For many, finding reasons to repeal Obamacare is like shooting fish in a barrel. Yet while ditching the new law may look like an easy target, settling on a popular alternative is more elusive than people think.
That’s because “disapproval” comes in many shapes and sizes.
Some don’t like Obamacare due to false advertising – those who supported it over-promised and under-delivered. The president pledged that if you “like what you have, you can keep it.” Unfortunately, that was campaign happy-talk. Private insurers are already changing their plans as are Medicare Advantage providers.
Obama also boasted that average insurance premiums would decline by $2,500 annually. That, too, was a stretch. Premiums for many will actually increase.
Then there’s the nearly $1 trillion in new spending over the next decade. Many believe we can’t afford a chicken in every pot approach to health care given the federal debt crisis and exploding cost trends.
And don’t forget about the states. Speaking on CNBC recently, Iowa governor-elect Terry Branstand described the fiscal impact on the states (due to mandates to expand Medicaid eligibility) as simply “unsustainable.”
Surveys capture these concerns, but the top line numbers may lead some to wrongly conclude that repealing Obamacare will be easy. Rasmussen polls, for example, have consistently shown almost 60 percent of likely voters support repealing the health care law.
Yet that percent covers a multitude of sins. It includes both conservative critics – those concerned about the cost and scope of the new law – as well as others who believe the legislation didn’t go far enough.
A recent McClatchy-Marist survey reinforces this point. While only 16 percent of registered voters prefer leaving the law the way it is, another 35 percent would like to expand it. 'Expanding' the law is a somewhat vague term, but some who favor this proposal probably support a public insurance option or even a Canadian-style single payer plan.
Most – if not all – of these voters may not support Republican efforts to either repeal Obamacare or replace it with more modest measures.
This truth underscores a reality about health care policy in America. It remains one of the most divisive and polarizing issues in the public square.
Gallup polls highlight this reality. In a survey released last week, Americans were nearly evenly divided when asked about the government’s responsibility to ensure people have health coverage – 47 percent said the government should ensure all Americans have coverage, while 50 percent said it wasn’t the government’s responsibility.
Deep differences about how to approach this issue have endured for the last 60-plus years.
Support declines in polls when voters are asked about their preferences for a “government-run system” to deliver health care. But most surveys find a hard core of about 35 percent who prefer a public-sector only type system.
Further divisions exist among those who want to repeal Obamacare from a more conservative perspective. For example the McClatchy-Marist poll also found that 11 percent support repealing the law and replacing it with something more modest while 33 percent just want to get rid of it outright.
This means finding a “repeal and replace” idea that generates majority support may be more challenging than many conservative critics of the new health law believe. Just because over 50 percent say they want the law repealed doesn’t translate to majority support for an alternative. Some conservatives oppose any federal role in health care, period.
This doesn’t mean critics of Obamacare should just cease and desist. The new law is too flawed. It will seriously harm the health care system and bankrupt the government. It must be overhauled.
But Republican and conservative strategists can’t repeat Obama’s mistake. Instead, they need to prepare for a daunting battle and leave plenty of time for public education.
Focusing on affordability – for consumers and for the government – is the key to success. Expanding lower cost insurance options (like purchasing insurance across state lines), reforming tax laws to make it easier for individuals to own their own insurance, providing the states with flexibility to create lower cost plans, and reforming medical malpractice laws are just some of the ideas that could make health care more affordable without busting state and federal budgets.
While all these ideas sound reasonable, convincing a majority of Americans to support such an approach may take a little time. But that work needs to start now.