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POLITICS

Obamacare taking on water

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Politics,Beltway Confidential,Jeffrey H. Anderson

As they followed one another off the political cliff in voting for the health-care overhaul, Democratic senators and representatives comforted themselves with their own self-created myth that, although ObamaCare was horribly unpopular as a bill, it would prove to be quite fetching as a law.  Furthermore, this transformation, this change they could believe in, would take place sooner rather than later — as voters would reward rather than punish them for passing ObamaCare in clear and open defiance of popular will.

In the two months since, President Obama has pulled out all the stops, aggressively trying to sell the overhaul while also rolling out ostensibly popular provisions ahead of schedule.  These provisions include a federal mandate that insurers cover all “children” up to the age of 26 on their mom’s and dad’s policies, with costs being borne through somewhat higher premiums for all families; and a tax credit for small businesses, but only — or at least mostly — for very small businesses (those with nine or fewer workers) with very low-paid full-time employees (those averaging less than $25,000 in annual income).

Unfortunately (from the perspective of ObamaCare supporters), a steady stream of revelations of previously undiscovered horrors buried in the bowels of ObamaCare appears to have more than negated any gains that the administration might otherwise have made.

Since passage, reports have revealed that ObamaCare would cost over $1 trillion by any standard, according to the Congressional Budget Office (CBO), not “merely” $940 billion as previously reported (while its total costs in its real first decade, 2014 to 2023, would continue to be well over $2 trillion); that ObamaCare has prompted major corporations to discuss dropping their employer-provided health-care plans; that businesses would have to file 1099s not only for every person to whom they pay $600 in wages but for every vendor with whom they do $600 in business, thereby imposing a paperwork nightmare and incentivizing companies to avoid doing business with a myriad of small firms rather than a handful of big ones; that ObamaCare would create 159 new federal agencies, offices, or programs; that the Obama administration’s Medicare Chief Actuary says ObamaCare would raise U.S. health costs by $311 billion in relation to current law and would shift about 14 million people off of employer-provided insurance — and some of them onto Medicaid; that ObamaCare’s would discourage employment, as — for example — hiring a 25th worker would cost a business $5,600 in addition to wages and benefits; that ObamaCare would impose a severe marriage penalty, offering additional subsidies as high as $10,425 a year if couples merely avoid marriage; that a lone provision in ObamaCare, which would penalize employers if their employees spend more than 9.5 percent of their household income on insurance premiums, would cut the net income of businesses like White Castle by more than half; that even though ObamaCare was supposed to get people out of emergency rooms and into doctors’ offices, those who build emergency rooms say the effect will be just the opposite and that they are gearing up for increased business; that doctors shortages are looming and would be accentuated by ObamaCare, both because more people would seek care (otherwise, what would the $2 trillion be buying?) and because fewer people would likely enter a demanding profession that would now promise greater restrictions and lower pay; and that President Obama’s nominee to head Medicare and Medicaid under ObamaCare is an open advocate of the British National Health Services’ NICE (National Institute of Clinical Excellence) and its methods of rationing care.

These revelations appear to have taken a toll.  Together, they seem to have made a notoriously unpopular law significantly less popular.

In its May poll (conducted from May 11-16), Kaiser Health detected a noticeable decline in ObamaCare’s popularity.  Almost alone among the polls, the monthly Kaiser poll had never showed ObamaCare facing a public-opinion deficit at any time this year.  This is partly because Kaiser polls all Americans — not merely registered or likely voters — and ObamaCare polls better among the politically disengaged.

In April, Kaiser showed that the gap between ObamaCare’s supporters and its opponents was 3 percentage points — in ObamaCare’s favor.  Now, in May, it shows that gap to be 6 percentage points in the other direction — a 9-point swing in just one month.  (In a poll of likely voters, released in May but not in April, Kaiser shows ObamaCare to be facing a 10-point deficit.)  Movement from last month has been even greater among those with strong sentiments, as the gap between those who strongly support the overhaul and those who strongly oppose it has widened from 7 points (30 to 23 percent) to 18 points (32 to 14 percent).  Furthermore, only 44 percent now say they are “confused” by the law, compared to 55 percent last month.  To know ObamaCare is apparently not to love ObamaCare.

Condemningly, Politico writes that the Kaiser poll “suggests the accelerated implementation schedule has failed to sway a skeptical public — or even keep health reform’s most ardent supporters on board.”  Supporting Politico’s statement, the percentage of Americans who strongly support the law has dropped from 23 to 14 percent in just one month.

Rasmussen, whose poll includes only likely voters, has recently registered a similarly dramatic shift against ObamaCare.  In the first eight weeks following the overhaul’s passage, Rasmussen showed strong and consistent support for repeal.  The average gap between those who supported repeal and those who opposed it was 16 points, and it was never lower than 12 points or higher than 20.  This week, the gap has ballooned to 31 points.  Americans now favor repeal by a margin of almost 2-to-1, with 63 percent favoring repeal and just 32 percent opposing it.

A more detailed look at the numbers provides even more encouragement for those who are actively pushing for ObamaCare’s repeal.  Independents support repeal by a full 50 percentage points:  72 to 22 percent.  The number of voters who “strongly” favor repeal (46 percent) dwarfs the number who oppose it even “somewhat” (32 percent).  Fewer than half of the President’s own party is against repeal (49 percent).  And, per capita, it’s easier to find a Democrat who supports repeal (36 percent of them do) than any voter — regardless of party — who opposes it (only 32 percent do).  By a margin of at least 15 points, every income group except for those making less than $20,000 a year (who oppose repeal by 8 points) supports repeal, with those making between $20,000 and $40,000 supporting it by the widest margin:  49 points.

Perhaps the most ominous sign for President Obama and the Democratic Congress is evidence that younger voters are jumping ship.  In the first eight weeks after passage, an average of 58 percent of likely voters under age-30 supported repeal — 2 points higher than voters as a whole.  This week, 70 percent of them support repeal — compared to 27 percent opposed, for a margin of 43 points.  The only group that’s even more supportive of repeal, at 72 percent, is those in their 30s.  But, in truth, every age-group is overwhelmingly supportive of repeal; it’s just a question of degree.  The smallest margin in support of repeal, logged by those between the ages of 50 and 64, is 19 points.

President Obama talked a lot about the need to pass ObamaCare and put it in the history books.  Americans are now making it clear that they want to relegate ObamaCare to the history books.

And once it is gone, there will be no shortage of ideas that can replace it — ideas that will actually lower health costs, make health care more accessible for all, and not compromise quality.  A fine example was presented in these pages two weeks ago by Peter Hansen, who wrote that the truly effective way to lower health-care costs is to give people the opportunity and incentive to shop for value — for the highest-quality care, at the lowest-possible prices.

To do so, and to increase fairness, Hansen argued that we should allow all Americans to deduct their full health-care costs (not just their insurance premiums) from their taxes — and not just from their income taxes but also from their payroll taxes (a more important deduction for lower-income workers).  This would level the tax playing-field between those with employer-provided insurance — whose taxes wouldn’t change (except that they could now also deduct out-of-pocket expenses) — and those who purchase insurance on the open market and would no longer have to do so with after-tax dollars.

Hansen’s proposal could be paid for in part by taking a page out of my small-bill proposal (www.smallbill.org) and gradually rerouting and putting to better use some of the funds that provide federal assistance for emergency rooms.  It could also be paired with a couple of other small-bill proposals, like allowing the purchase of insurance across state lines and providing some federal funding for state-run high-risk pools to help give access to insurance for those with prohibitively expensive preexisting conditions.  In addition, his proposed $1,000 tax deduction for buying insurance could be changed to a $1,000 tax credit, which would more profoundly reduce the number of uninsured.  And I would cap the health-care deduction at some defined level of annual health-care spending, perhaps at $50,000 or so, to try to prevent taxpayers from having to subsidize cutting-edge, unusual, or perhaps even unnecessary procedures purchased out of pocket by the truly rich.

With or without the incorporation of these suggestions, Hansen’s proposal is refreshingly simple and keen-sighted, and it rightly focuses on the one thing that ObamaCare doesn’t really focus on much at all:  lowering health costs.  In truth, the Obama administration’s obsession with insurance (and with government control) has kept it from focusing on making health care more affordable — which is what Americans really want.

A huge part of the problem with our health-care system today is that far too much money is funneled through insurers, which keeps patients from controlling and allocating their own health-care dollars more efficiently and which also adds an unnecessary layer of costs.  Dr. Marcy Zwelling, a Southern California private physician, says that the same MRI for which insurers are billed $2,000 to $3,000 — and for which they might actually agree to pay something like $1,000 (depending on their negotiated rates) — costs only $300 to $400 for patients who pay cash.  Two weeks ago in these pages, Tony Mecia cited Dr. Brian Forrest, a North Carolina doctor who says that the prostate-cancer screening test for which a lab bills insurers $184 can be purchased by his patients for $30 in cash.  It makes no sense to be funneling so much money through an unnecessary middle-man.

Yet, according to the CBO, in ObamaCare’s real first dozen years (2014 to 2025), it would funnel $1 trillion from American taxpayers, through Washington, to private insurers — in exchange for insurers’ largely giving up their autonomy to the government.  Thus, ObamaCare would further entrench insurers’ position as an inefficient middle-man — that’s a key reason why insurers largely supported the overhaul — while simultaneously entrenching an even more problematic and inflexible middle-man in the form of the federal government.

Conversely, Hansen’s plan would empower patients, make prices more transparent, give patients more opportunity and incentive to shop around, and thereby lower health costs — all without reducing liberty or lowering the quality of care.

Hansen’s plan, or one like it, would be like a breath of fresh air.  But first we have to get rid of ObamaCare.

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