The Affordable Care Act, “Obamacare,” has now been with us for three years.
It’s gone through Supreme Court tests. It’s gone through efforts to repeal. A huge chunk of it’s already been implemented.
And for the 85 to 90 percent of Americans who already have health insurance, they’re already experiencing most of the benefits of the Affordable Care Act even if they don’t know it. Their insurance is more secure. Insurance companies can’t drop them for bad reasons. Their kids are able to stay on their health insurance until they’re 26 years old. They’re getting free preventive care.
This — “experiencing most of the benefits of the Affordable Care Act even if they don’t know it” — caused quite a bit of snickering to break out among conservatives on Twitter. And understandably so; it certainly sounds lame to say that everyone would really love a program if only you understood it properly.
And yet … this point to exactly the reason why Obamacare has so many problems with public opinion. Take, for example, “rescissions.” The ACA eliminated what had been a big problem: People who would pay premiums, and then when they went to file a claim they would find out that whatever it was wasn’t covered, or their policies could even just be canceled. Forbidding that is a major victory for consumers. But it’s one that virtually no one will appreciate, because the whole point of the problem is that people who thought they were adequately insured couldn’t collect on their claims.
Going forward, what probably matters the most to the future popularity, in the 2014 election cycle and beyond (and see varying views from Philip Klein and Greg Sargent), is that people are not going to be encountering something called “Obamacare” or “Affordable Care Act” or, in most cases, anything that could even be attributed to the ACA. At best, that will apply to people on the exchanges, but even then I’m not sure most will really think “Obamacare” when they deal with it. What I suspect that means is that how people feel about it will be affected to some extent by their actual interactions with the health-care system, but to a larger extent by partisanship and partisan spin. That is, Republicans will attempt to attribute to Obamacare every premium increase, every application snafu and every employer who stops offering health care; Democrats, for their part, will talk about every piece of good news they can find and claim those stories are consequences of the ACA.
Generally, the problem for Obamacare is that to the extent that it works, it’s largely invisible. The one exception will be a one-time bump of people who wanted insurance suddenly being able to get it, and for some people large cuts in premiums as subsidies kick in (and my guess is that very few of those who will receive those subsidies have any idea they exist right now). But that’s a fairly small slice of the population, and after that one-time bump, it’ll just be (perceived as) the way things are, not an effect of “Obamacare.”
On the other hand — the flip side of that is that removing the exchanges and subsidies, once they start functioning, will almost certainly be a political disaster.
Which means that it’s quite possible the ACA is now fated to be unpopular — and to make repeal even more unpopular.