April 21, 2014
Thursday, December 26, 2013

Healthcare to get a boost soon

US President Barack Obama speaks about healthcare from the Rose Garden of the White House in Washington in October.
By Christopher Flavelle
Bloomberg News

US public’s views likely to turn around once coverage start to take effect

A CNN poll shows that support for the Patient Protection and Affordable Care Act has fallen to a new low, with just 35 percent of respondents saying they approve of the law. Look a little deeper, and the poll suggests the public’s views will turn around once the coverage starts to take effect next month.

First, 15 percent of respondents oppose the law because it doesn't go far enough. So that leaves 43 percent who think the law is too liberal. But even among that group, there’s reason to think some of their opposition is based on not quite understanding how the law will work or who it will affect.

A good example is the widespread concern that people won’t be able to keep their current doctors. Thirty-five percent of respondents said they thought they would be cut off from the doctors they now see. That isn’t surprising, given recent news stories about exchange plans that will seek to lower costs by providing access to fewer doctors and hospitals than traditional employer-sponsored insurance plans.

But those new networks will cover far fewer than 35 percent of US citizens. The Congressional Budget Office estimated that 7 million US nationals would be covered by exchange-based plans next year, and as we now know, the actual figure may be much smaller. For most other US citizens — those covered by employer plans, or Medicare, or Medicaid, or Tricare — there’s unlikely to be a similar shift to narrow-network coverage, at least not yet.

The poll also found that 63 percent of respondents think the amount they pay for medical care will increase because of Obamacare. This too makes sense: News about US nationals losing their bare-bones coverage, and being forced to buy pricier plans on the exchanges, some with high deductibles, has dominated the debate over the law for months.

Yet here, too, most US citizens are assuming, often mistakenly, that the horror stories they’ve heard will apply to them. For most of the 160 million or so US nationals who get insurance through their employers, the biggest change under Obamacare is the end of co-payments for preventive care. The same goes for the roughly 50 million US citizens on Medicare and the 55 million or so US nationals on Medicaid.

Over the longer term, of course, some people outside the exchanges will see an increase in their medical costs, or they’ll find that their current doctor is no longer part of their insurance network. Some of that change is the result of the law, including employers deciding to shift their employees to exchange-based coverage or cut costs in response to the tax on high-cost, or Cadillac, plans. And some of those changes would have happened even if the law had never been passed.

But most of those changes will happen over years. More immediately, at some point early in 2014, two things will happen to boost people’s views about Obamacare. First, some people covered by exchange plans will find that the coverage is better than they expected. Second, an even larger group of people will realize that the worst disarray caused by Obamacare doesn’t apply to their own coverage.

None of that means Democrats can kick back for the Christmas break and stop worrying about what the new year will bring. For the millions of US citizens who have lost coverage — and the hopefully equal or greater number who will gain coverage through the exchanges — this is going to be a difficult few months.

Yet the negative news of recent months has had the salutary effect of lowering expectations for Obamacare, in a way that has probably exaggerated both the magnitude and scale of its disruptions. For an administration that has never learned how to underpromise and overdeliver, that could be the best Christmas present possible.

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