Repeal or rhetoric: A nation divided over health reform

by William Atkinson


Americans remain consistently split on health reform - and fickle on the specifics. Why recent polls may (or may not) indicate major change ahead.

There is no denying it: Americans are split over health care reform - the Patient Protection and Affordable Care Act. The latest poll confirms this.

A Harris Interactive/HealthDay poll of 2,019 adults taken last November found that 28 percent of adults want to repeal the legislation, 31 percent want to keep all or most of the reforms, and 29 percent aren't sure.

Two-thirds of the respondents said they like the fact that the reform package prevents insurers from denying coverage to people with pre-existing medical conditions. Another 60 percent want to keep the provision for tax credits, so small businesses can afford coverage for employees. Fifty-five percent like the idea that the law allows children to stay on their parents' insurance plans until they are 26.

And a little more than half support the idea of new insurance exchanges where people can shop for insurance. Only one part of the law remains widely unpopular. Fifty-seven percent of respondents oppose the requirement that people without health insurance buy it or face a penalty, while only 19 percent support it.

Those who want all or most of the law repealed say they think it's an unwarranted expansion of big government that will lead to higher taxes, rationing of health care, and possibly even socialism. Eighty-two percent of those wanting to repeal all or most believe it's "too expensive" and "will mean higher taxes." Seventy-seven percent believe it'll reduce the quality of individuals' health care. Seventy-four percent believe it'll lead to "rationing of health care."

Seventy-one percent see it as a form of "socialism." However, a large percentage of the people who want most of the law repealed are happy with many of its provisions. Of those who want the legislation repealed, forty-four percent say they would like to keep the provision that bars insurers from denying coverage to people with pre-existing medical conditions. Thirty-eight percent favor offering tax credits to small businesses to help pay for employee's insurance.

Sara Collins, vice president for affordable health insurance with The Commonwealth Fund, notes public polls on health care reform over the last several months, including this most recent poll, have been relatively consistent.

"They continue to show a split in the public's view of the law from an overall perspective," she states. "However, when you start asking people about particular provisions, the majority tend to like certain ones. These include allowing people under 26 to stay on their parents' policies, guaranteed coverage for pre-existing conditions, and bans on lifetime benefit limits."

Fred Hunt, president of the Society of Professional Benefit Administrators, sees similar sentiment. "When you're given candy, you like it, and you want to keep it," he states. "I know a number of people who were stern opponents of health care reform, and they're still stern opponents. But, oh, by the way, it sure is nice being able to have my daughter in college covered until she turns 26. And I have a friend with a pre-existing condition, so it's nice that reform can help him."

Part of the reason for the split, according to Dr. Devon Herrick, a senior fellow with the National Center for Policy Analysis, has been the difficulty of understanding all of the law's implications.

"During the presidential campaign and during the health care reform debate, the American people were told, ‘If you like what you have, you can keep it,'" he says. "Part of the issue now is that, as people begin to hear more and more about the 2,600 or 2,700 pages of the bill, they begin to hear about some things they like, as well as some things they don't like."

Before the election, Herrick says, polls showed that 84 percent to 86 percent of the population liked what they had already in terms of health care coverage.

"They knew that some things needed to be fixed, but how that should be accomplished was generally determined by one's political party affiliation."

It has always been Herrick's belief that, when people say they want health reform, it's more of a theoretical construct in many cases.

"They favor it for someone else, but they don't want to lose what they have," he explains. "And these days, some people are worried they might lose what they have." Another reason for public concern relates to cost.

"While we believe health care reform was the right thing to do, it imposes real costs on the system," admits Mark C. Blum, executive director of America's Agenda: Health Care for All.

"Many people didn't anticipate this, because there was a large expectation that reform would focus on cost containment much more coherently and aggressively than it did."

That is, according to Blum, about 85 percent of Americans already have coverage. Reform focused more on providing coverage for the 15 percent who don't.

"However, not enough attention was paid to the extra costs that will have to be borne by those with coverage. So, what really needs to be addressed now is cost containment and improved health care efficiency," Blum says.

What impact will public perception of the new law have on congressional and White House action in the months to come?

"We expect to see a lot of posturing over the next two years leading to the next presidential election," Blum replies. "However, realistically, we don't think repeal will occur, with a Democratic Senate and Obama as president. What happens after 2012, though, is another thing."

NCPA's Herrick believes shifting public perspective will have a "sobering effect" on the next Congress. "During the debate, the bill was hard to digest into ‘sound bites,' so the Democrats tended to attack health insurers, promote the more popular aspects of the bill, and play down the negative aspects and the costs," he explains.

"However, they thought that, once it passed, it would tend to grow on people. That hasn't happened yet, and it cost them heavily in the recent election. However, a lot of Democrats still believe that health care reform will grow on people."

There are a lot of challenges that will have to be dealt with, Herrick adds. One is the individual mandate. "Health insurance costs are rising at twice the rate of income, so sooner or later this is going to be a problem because people will be forced to purchase something that is rising twice as fast as their wages are rising," he explains.

Another challenge is that people will have the ability to "game" the system. "The penalty for not buying coverage is pretty weak, and we are not sure it will even be enforced," he notes. "Yet, insurance companies are being told that they must sell to anyone who applies at rates that are tightly banded together. So, if people can wait to buy coverage until they are sick, this doesn't help an insurance pool very much."

SPBA's Hunt doesn't believe that total repeal will occur. However, the recent election's focus on reducing the deficit adds a whole new twist. "Areas where health care reform is going to increase the deficit will be looked at carefully," he states.

Overall, though, Hunt believes some people are over-reacting to the implications of the new law.
"In my over-30 years in this business, I recall a lot of legislation that was viewed as the ‘end of the world' for employee benefits," he recalls. "For example, I remember when ERISA passed, and 95 percent of the employee benefits community was absolutely sure this would be the death knell for employee benefits.

They felt that no one would be crazy enough to maintain an existing employee benefits plan or start a new one, because the crazy ERISA law and all of its reporting requirements and liabilities did not make any sense. Of course, this is not what happened."

A new wrinkle
On Dec. 13, the reform health care reform law hit its first major roadblock, when U.S. District Judge Henry E. Hudson in Virginia ruled that a central requirement of the law, requiring almost all Americans to carry health insurance, is unconstitutional. The ruling is expected to eventually make its way to the U.S. Supreme Court, which could take two years.

In the meantime, though, Hudson denied a request by Virginia's attorney general, Ken Cuccinelli, to strike down the law in its entirety or block it from being implemented while the ruling is appealed by the Obama administration.

An Associated Press article on the ruling noted, "Whatever the eventual outcome, Monday's ruling could create uncertainty around the administration's efforts to gradually put into effect the landmark legislation extending health coverage to 32 million uninsured Americans. And it can only increase the public's skepticism, which has not significantly receded in the months since the law's enactment, defying Obama's prediction that it would become more popular as the public got to know it."

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