollster Geoff Garin told The Washington Post‘s Greg Sargent. “That actually made more voters less likely to support him than more.”
This didn’t mean the law was popular.
“A majority disapproved of the Affordable Care Act, but in Virginia, as elsewhere, we found that a lot of these voters want to fix the law,” Garin said.
Since then, the federal online health care marketplace languished for a few more weeks as news of cancelations dominated the media. Approval of the law and the president sunk to new lows. But public opinion of the law essentially remains unchanged.
“While the public is hardly enthusiastic about Obamacare, the same polls that show unfavorable attitudes toward the law also show an electorate that isn’t looking to repeal it but rather fix it,” veteran political analyst Charlie Cook wrote last week.
From the moment the Affordable Care Act became law, its critics called it flawed and doomed to fail. The flubbed launch of the health care exchanges reaffirmed this assumption. However, the best way to “fix” it is to give it a chance to be properly implemented.
Numbers released on Monday show that the number of people who picked a plan through the health care exchanges by December 28 was respectable — given that for two out of three months, the key way to pick a plan online was barely functional. While the fate of the law ultimately depends on Democrats retaining control of the presidency, Congress or both, there are promising signs that show that the main fix the law needs — a mostly healthy group of enrollees in all 50 states — still may be possible, even in its first year.
Here are five reasons to be optimistic about the future of Obamacare.
Photo: KentonNgo via Flickr
HealthCare.gov Is A Non-Issue
“Based on my review,” Rep. Bill Johnson (R-OH), a former IT executive, wrote on October 30, 2013, “the problems with the HealthCare.gov website are catastrophic.”
The verdict that the federal online exchange could never be fixed filled the airwaves, until early December when suddenly it was — more or less — fixed.
How do you know that the Obama administration has achieved its goal of the site working for most people? Republicans have stopped complaining about it. House Republicans recently passed a bill to require the government to disclose data breaches that haven’t actually occurred. But as conservatives anxiously deflect from the scandals of Chris Christie by listing President Obama’s “scandals,” HealthCare.gov doesn’t even make the cut.
Just weeks ago, commentators were trying to decide if the rollout of the site was more like Katrina or the Iraq War. Now that the site is functioning, the original contractors are being replaced and the occasional site slowdowns and overloads typical of all e-commerce are barely newsworthy.
If only Katrina and Iraq could have been fixed so quickly.
“Signup rates are impressive in many large states in which Republican governors and legislatures have worked actively to undercut the law,” notes the blog Xpostfactoid.
A working federal exchange offers the best antidote to Republican sabotage. Now, the administration’s challenge is what it always should have been: getting people to the website.
AFP Photo/Karen Bleier
Signups Resemble Massachusetts Rollout
If you’re an Obamacare critic, you love that only 2.2 million people picked a health insurance plan through an Affordable Care Act marketplace — 1.1 million fewer than the Congressional Budget Office projected. And you’re delighted that only 24 percent of that number were young people, even if — as the above chart shows — signups by young adults 18-34 have skyrocketed.
Critics know for the law to fail, the people who sign up need to be more unhealthy than originally predicted. And since we have no idea how healthy new enrollees are until they begin filing claims, age is the best predictor of health.
However, the best predictor we have of how enrollment will work comes from Massachusetts, where a nearly identical rollout took place in 2007.
“In Massachusetts, according to analysis from MIT economist (and Obamacare architect) Jonathan Gruber, younger people tended to sign up later,” The New Republic‘s Jonathan Cohn pointed out. “The same thing seems to be happening in Colorado, one of the states that’s kept close records on age.”
“The insurance market will be stable with an enrollment mix like this,” Larry Levitt, senior vice president at Kaiser Family Foundation, wrote Monday. “But heightened outreach to young people, and even more importantly healthy people, will help to keep premiums down.”
With 50 independent insurance marketplaces, it’s likely that some states will have healthier populations than expected while others struggle to bring in the kind of young, strapping folks who are much more profitable for the industry and will keep the cost of premiums down.
However, there’s little to no chance of what Republicans are hoping for: the so-called “death spiral.” The law includes several safeguards for the industry, which is taking huge financial risks by ending its very profitable discrimination against people with pre-existing conditions.
The best hope the GOP had for a complete failure of the law has passed. Now they have to argue that a system that finally offers a minimum amount coverage to all Americans — sick or well — should be replaced by one that doesn’t.
People Are Picking Higher-Benefit Plans
The first, as depicted above, shows that 80 percent of those who picked a plan chose an offering of silver or above. These plans require a higher premium but result in lower deductibles and out-of-pocket costs.
Not so coincidentally, 79 percent of enrollees received a federal subsidy to help them pay for their coverage — which requires them to purchase a silver plan.
“Put those numbers together and it appears that most exchange buyers thus far may indeed find their coverage and care affordable,” Xpostfactoid wrote. “Add in that most enrollees with children will find the children enrolled in CHIP, further reducing their out-of-pocket costs, though not their premiums.”
While Republicans including Senator Ted Cruz (R-TX) cling to the notion that “full repeal” is the only option, they’re now demanding that insurance be taken away from 1,738,000 middle-class Americans who’ve picked a plan they believed they could afford. Millions more have signed up for Medicaid, which is generally entirely subsidized by the government. Republicans have shown they’re willing to take emergency unemployment benefits and food stamps from those who are still struggling in this economy.
But would they be willing to cancel millions of insurance policies after creating an uproar over insurance cancelations?
If The Law Continues To Control Costs As It Has, Our Long-Term Debt Crisis Fades Away
For the first time since the 1990s, health care spending shrank as a share of Gross Domestic Product last year. While the slowdown in private insurance costs is happening globally and can’t be connected to Obamacare. However, the growth of Medicare’s costs has slowed dramatically since the law was first passed, even as Baby Boomers began retiring. In addition to reforming the insurance marketplace, Obamacare added reforms that punish Medicare providers for hospital readmissions.
These reforms have led to a lower growth in costs that has continued into 2014.
“If the slowdown in Medicare were to continue in the future,” Peter Orszag, former director of the White House’s Office of Management and Budget, wrote, “everything we think we know about the nation’s long-term fiscal picture is wrong — as this crucial graph from the Council of Economic Advisers shows.”
Millions of Americans Now Have Health Insurance
The HealthCare.gov crisis and constant Republican attempts to derail the law obscure the historic nature of what’s occurring in America right now.
For the first time ever, sick people cannot be denied coverage. Insurance companies have to meet minimum standards and spend at least 80 percent of their premiums on actual care. The federal government is actively trying to enroll millions of Americans in health insurance using exchanges that will be the foundation for increased competition and innovation. And all Americans who earn up to 400 percent of the poverty level — except in states that refuse to expand Medicaid — are being offered financial help paid for by new taxes on the rich and corporations to get insurance they can afford.
Though holes remain in our health care system, which simultaneously has the highest costs in the industrialized world along with the highest rate of uninsured citizens, this is the first effort to make health insurance a basic expectation for all Americans.
Millions of Americans have gotten covered through the Affordable Care Act. Freelance journalist Anna Clark described her experience signing up for the exchange and the unexpected emotion she felt:
Two days before the enrollment deadline, I finally logged on to HealthCare.gov for the first time. Item by item, I typed in my information.
An hour later — with no delays or glitches — I had health insurance. With some modest budget adjustments, I can afford it too: It is about $232 a month for the Humana Connect Platinum 1000/1500 Plan. An HMO with a $1,000 deductible, it costs $25 for primary-care visits and $35 for specialists. My medical out-of-pocket maximum (including drugs) is $1,500.
This stunned me. For many long moments that snowy morning, I sat still. My coffee cooled beside me, and my skin bristled. With a shock, I felt, for the first time, how unsafe I had been over the years. Before, there was no use noticing this fear. But with the email confirming my enrollment blinking before me, I suddenly had permission to recognize the fear and relief that welled up in me, and it took my breath away.
Photo: LeDawna’s Pics via Flickr