The Next Phase of the Obamacare Battle
Tuesday was a good day for the Affordable Care Act. The administration met its original projection of 7 million enrollments during the first six-month open enrollment window on private health insurance exchanges. That doesn’t include last-minute enrollments on the dozen-plus state-based exchanges, either, which should be significant. And while some conservatives argue that those numbers are “cooked,” in part because it’s unclear how many people who enrolled in health plans have paid (or will pay) their first premiums, HHS secretary Kathleen Sebelius claims that 80 to 90 percent of enrollees have met their first premium obligations. (As someone who enrolled in a plan last month and forgot about the whole “payment” thing until the last minute, I get it.)
So some level of celebration was certainly in order for supporters of the law. But to argue that yesterday’s marker proved that the GOP’s midterm strategy of running against Obamacare will no longer work is a tad premature. There’s still one big problem: it’s not popular in many, if not a majority of, places—even among some groups of people who have benefited from it.
Kentucky’s implementation of Obamacare, for instance, has been liberals’ go-to example of a red state where the law’s success may shift the public’s attitude towards it. Seventy-five percent of Kentucky’s 360,000 enrollees were previously uninsured, which means that the new law brings down Kentucky’s uninsured rate by 42 percent. Many of those added to the rolls, through either the exchanges or the Medicaid expansion, have come from impoverished, rural parts of Eastern Kentucky. The state’s exchange, Kynect, actually works.
Some liberals are wondering, then, how can Kentucky senator Mitch McConnell still go around calling this law a “catastrophe”? Doesn’t he realize he’ll get punished by his constituents who’ve benefited so greatly from the law, they ask?
No, he doesn’t realize that, and he won’t, because the law remains extremely unpopular in Kentucky, as Perry Bacon Jr. writes in an excellent, frustrating Yahoo! News piece about how “Obamacare’s success did nothing to change the politics of the law.” He explains:
Far from being seen as a success story, though, in Kentucky, the health care law and [Gov. Steve] Beshear’s strong embrace of it remain deeply controversial. A recent poll showed that a plurality of Kentuckians continue to favor repealing the law. Other than Beshear, many of the state’s leading Democrats, aware of the lingering tensions around the ACA, avoid speaking about it publicly, wary of being seen as too supportive of “Obamacare.”
And Kentucky Republicans are acting just like those in Washington and states around the country: GOP state legislators in the Democrat-controlled Kentucky House this month pushed unsuccessfully for a provision to repeal the state’s Medicaid expansion under the ACA and suspend its health care exchange.
“The politics have really not changed,” said Regan Hunt, executive director of Kentucky Voices for Health, a nonprofit group that supports the health care law. She noted that while it’s easy to find Republicans in the state’s Legislature who will publicly blast the law, “I don’t know if we have true Democratic champions” besides [Governor Steve] Beshear.
As the piece notes, the main (or only?) reason that Obamacare has been implemented so expansively in Kentucky is that Gov. Beshear loves it, and he’s a lame duck. McConnell’s would-be Democratic challenger in this year’s Senate election, Alison Lundergan Grimes, will barely even talk about the law.
This raises the possibility of a real conundrum! What if the rhetoric on Obamacare is so entrenched that its real-life effects won’t do a thing to change its political perception?
It doesn’t necessarily have to be this way.
First, there’s naturally going to be a lag: it may take some years for people to get over their pride and admit that the law benefits them. In his Rose Garden speech on Tuesday, President Obama cited the “many who don’t realize that they’ve received” the benefits they’ve received. Maybe they will “realize” that someday. Unfortunately for the Democrats, perceptions may be pretty well locked-in going into this fall’s midterms, at the very least.
Then there’s a bigger issue with Obamacare Implementation: Phase Two, which began yesterday and will continue for the foreseeable future. Namely, will newly enrolled people understand what’s in their plans, and will the plans live up to their expectations?
Obamacare-certified plans promise a lot: coverage of a wide variety of required services, preventative care with zero co-pay, no annual or lifetime limits, and coverage of all pre-existing conditions. On the other hand, they are still insurance plans offered by private health insurance companies, and so we should fully expect those companies to find and try to exploit whatever new loopholes there are in order to get out of these requirements. If the first phase of implementation was mostly anecdotes about trying to navigate a shitty website, the second phase will be anecdotes about people whose insurance claims for an expensive treatment were still somehow denied, despite all the promises.
So yes, people have signed up. Hooray! Now let’s try and make sure that these new insurance plans aren’t just the same old insurance plans with a shiny new name.