Friday, November 8, 2013

Obamacare Approval

(Poll of Polls, from Andrew Sullivan at The Dish)

As Andrew Sullivan at The Dish observes, it is interesting, in fact, surprising, that the Poll of Polls shows favorables on Obamacare moving up since the October 1 web site disaster. Could it be that people generally understand about problems, even big ones, occurring during a product or program's launch period; and that, at long last, folks are coming in contact with an actual program, with specific features in the real world that they can observe and experience for themselves; and they have survived the encounter (despite GOP insistence) and are beginning to like what they see?

I think it's not only possible, but likely. What I'm really interested in is what this chart will look like next May, or June, as we move into the stretch for the midterms. And here's my prediction: the lines will have crossed, or be just about to cross, moving favorables over unfavorables for the first time. Why do I think so:
  • The web site will have been fixed (before Christmas) and it is very easy now to put your info in; to compare policy options; to see what (if any) subsidy support you are eligible for, and to sign up and buy insurance (although open enrollment is closed until October 1).
  • Enrollment was pretty much on target, greatly helped by the almost 2 million folks whose policies were cancelled and decided to buy new coverage on the Exchanges. Total enrollment is 6.8 million, with 2.5 million under 35.
  • The cancellation crisis is behind us. Of the 6 million people who lost coverage, 3 million renewed with their insurance companies directly; 2 million went to the Exchanges, and 1 million chose to pay the fine and skip insurance.
  • Large employers have continued to offer insurance to their employees, with almost no one pushing their workers out into the Exchanges. The Total number of people getting insurance at work has actually grown slightly, as more small employers, using ACA credits, are offering plans.
  • Overall healthcare costs are adding a 6th year to their record of cost moderation and premium increases (on exchange and off, both group and individual) have remained moderate.
  • There have been some pressure on doctors, especially in moderate income and poorer neighborhoods, as the medical system reacts to the surge of new patients from Medicaid and the Exchanges. But the system is adjusting. In some states, PAs' and Nurse Practitioners are being granted new practice authority.
  • States that refused the Medicaid expansion are under enormous media  and political pressure to accept the Federal money, expand Medicaid, and stop the travesty of having people with incomes from 100%-138% of Federal Poverty Levels not  able to get subsidy support, where anyone with incomes from 139%-400% of FPL can qualify for subsidies.
  • There are quite numerous complaints from people whose individual policies were cancelled, and bought on the Exchanges, that they can't use the same doctors or hospitals they could before. But the great majority of people on the Exchanges, most of whom did not have insurance before, understand how tight provider networks help reduce costs, and are satisfied with the medical services they have access to.
In short, people are encountering the real program, and finding it works fine, and that no other part of their relevant world has blown up, or even seems remotely at risk of doing so. The big adjustment in the individual market, from bare bones to a full range of essential benefits, has been made. Many are paying more, but they mostly understand that they now have much better insurance. Complaints are still heard, but now the much louder media sound is of people telling their positive, happy and hopeful stories.

Democrats running against incumbent Republicans are hammering their opponents, and through them, the GOP for misleading and frightening folks. They are telling potential constituents: don't send the Republicans back, unless you want to lose this very good thing called Obamacare.

The possibility of a huge upset in November is beginning to be discussed seriously.

That's what I think is coming. Very, very exciting.

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