As the dust settles

on the first enrollment period of the new Affordable Care Act, we are learning that a lot more people than a lot of people predicted have signed up for insurance.  President Obama is claiming 7.1 million people signed up on the health insurance exchanges – along with unknown numbers of others who signed up directly with insurance companies.  There was a claim yesterday that 90% of the enrollees had actually paid a first premium, a crucial step to being able to actually use the insurance.  We all know that there will be hassles when people go to their medical provider, when insurance cards don’t arrive in the mail, when someone with expanded Medicaid goes to a doctor who doesn’t accept that plan, but then, there have always been hassles with health insurance.  This will be nothing new.  What will be new is the massive number of new people suddenly looking for a provider.  Adjustments will have to be made all around.

But the biggest losers as of this morning would seem to be the opponents of the ACA or Obamacare as they call it.  Here is Dan Wasserman’s cartoon from this morning’s Boston Globe.

obamacare wasserman

 

And then there is this story from Politico.

Back in the fall, conservatives seized on the flubbed Obamacare rollout as proof that President Barack Obama’s brand of liberalism doesn’t work.

Now, the law’s opponents aren’t about to say that critique was wrong — but they’ve lost the best evidence they had.

On Tuesday, Obamacare sign-ups passed 7 million, six months after the launch of a federal website that could barely sign up anybody. There are still a lot of questions about how solid that figure is, but the idea that the law could even come close to the original goal after such a disastrous start would have been laughable even a few weeks ago.

That’s left the critics questioning the early numbers or changing the subject. It’s a reminder that the attacks on the website were more than complaints about technology, but a proxy for a much deeper argument about what government should do and what it can’t do

But the Republicans do seem to be suffering from a compulsion disorder.  Here is Representative Paul Ryan quoted in the Politico story

And House Budget Committee Chairman Paul Ryan, who on the same day released a budget plan that would repeal the law, wasn’t fazed by the enrollment news.

“I think Obamacare is a slow-rolling fiasco. I think it’s a Pyrrhic victory,” the Wisconsin lawmaker said during a conference call with reporters Tuesday, at the same time that Obama was giving his victory speech in the Rose Garden.

But it was so much easier when they could just say the federal government can’t tie its own shoelaces. Now, they have to acknowledge that the government fixed the problem — and enrollment came roaring back.

Louisiana Governor Bobby Jindal is set to release his health care plan – I guess he is running for President.  According to the Washington Post

Louisiana Gov. Bobby Jindal will announce Wednesday a plan to repeal and replace President Obama’s health-care law, an effort by the Republican to insert himself into the increasingly competitive early maneuvering for his party’s presidential nomination.

In his 26-page plan, Jindal lays out a lengthy critique of the health law — which he refers to throughout as “Obamacare” — and reiterates his belief that it needs to be entirely done away with. In its place, he sets forth a bevy of ideas that have run through conservative thought for years, in some cases renaming them and in other cases suggesting new variations on old themes.

These themes appear to include giving those on Medicare a subsidy to buy private insurance and giving Medicaid money to the states to provide whatever care they decide on.  I have a feeling that this every-state-for-itself  idea will be proven to be a real problem as people in states that didn’t accept the expanded Medicare under the ACA are faced with citizens who won’t understand why Uncle Charlie can get health insurance subsidies and they can’t.  I don’t think this is a plan people will go for – especially after they get a feel for what is covered under ACA – but at least Jindal has something.

President Obama’s poll numbers are creeping up.  Democrats running for re-election would do well to be cautious about running away from the ACA, and optimistic me says that Nate Silver might just be wrong this time with is prediction that the Republicans have the edge in the mid-terms.  It won’t be easy for the Democrats:  They have to turn out their base in larger numbers than is usual for a mid-term, but it can be done.  Nate did favor Duke which lost in the first round of the NCAA men’s basketball tournament.

The state of health care reform

As everyone knows, the rollout of the Affordable Care Act has been pretty bumpy what with website problems, Congress not providing funding for getting the word out, and states refusing expanded Medicaid even if it is free money.  There have been surprises also.  The red state of Kentucky with a Democratic Governor, Steve Beshear, is running a successful program.  Connecticut has an online program that it is thinking of selling to other states.  Massachusetts with the original universal health care program hired the same folks that messed up the federal website resulting in problem after problem resulting in a backlog in processing paper applications.

In the meanwhile, the Congressional Republicans would still like to either eliminate or defund the ACA, but as Greg Sargent wrote recently in the Washington Post people are beginning to move away from supporting those actions.

Obamacare is a disaster for Democrats, and a certain winner for Republicans. That’s what we keep hearing, anyway.

So why does it look as if the percentage of Americans who favor repeal may have actually shrunk since its rollout problems began?

That’s what the February tracking poll for the Kaiser Family Foundation suggests. To be sure, the new poll finds that opinion of the law is more negative than positive: 47 percent of Americans view the law unfavorably, while 35 percent view it favorably (though opinions have improved a bit since October).

But unfavorable views have not translated into support for the GOP position of repeal; indeed the repeal position may have lost ground since the October rollout problems, while a clear majority favors keeping and improving the law.

Some Kaiser survey results

Some Kaiser survey results

I think most people, including President Obama, would say that the ACA could be improved.  Any piece of legislation of that scope is going to have parts that don’t work well or have unintended consequences which need fixing.  And they need fixing in a systematic way and not just on the fly through delays and exceptions as the administration has been trying to do.  The poll results show support for making fixes.

The poll shows that 48 percent want to keep and improve the law, and another eight percent want to keep it as is — for a total of 56 percent who want to keep it. (50 percent of independents want to keep and fix.)

Meanwhile, 19 percent want to repeal the law and not replace it, while 12 percent want to repeal and replace with a GOP alternative — totaling 31 percent.

Back in October Kaiser found that 37 percent want repeal/replace or just repeal, versus 47 percent who want to keep/expand it. There was a temporary spike for repeal in December, at the height of the problems; now it appears to be back down to below where it was.

In fairness, the wording is not directly parallel. The new poll offers respondents the option of keep and improve, while the October poll offered folks keep or expand. But this underscores the point: When people are offered keep and improve — the Dem stance — support for keeping the law grows.

Paul Krugman pointed out in his last New York Times column that Republican attempts to find horror stories have so far not really succeeded.

Remember the “death tax”? The estate tax is quite literally a millionaire’s tax — a tax that affects only a tiny minority of the population, and is mostly paid by a handful of very wealthy heirs. Nonetheless, right-wingers have successfully convinced many voters that the tax is a cruel burden on ordinary Americans — that all across the nation small businesses and family farms are being broken up to pay crushing estate tax liabilities.

You might think that such heart-wrenching cases are actually quite rare, but you’d be wrong: they aren’t rare; they’re nonexistent. In particular, nobody has ever come up with a real modern example of a family farm sold to meet estate taxes. The whole “death tax” campaign has rested on eliciting human sympathy for purely imaginary victims.

And now they’re trying a similar campaign against health reform.

Krugman cites the Response to the State of the Union Address.

 In the official G.O.P. response to the State of the Union address, Representative Cathy McMorris Rodgers alluded to the case of “Bette in Spokane,” who supposedly lost her good health insurance coverage and was forced to pay nearly $700 more a month in premiums. Local reporters located the real Bette, and found that the story was completely misleading: her original policy provided very little protection, and she could get a much better plan for much less than the claimed cost.

Louisiana is running ads about people losing health care insurance with actors.

In Michigan, Americans for Prosperity is running an ad that does feature a real person. But is she telling a real story? In the ad, Julia Boonstra, who is suffering from leukemia, declares that her insurance has been canceled, that the new policy will have unaffordable out-of-pocket costs, and that “If I do not receive my medication, I will die.” But Glenn Kessler of The Washington Post tried to check the facts, and learned that thanks to lower premiums she will almost surely save nearly as much if not more than she will be paying in higher out-of-pocket costs. A spokesman for Americans for Prosperity responded to questions about the numbers with bluster and double-talk — this is about “a real person suffering from blood cancer, not some neat and tidy White House PowerPoint.”

Even supporters of health reform are somewhat surprised by the right’s apparent inability to come up with real cases of hardship. Surely there must be some people somewhere actually being hurt by a reform that affects millions of Americans. Why can’t the right find these people and exploit them?

The most likely answer is that the true losers from Obamacare generally aren’t very sympathetic. For the most part, they’re either very affluent people affected by the special taxes that help finance reform, or at least moderately well-off young men in very good health who can no longer buy cheap, minimalist plans. Neither group would play well in tear-jerker ads.

There is about a month left to sign-up before one has to pay a tax penalty for not having coverage for 2014.  The last number reported was 4 million sign-ups.  A priority:  Get the young and healthy to sign-up.

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Chart from Kaiser via the Washington Post

Picture of buttons from sites.tufts.edu