The Affordable Care Act is one of the great comeback stories of public policy: after a terrible start, it has dramatically exceeded expectations. But hardly anyone seems to know that….
Over the weekend I had dinner in NYC with some very smart, sophisticated people; yes, all of them liberals. And almost everyone in the group was under the impression that Obamacare is still going badly — they wanted me to tell them whether it could still be turned around….
[H]ere we have smart, pro-reform people living in a state where reform is going really well. And they don’t know it!
Krugman attributes this knowledge gap to a media bias against Obamacare. But that part of it is simply a function of media norms. The website fiasco in October was a much more dramatic and unexpected – newsy – story than the fixes in November, or the signup surges in December and March.
The main explanation (sorry to beat this drum again) is more basic: The law is designed to do poorly in polling, at least once Republicans put up a united front against it.
After all, I suspect that few of Krugman’s “smart sophisticated … liberals” signed up on the exchanges; odds are that most or all of them had employer-linked insurance (or, if they were older, Medicare). Even if some of them were in the exchanges, his dinner partners probably hadn’t been uninsured, and probably hadn’t qualified for subsidies. In other words, they probably had no personal experience with the exchanges. And even if if they did, they aren't the kind of people who were big winners in that part of the law.
They might have noticed if they benefited from the closing of the Medicare doughnut hole or took advantage of free preventative-care doctor visits. Some might have post-college kids who were able to stay on their insurance. On the other hand, those who were in the private insurance market, employer-linked or not, probably have had their premiums go up over the last few years. Even if that increase wasn’t historically high, individuals have a hard time assessing that sort of thing and it's a lot easier for them to assume that any increase is related to the Affordable Care Act.
I’m guessing that those in Krugman's crowd who signed up for the exchanges at least knew that getting insurance through “New York State of Health,” means the ACA (I still would love to see a study of how many in the exchanges know that they have “Obamacare”). On the other hand, being in New York, or another state where the website was functional, might have made members of this group less likely to follow the news of the improvements at Healthcare.gov.
For most of us, Obamacare isn’t that visible, and the benefits often are the least visible part. The biggest winners are probably those on expanded Medicaid, and I’m confident many of them don’t know they were helped by Obamacare. Don’t expect it to get better; it’s going to be less and less likely that people will identify the benefits they are receiving with “Obamacare.” In five years, plenty of those in the exchanges won't realize that under the old system they would have had a pre-existing condition that would have barred them from being insured. Even if they realize that such a restriction once existed, they almost certainly won’t realize that their minor medical condition would have qualified.
Given all that, once Republican opposition guaranteed that the ACA would be controversial it was likely that it would poll badly, even if it worked well -- and even if it worked so well it couldn't be repealed.
This isn't the result of media bias, or the administration’s failure to win the spin; and it’s not even a sign that the law isn’t working as intended. It’s just the logical outcome of the way the law is set up.
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Jonathan Bernstein at firstname.lastname@example.org
To contact the editor on this story:
Max Berley at email@example.com