MedCity Influencers

Obamacare: Many against it simply want more of it

Voters don’t dislike Obamacare in the Tea Party sort of way. Many who say they are opposed to the Obama-styled US healthcare reform bill are against it because they wish it went further, according to a new poll. They are not part of the repeal-and-replace crowd that incoming GOP Congressman claim to represent.

The new Republican House majority coming to Washington next week is ready to dismantle the healthcare reform law.

Majority opinion is on their side, they say. The most recent evidence they point to comes from last week’s CNN Opinion poll, which showed public opposition to reform, while slipping slightly since its November high water mark, exceeded proponents by a 50-43 margin.

But a closer reading of the poll by U.S. News and World Report opinion editor Robert Schlesinger puts those results in a new light. One of every four people who said they were opposed to reform said it didn’t go far enough. If you add those people to those supporting reform, a clear majority of Americans – 56 percent – are opposed to Republican efforts to dismantle or defund the bill.

People forget that some of the most virulent opposition to healthcare reform came not from Tea Party activists making headlines with town hall meeting protests, but from frustrated healthcare reform activists who backed either a single-payer insurance system (“Medicare for all”) or a public option that would compete with private insurance companies.  Conservative Democrats in the Senate refused to consider those options during the debate.

Yet between 2003 and 2009, no less than 17 different opinion polls, including ones taken by the New York Times, the Associated Press-Yahoo, Quinnipiac, the Washington Post/ABC News and Kaiser Family Foundation, showed either a majority or a plurality of Americans backing a single-payer system, according to Wikipedia. For many of the activists pushing single-payer, the public option was a compromise plan.

So it’s no wonder that when pollsters ask that segment of the public what they think about “reform,” they check the “opposed” box. But it hardly makes them supporters of “repeal and replace,” the slogan of in-coming Republicans.

Meanwhile, the front-loading strategy that the Democratic architects of the law employed will continue to undermine opposition to the law. Popular provisions like extending insurance to children living at home up to age 26 and non-discrimination for previous medical conditions have already gone into effect.

Starting January 1, insurance companies will be held to medical-loss ratio rules that limit overhead to 85 percent of premiums in the large-group market and 80 percent of premiums in the small group and individual market. The near-old population will have the option of buying low-cost, long-term care insurance from the government.

In Medicare, seniors will begin getting a 50 percent discount for brand name drug purchases while they’re in the so-called donut hole of non-coverage. Primary care physicians will get a 10 percent pay bump on their Medicare services, while all co-payments for prevention measures given a high rating by the U.S. Preventive Services Task Force – like colonoscopies – will be waived.

Of course, there is one element of reform that the latest polls continue to show most Americans are against. That’s the individual mandate, which requires people buy healthcare coverage.

But that’s heading for a Supreme Court challenge, and wouldn’t have become effective until 2015. The incoming House will be on strong ground with the public when they give that measure a thumbs-down vote. But when the leadership schedules the vote on the entire legislation, they might want to recheck the numbers in the latest polls.

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