Believe it or not, Americans like Obamacare. They just don’t know they like Obamacare.
Consider the prohibition on denying insurance coverage due to preexisting conditions. Seven in 10 Americans, including 6 in 10 Republicans, support this provision, according to a recent Kaiser Family Foundation poll.
What about allowing young adults to stay on parents’ plans until age 26; eliminating out-of-pocket costs for preventive care; providing subsidies to low- and moderate-income Americans to help them purchase coverage; and helping states expand Medicaid to cover more uninsured low-income adults?
At least 80 percent of Americans are fans of every one of these provisions. Among Republicans only, at least two-thirds are, too.
The only major component that a majority of Americans don’t like is the individual mandate — that is, the requirement that nearly all Americans sign up for insurance or pay a fine.
But as is often pointed out, you need this unpopular provision to preserve the popular one about preexisting conditions. Without a mandate, only increasingly sick people will buy coverage, sending insurance markets into a death spiral.
Other polls document similar support for most of the ACA’s core components, despite antipathy toward the law itself. There’s an entire subgenre of journalism about people who benefit from Obamacare but still oppose the law and/or support Donald Trump, who promised to repeal it. These stories often find Obamacare beneficiaries who don’t realize they’re Obamacare beneficiaries.
Of course, the public confusion is understandable. Some elected officials don’t seem to know what the law does, either.
“What we really need is to get insurance de-linked from employment and allow me, if I'm an individual employer, a business of one, you need to let me pool together easily with large groups so I’m a pool of thousands if not millions of people so I don't get this problem of jacking up my rates when I get sick,” Sen. Rand Paul (R-Ky.) said on “Morning Joe.”
This pooling of risk and barring of rate hikes once people get sick are exactly what the Obamacare exchanges do.
All of which is to say that Obamacare does not have a policy problem. It has a branding problem.
Thanks to years of Republican fearmongering and (frankly) journalistic malpractice, voters have little idea what Obamacare is. All they know is that it’s bad, and partisan, and a failure. The law itself has become a vessel for everything people dislike about the U.S. health-care system, including and especially problems that long predated the law: high prices, complexity, opacity, uncertainty.
Americans don’t even recognize Obamacare’s one inarguable accomplishment: the precipitous decline in the uninsured rate.
The share of Americans who lack health insurance has nearly halved since the Affordable Care Act passed and now stands at an all-time low of 8.9 percent, according to the Centers for Disease Control and Prevention. Yet a recent Economist/YouGov poll found that only a little more than a third of Americans believe the rate has declined.
To the extent that Americans understand anything factual about Obamacare, it seems to be the law’s shortcomings, disappointments and holes — many of which could be plugged if Republicans were willing to work on improving it.
For example, insurers have sharply raised prices and pulled out of many state exchanges in part because enrollees have proved sicker and more expensive than expected. This problem could be remedied through some combination of a stronger individual mandate, more generous subsidies and extended risk corridors and reinsurance.
If you care about preserving the law, there are two silver linings to all this.
First, many Republican politicians realize — even if they won’t publicly acknowledge — that they’ll be in big trouble with voters if they mess with the law’s core components. Even top Trump aide Kellyanne Conway promised that no one who currently has insurance will lose it, something impossible under any of the repeal plans on the table.
Second, if indeed Obamacare’s most pressing problem is branding, the law couldn’t hope for a more gifted brand rehabber than the next president.
Trump may have little interest in policy, experts, numbers, details. But he is undoubtedly a marketing genius. One possible outcome of the current repeal-and-replace free-for-all is that congressional Republicans decide to keep essentially the existing system in place, with some reforms, improvements and hole-plugging, and Trump slaps a shiny new name on the whole thing.
Welcome to the revolutionary, gold-plated “Trumpcare.” Has a nice ring to it, don’t you think?