Obamacare Enrollment (part 2) Who Will Remain Opposed to Obamacare in 2015? “Zero-Sum Thinking”

In 2015, I predict that Obamacare enrollment will soar, matching 2014’s success.

This may seem counter-intuitive. After all, in recent months, the public’s perception of Obamacare seems to have soured. The Henry J. Kaiser Foundation’s health care tracking poll for July reveals that 53% of those surveyed last month said they view the Affordable Care Act unfavorably—a jump of 8 percentage points since June.  July’s results mark the first time since January, that more than half of all Americans opposed the health reform law

Is this because people who have enrolled in the Exchanges are unhappy with the insurance they purchased?


Most People Who Signed Up for  Obamacare Are Happy

Just one month earlier a Kaiser Foundation poll showed that “71%” of those who have enrolled in insurance plans that comply with Obamacare’s rules “rate their coverage as excellent or good overall,” and “more than half (55%) say it is an excellent or good value for what they pay for it.”

This is in part because in the Exchanges, middle-income as well as low-income customers qualify for government assistance to help cover premiums. As a result, 87% of customers have received subsidies that come in the form of tax credits.

Nearly six out of ten of Obamacare’s new customers were previously uninsured, Kaiser reports, while the remainder are “plan-switchers” – people who previously had individual market coverage and switched to new coverage after Jan. 1.  This group includes people who had their old policies cancelled as the ACA’s requirements kicked in, as well as people who switched for other reasons, including the availability of premium subsidies.

No surprise, customers who were forced to switch to a plan that meets Obamacare regulations are not as pleased as those who were previously uninsured. Yet nearly half of the “switchers” acknowledge that after using the tax credit, their new, more comprehensive Obamacare plan costs less than their old policy. This means that they are getting more for less. And I would predict that as they use their new policies ( and discover, for example, that preventive care is free)  many will become more enthusiastic.

Here is  the bottom line: “As a whole,” Kaiser observes, “enrollees are more likely than the public overall to have a favorable view of the ACA: they are roughly evenly split between positive and negative views (47% favorable vs. 43% unfavorable). By contrast, views among the general public are more negative than positive (38% favorable vs. 46% unfavorable.)

In other words, people who have had direct experience with Obamacare are more likely to support it. Those who have only read about reform are more likely to be opposed

What Determines Whether A Person Approves or Disapproves of Reform? 

A close look at the polls reveals that how someone feels about Obamacare has far more to do with his or her politics than with any direct knowledge of the program. Sixty-nine percent to Democrats view the Affordable Care Act favorably, compared to only 14 percent of Republicans.

The majority of those Republicans have never shopped the Exchanges because they don’t need Obamacare. Many work for an employer who offers generous benefits. Indeed, of the 15 million 20-somethings who have stayed on a parent’s employer-based plan, 63% identify themselves as Republicans. This is because Republican parents are more likely to have health benefits at work. Other Republicans who own their own businesses often fund their own medical care with money that they have tucked way in tax-advantaged health savings accounts. Finally, some Republicans shun the ACA’s marketplaces because they want nothing to do with government social programs–even if they might qualify for subsidies.

What Many Republicans Don’t Know About Obamacare

Since many have never priced policies in the Exchanges, Republicans are inclined to believe the misinformation that reform’s opponents have planted in the media, including the myth that Obamacare is “unaffordable.”

In truth, last year, after using his tax credit,  the average Exchange customer paid $82 a month for coverage. Many people shell out more for cable TV.

Here’s an overview of what various Exchange customers paid last year:

Somehow, the mainstream media rarely broadcasts these numbers. It’s easier to just quote a pundit’s claims about “sticker shock.” And sadly, as I have reported, these days, many journalists don’t have the time—or in some cases, the desire—to fact-check what their sources are saying. But as I suggested in part 1 of this post (URL) those who have enrolled in Obamacare are beginning to tell their friends. Word-of-mouth will play a major role in driving 2015 enrollments.

Zero-Sum Thinking

Meanwhile, it seems that the less someone knows about Obamcare, the more likely he is to disapprove.


Not long ago, Robert Blendon, a public opinion analyst at the Harvard School of Public Health, told ABC that “negative views about the law are driven by people who already had insurance”—in most cases, through their employer. “They worry that the coverage expansion will raise their premiums or compromise the quality of care they receive.”

‘Rightly or wrongly” he added, “people who are not directly aided by [Obamacare] are worried.”

When I asked Blendon to expand, he pointed to a recent advertising survey done by Kantar Media showing the large number of negative Obamacare ads running on commercial outlets.  Kantar estimates that since the Affordable Care Act passed in 2010, $445 million has been spent on political TV ads mentioning the law, and spending on negative ads has outpaced positive ones by more than 15 to 1.

Those ads have reached  wide audience, and in his e-mail, Blendon observed: “They all focused on what the risks are to middleclass individuals” who already have coverage. For example, some fret that if more people are insured, their doctors’ waiting room might be crowded.

In this way, Republicans have encouraged “zero-sum thinking” (the assumption that if someone else gains something, you may well lose something): “If more low-income families are insured, there won’t be enough doctors and nurses to take care of my me and my children.”

According to Blendon the advertising assault on the Affordable Care Act draws on lessons Republicans learned during the Clinton administration about harnessing “the ambivalence the middle class has about big reform” to win midterm elections.   They assume that “big reforms” won’t help them—and might cost them something.

I agree, though in this case I would say we’re not talking about the middle-class (defined as households earning roughly median income, or $52,000) Half of all Americans earn more than median income, half earn less. Upper-middle households, earning more than, say, $70,000, are more likely to enjoy employer-based coverage, in large part because they are more apt to be able to afford their share of the premium. (In 2012, 86% of families with joint income over  $75,000 enjoyed employer based coverage, vs. 31% of those bringing home $50,000 to 74,000 and just 12% of those earning $40,000 to $49,000.

As More People Experience the Reality of  Obamcare, Attack Ads Become Less Potent

Nevertheless, even the GOP is beginning to realize that the number of Americans who feel so economically secure that they feel ambivalent about government assistance for the middle-class is shrinking. More and more families realize that they–or their adult children–might well need Obamacare. As Bloomberg News recently reported, the fact Republicans have cut way back on ads that attack Obamacare in North Carolina, Louisiana and Arkansas is “a sign that the party’s favorite attack against Democrats is losing its punch.” 

What California Tells Us About the Future of Obamacare

Meanwhile, support is increasing in one state that has been particularly successful in enrolling the uninsured—California. Since the launch of the state’s health insurance exchange, Covered California, and the expansion of MediCal, the insurance program for low income people, California has extended coverage to more than 3 millions state residents, helping to cut the rate of the uninsured by half.

Meanwhile, state polls reflect growing awareness of the benefits of the ACA. The San Jose Mercury News reports;  “The nation’s new health care law is surging in popularity in the Golden State, according to the Field Poll, which finds more Californians today — of all political stripes — support the Affordable Care Act than at any time since it was signed into law four years ago.

The poll of 1,535 likely voters from June 26 to July 19 showed that 56 percent of registered voters say they support the law, while 35 percent are opposed.” Support is up six points from last year.”

Here, let me suggest that it’s worth remembering the old saw: ““Whatever is going to happen, will happen first in California?”

The biggest increase in support (or the largest reduction in opposition) is coming from those groups that were previously opposed or evenly divided.” the San Jose paper reported. “GOP support is up 5 percentage points from last year. And fifty-six percent of voters with no party preference, favor the law—up two percent from a year earlier.”

All in all, this seems an early indication that when it comes to health care reform, familiarity breeds support.

Originated at Health Beat Blog – Maggie Mahar