10
Reasons Most People Like Obamacare Once They Know What's Really In
It
By
Joshua Holland, AlterNet
Posted on July 4, 2012
There
are two Affordable Care Acts. There's the legislation passed by Congress in
2009, and then there's the mythical Affordable Care Act – the perfidious
“government takeover” decried and demagogued by so many conservatives (and quite
a few liberals). The former is quite popular, the latter gets decidedly mixed
reviews.
Don't take my
word for it. A recent poll by the Kaiser Family Foundation found Americans split
down the middle, with 41 percent approving of the law, and 40 percent saying
they didn't like it (PDF). But
then Kaiser asked about 12 specific provisions in the legislation, and found
that, on average, 63 percent of respondents approved of the nuts and bolts of
Obamacare. Of the 12 measures they tested, only one – the controversial mandate
to carry health insurance or pay a penalty – received the approval of less than
half of Americans (35 percent).
Or consider this
divide: while only 12 percent of Republicans had a positive view of the law
overall, 47 percent, on average, viewed its specifics favorably.
And here's the
kicker: Kaiser found that the most popular parts of the law were also the ones
most Americans weren't aware of, and vice-versa. Almost everyone knows about the
mandate, which most people don't like, but fewer than half of those polled knew
about the law's tax credits for small businesses that offer their employees
coverage, a provision that eight out of 10 people liked when they heard about
it.
None of this
should come as a surprise, given the level of mendacity of the law's opponents.
If the Affordable Care Act did in fact feature “death
panels,” resulted in deep cuts to Medicare, represented a "massive” tax increase and “Sovietized” our healthcare system, nobody would support it.
Fortunately, none of that bears any resemblance to reality.
Obviously, the
law should be judged on what it actually contains, but according to Kaiser, six
in 10 say they don't have enough information about the details to understand how
it will impact them personally. So here, in no particular order, are 10 things
you may not know about the Affordable Care Act.
1. People
Will Be Getting Checks
Call it a crazy
hunch, but my guess is that the law will look a lot less tyrannical when people
start getting checks in the mail to help pay for their insurance.
Folks making up
to four times the federal poverty line will be eligible for subsidies. In 2012,
that would mean a family of four making up to $92,200 (it's a bit higher in
Alaska) would see some cash.
Those subsidies
will come in the form of “advanceable” tax credits, meaning that people won't
have to wait until they pay their taxes to get the cash, and they'll be fully
refundable, so those who don't pay enough in federal income taxes will get a
check in the mail from the IRS.
2. The
Richest Americans Are Going to Pay More Taxes
Wealthy
investors are outraged, but most people probably don't know that a 3.8% surcharge on investment income – dividends and capital gains --
kicks in this January for everyone with an adjusted gross income of over
$200,000 ($250,000 for joint filers). So those currently enjoying the lowest
rate on investments in our nation's history will pay for a decent chunk of the
bill.
3. Insurers'
Overhead – and Profit Margins -- Are Limited
For the past 18
months or so, insurers have been required to spend 85 percent of the premiums
they collect on healthcare (80 percent for individual and small-group plans). If
they spend less than that, they have to send their customers a rebate to cover
the difference.
Forbes' Rick Ungar called it,
“the true ‘bomb’ contained in Obamacare and the one item that will have more
impact on the future of how medical care is paid for in this country than
anything we’ve seen in quite some time.”
4. Much Ado
About the Mandate
With the Supreme
Court's ruling last week, the mandate is gone, but the penalty for not carrying
insurance remains. If there's one thing Democrats, Republicans and independents
agree on, it's that they don't like it.
And they
shouldn't. But most people probably don't know just how modest the impact of the
mandate really is. According to the Congressional Budget Office, just 1 percent
of the population will pay the penalty, which maxes out at 1 percent of one's
income.
A lot of
conservatives are convinced that jack-booted gummint thugs will round them up
and stick them in FEMA camps if they don't pay up. But as Timothy Noah points out, “the health reform law explicitly states (on Page 336):
'In the case of any failure by a taxpayer to timely pay any penalty imposed by
this section, such taxpayer shall not be subject to any criminal prosecution or
penalty with respect to such failure.'" They can only dock future tax
refunds.
5. And Nobody
Ever Talks About the Employer Mandate
Starting in
2014, companies with 50 or more full-time workers (two part-timers count as one
full-timer for this purpose) will have to pay penalties if they don't cover
their employees' health insurance. (This provision is a bit complicated -- all
the details are here.)
6. Shaves the
Deficit
Mitt Romnney
says that “Obamacare adds trillions to our deficits and to our national debt,
and pushes those obligations onto coming generations.”
That message
appears to be sinking in. According to Kaiser, a majority of Americans – and a
third of Democrats – think the healthcare law will increase the deficit. But
according to the Congressional Budget Office, the law will reduce the projected deficit by $210
billion over the next
decade.
7. Chicks
Will Dig This
Many people are
aware of the regulation requiring insurers to cover people with pre-existing
conditions. It's one of the most popular parts of the whole. But fewer know
that, beginning in 2014, insurers won't be able to charge women higher premiums
than men.
Also coming in
2014: a ban on insurers placing annual limits on healthcare (lifetime coverage
limits were already banned in 2010).
The Kaiser poll
found that few people were aware of another popular new insurance regulation:
since 2010, insurance companies can no longer charge co-pays or hold you to a
deductible for preventive health services.
8. New
Dollars for Community Health Centers
Kaiser didn't
ask for people's opinions on this one, but it may be one of those
under-the-radar provisions that actually ends up helping a lot of
people.
Community health
centers (CHCs) now serve the primary care needs of about 20 million Americans,
and they have a proven track record. But the system is strained and
underfunded.
The expansion of
Medicaid will help alleviate some of the pressure, and the healthcare law also
allocates $11 billion over a five-year period to build new CHCs and upgrade
existing infrastructure. Most of the dollars will end up in poorer
communities.
A lot of
underserved people live in rural America, and the law also provides money to
train and place 16,000 primary caregivers in rural communities over a five-year
period.
9. Essential
Benefits
Starting in
2014, in order for insurers to sell coverage through state-based exchanges – a
place where a lot of the newly insured will likely end up – they will be
required to cover a package of “essential benefits,” including maternity care,
mental healthcare and substance abuse treatment, pediatric care, ambulance rides
and hospitalization.
They don't have
to if they don't want to participate in the exchanges, yet this measure is,
according to many, at the heart of the supposed “government takeover” of our
healthcare system.
10. It's Not
So Easy to Repeal
There is no
doubt that we'll hear lots of Republicans blustering about how they'll repeal
Obamacare on day one if they win the White House and the Senate, but it's a lot
less clear that they'd actually follow through.
As Igor Volsky
notes,
unless the Republicans were to win both the White House and a huge number of
senate seats, they “can do little more than weaken Obamacare’s regulations and
defund some of its provisions.” They also have nothing to replace it with, and
would own our screwed up healthcare system for a generation. And they'd lose an
issue that fires up the conservative base. They will, however, do their best to
gum up the works as the law is implemented.
The takeaway to
all of this is that the healthcare law is only going to get more popular as it's
provisions kick in. People will see some tangible benefits, and the
fearmongering will prove unfounded.
Like the idea of
government itself, people are suspicious of the Affordable Care Act as an
abstraction, but when it gets to the specifics they tend to like it a lot
better.
