Obamacare launch: What Americans like about the law, and what they don't

The American public is more worried than supportive regarding President Obama’s signature policy initiative, the health-care reform law that’s reaching an enrollment deadline on March 31.

A narrow majority of US adults say they oppose the law, which is designed to reduce the number of people who lack health insurance, according to a new Christian Science Monitor/TIPP poll conducted this week.

The big concern is that the law will drive up costs for taxpayers or for families with medical expenses.

Asked what worries them most about the law, 27 percent say it’s the cost to taxpayers and the impact on the federal budget, and another 18 percent said it’s the cost to themselves or their families. Others said their top concern is about the law’s effect on the quality of care (21 percent), on their privacy and the size of government (12 percent), or on their choice of doctors (7 percent).

What do they like most about the law? The top answers are “access to coverage regardless of pre-existing conditions” (41 percent) and “subsidies to help low-income people buy insurance” (26 percent).

The results, when viewed alongside other polls about “Obamacare,” show the broad political challenge that the president and Democrats face regarding the law. Even though particular elements of the Affordable Care Act are popular – as is its broad goal of expanding access to health care – the financial math is a sticking point.

To put it in a nutshell, having the word “affordable” in the law’s name doesn’t guarantee that shoppers on the new Obamacare exchanges can afford the insurance – even when the law’s subsidies are factored in. Nor does the law ensure any taming of overall US health-care costs, of which a rising share is borne by taxpayers.

The cost issue opens up questions about whether the law is really improving the US health-care system. That's a practical concern for Main Street America, but it also has big political implications. Republicans hope to capitalize on public concerns about Obamacare in this fall's congressional elections.
 
Longer term, some analysts see a potential "death spiral" for the law itself. That is, if high prices keep many healthy people from enrolling in Obamacare, the pool of people who do enroll could be disproportionately those who use lots of medical care, which would prompt insurers to raise premiums still higher.

The Monitor/TIPP poll also asked, “How does Obamacare impact your health insurance premiums?” The responses, which included both people buying on Obamacare exchanges and the much larger group of Americans who have employer-based health plans, found almost four times as many people seeing price hikes as price cuts.

Some 33 percent said their premiums have already increased. Another 13 percent said premiums are “going to increase.”

Only 8 percent said their premiums have already decreased, while 4 percent said premiums are “going to decrease.” The rest of those surveyed saw no change or weren’t sure.

Those who see premiums falling would include households who buy insurance with the law’s newly available subsidies based on their income level. Other people who are near poverty are getting new insurance through Medicaid, as a result of the law’s expansion of that program.

But, as the Monitor recently reported, insurance can still be costly for people on Obamacare’s states exchanges, because the subsidies gradually phase out as as one’s income rises further from the poverty line.

In all, 51 percent of poll respondents say they’re generally opposed to the law, while 40 percent generally support it. Those percentages haven’t changed much in recent months in the Monitor/TIPP polling, as the law’s March 31 deadline for uninsured people to obtain coverage (or perhaps owe a tax penalty) has drawn closer. (The White House on Wednesday extended the official enrollment deadline, giving Americans until mid-April to request an extension to complete their enrollment applications.)

Other polls have also found disapproval of the law outweighing support, but with some nuances.

One new Associated Press/GfK poll finds public support of the Affordable Care Act “languishing at its lowest level since passage” four years ago. Yet the Kaiser Health Tracking Poll finds support up in the past month, with 38 percent having a favorable view of the law (to 46 percent unfavorable).

A new Fox News poll pegs support at 40 percent and opposition at 56 percent, levels that haven’t changed dramatically in its polling over the past four years.

The Kaiser poll finds strong support for particular features of the law, including the subsidies (77 percent), expansion of Medicaid for poor households (74 percent), and enabling people to get insurance regardless of preexisting conditions (70 percent).

The law’s mandate for individuals to buy insurance or face possible tax penalties is unpopular, supported by 35 percent in the Kaiser poll.