Rubber Meets the Road for Obamacare

If the law is going to get more popular, now’s the time.

National Journal
Sam Baker
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Sam Baker
Dec. 30, 2013, 12:16 p.m.

Demo­crats have said for years that Obama­care will get more pop­u­lar as people be­gin to see its be­ne­fits. Now we’ll find out wheth­er that’s true.

Many of the Af­ford­able Care Act’s most pop­u­lar pro­vi­sions take ef­fect Wed­nes­day. Be­gin­ning this week, in­surers can­not use a preex­ist­ing con­di­tion as a reas­on to deny someone cov­er­age or charge a high­er premi­um. New in­sur­ance policies take ef­fect that must cov­er cer­tain be­ne­fits. And, biggest of all, new tax sub­sidies kick in to help low-in­come con­sumers cov­er the cost of their premi­ums.

All of this is hap­pen­ing amid stub­bornly bad — and, ac­cord­ing to some polls, fall­ing — pub­lic ap­prov­al of the health care law. The latest track­ing poll from the Kais­er Fam­ily Found­a­tion put its fa­vor­ab­il­ity rat­ing at 34 per­cent, com­pared with 48 per­cent who had an un­fa­vor­able view.

Obama­care’s ap­prov­al rat­ings have been up­side-down for years, and Demo­crats had all but giv­en up try­ing to turn the num­bers around un­til the law’s most pop­u­lar pro­vi­sions took ef­fect. 

The botched rol­lout of Health­Care.gov made mat­ters worse. Ap­prov­al of the law, and Pres­id­ent Obama’s own ap­prov­al rat­ings, sank as the fed­er­al en­roll­ment web­site sputtered. Ad­min­is­tra­tion of­fi­cials say their biggest con­cern dur­ing the site’s early troubles was that people would give up on the Obama­care “brand” and simply wouldn’t come back to the site once it began work­ing.

That hasn’t happened.

Ac­cord­ing to the Health and Hu­man Ser­vices De­part­ment, more than 975,000 people se­lec­ted and en­rolled in a plan through Health­Care.gov this month. The total for all 50 states is now above 2 mil­lion — still shy of the 3.3 mil­lion sign-ups HHS ini­tially ex­pec­ted to re­ceive by the end of the year, but rap­idly pick­ing up steam.

One po­ten­tial prob­lem for the ad­min­is­tra­tion, though, is that people don’t as­so­ci­ate new be­ne­fits they might like with the health care law. As Demo­crat­ic strategists have noted, cov­er­age un­der the Af­ford­able Care Act isn’t an eas­ily iden­ti­fi­able be­ne­fit like Medi­care or So­cial Se­cur­ity. It’s private in­sur­ance, paid for in part by a sub­sidy that goes dir­ectly to the in­sur­ance com­pany.

Many in­di­vidu­al pieces of the Af­ford­able Care Act, in­clud­ing many of the policies that take ef­fect Jan. 1, are pop­u­lar on their own. The ad­min­is­tra­tion has already struggled with earli­er be­ne­fits — namely re­bates paid by in­sur­ance com­pan­ies — that poll well but which people don’t seem to con­nect to Obama­care.

And that’s as­sum­ing people like the cov­er­age they’ll get un­der the law. In or­der to keep premi­ums low, many in­sur­ance com­pan­ies have lim­ited the net­work of pro­viders they’ll cov­er in new policies, mean­ing some people who had their plans can­celed might not be able to keep their doc­tors. And con­sumers who be­nefited most from the pre-Obama­care in­di­vidu­al mar­ket — young, healthy, reas­on­ably af­flu­ent men — will see their premi­ums for cov­er­age rise un­der the new rules.

If con­sumers don’t like the cov­er­age they get, or don’t con­nect it to Obama­care, pub­lic ap­prov­al could con­tin­ue to sag, cre­at­ing a drag on Demo­crat­ic can­did­ates in 2014.

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