Wednesday, June 24, 2015

Polling reflects the ACA's tough tradeoffs

A couple of thoughts* about Kaiser's recent analysis of its most recent survey of those who bought their insurance in the individual market in 2015, on exchange or off-exchange, ACA-compliant or not. To review some key points first (some from the original survey report, others from the analysis):

1) a slight majority of individual market buyers do not qualify for ACA subsidies;
2) among those who bought ACA-compliant plans off-exchange, 30% say the law has helped them and 40% say it's harmed them;
3) those who remain in grandfathered or grandmothered non-compliant plans are predictably super-negative -- their helped/harmed split is 8-41;
4) conversely, those who bought subsidized on-exchange plans say the law has helped rather than harmed them by a 57-25 margin; and
5) among all surveyed nongroup market participants taken together, ratings are modestly positive: the helped/harmed split is 40-33, and favorable views of the ACA outnumber unfavorable views 51-43.

On the whole, the strong positive views of subsidized marketplace customers outweigh the not-quite-so-strongly negative views of the slight majority of nongroup market customers who are unsubsidized. Of course, those nongroup market participants who view the ACA positively are a lot poorer than those who view it negatively -- most of them are what the National Health Interview Survey (NHIS) deem the "near-poor," with incomes between 100-200% FPL.  These reactions illustrate the tough tradeoffs that Democrats embraced in crafting and passing the ACA. In brief, they raised prices on the then-majority of long-term nongroup market participants to protect those with preexisting conditions (which eventually could be any of us) while subsidizing access to those who were previously priced out. Republicans would like to unwind those tradeoffs but not make any of their own to expand access beyond where it was in 2010.

This post began as an update to my recent post exploring why the ACA's overall approval ratings remain negative (though a couple of recent polls have the law in slightly positive territory). 

1 comment:

  1. Well done as usual, Andrew. They don't pay you enough for your insights.

    One slight but interesting correction to your point about the tradeoffs the Democrats made.

    Obama's speeches in 2009 described a world where even the existing non group market participants would benefit from the ACA. Over 10 times he told audiences that everyone's insurance premiums would go down.

    Was he completely cynical? Or just out of touch? Or was he reflecting an old talking point of the left that if we would cover the uninsured, hospitals and doctors could lower their prices and that this would drive down insurance premiums?

    comments welcome