Why are so many Americans against Obamacare?
What is it about Obamacare that so many Americans are against such that it became an election pledge to repeal it?
I could understand a candidate promising tax cuts and then after being elected scrapping Obamacare to pay for them. But this was not the case. It was a specific election promise to leave 10 million fellow Americans with no health coverage.
As someone who comes from a country where universal health care is taken as granted (perhaps even taken too much for granted) I find it very difficult to understand why so many people would vote this way.
And, it is not as if they voted for other policies and had to go along with this to get them because it was such an essential part of Trump's campaign.
It's maybe worth to note that this health program became significantly more popular since the question has been asked. https://www.kff.org/health-reform/poll-finding/6-charts-about-public-opinion-on-the-affordable-care-act/
These are a few reasons why each group is against Obamacare.
— It requires nearly all Americans to get health insurance.
Some do not think that the government should force citizens to buy health insurance and penalise them if they do not do so. There are taxes that Americans have to pay should they not buy health insurance. This is also one of the main reason Americans are against Obamacare.
Some are just against the fact that the government is ordering everyone to purchase coverage.
— The premiums are hefty for those who can afford it.
Americans who can afford to buy insurance directly from a provider are charged higher premiums so that they could assist in paying for the subsidies provided to those who buy their coverage from government-run marketplaces.
Thus, some view Obamacare on a whole as a welfare scheme and the Medicaid expansion and subsidies for low- and moderate-income enrollees as an entitlement program that uses taxpayers' money to help people they consider undeserving.
Furthermore, the premiums are set to rise by an average of 22% in 2017.
— People are angry with cancellations of their existing plans.
Obamacare changed the rules of the types of public insurance that people can directly buy, thus some insurers cancelled their old plans and charged higher premiums for the new plans to existing customers. Thus, these group of people doesn't really benefit from Obamacare and thus they are upset about it.
— Insurers have lost money.
Some insurers lost money as the customers are sicker than they expected. Thus, the cost would have to be covered by better-off Americans. This will deter healthy, young Americans from signing up, resulting in an increase in prices of premiums.
— Republicans uniformly oppose it.
Some oppose it simply because it's a Democratic healthcare plan and it was passed when both the House and the Senate were under Democratic control.
Only one Senate Republican, Olympia J. Snowe (R-ME) voted the bill out of the Finance Committee while another Republican in the House, Rep. Joseph Cao (R-LA 2nd District), voted for the initial version in 2009. No Republicans voted for the amendment in 2010.
The majority of the Republicans have been consistent in their opposition towards Obamacare.
Below is a graphic from Vox that shows the percentage of Americans who agrees with each statement listed:
Articles worth checking out:
I could understand a candidate promising tax cuts and then after being elected scrapping Obamacare to pay for them.
Obamacare repeal includes tax cuts:
- .9% Medicare tax surcharge on high income Americans
- 2.9% Medicare tax on capital gains, dividends, etc.
- Medical devices tax
- Individual mandate
- Business mandate
And it expands certain tax credits for Health Savings Accounts and individual purchases of insurance.
No universal coverage
Obamacare does not actually offer universal coverage. It made certain kinds of coverage more expensive while using subsidies to pay for Medicaid expansion and subsidies for individual health plans. Also, because its subsidies were only available to individual purchasers, some employers (e.g. Wal-Mart) canceled their employer-based plans so that their employees could access the subsidies of the individual health plans.
Obamacare relies on insurance companies registering for the exchanges, but it doesn't actually fund them adequately. The result is that in some counties only one insurer participates, and there have been more and more threats for the last insurer to drop out. It was in response to these reports that Donald Trump was promising to repeal Obamacare shortly before the election.
Increased deficit impact
Obamacare took several steps to make its deficit impact look lower than it was.
- It assumed that it would be successful in restraining costs and convinced the Congressional Budget Office (CBO) to go along.
- A catastrophic insurance plan that was supposed to collect premiums in the first decade and not start paying until the second decade. That proved unreasonably optimistic, and it was already canceled as too expensive in the short term.
- Inclusion of student loan reforms that were intended to bring down net costs by allowing the government to collect the entire interest payment instead of just guarantee fees.
- An unpopular tax on individuals doing contract work (since canceled).
- An unpopular tax that was to take effect in 2018 on "Cadillac" health plans. Retained but delayed in repeal for the same reason (it makes the second decade costs look better).
- Cuts in Medicare spending were double counted. They counted them once as increasing the size of the Medicare trust fund and a second time to pay for Obamacare.
Increased deductibles and copays
One of the ways that Obamacare makes the numbers work is that it made insurance cover less. It effectively increased the minimum amount below which people pay all their health care costs (the deductible) and increased the shared fees for services (copays). Thus for many people, insurance is more expensive under Obamacare than it was prior to that.
May be exacerbated by general trends. I.e. people may be blaming Obamacare for something that would be happening anyway.
Obamacare requires coverage for certain things. Those certain things are expensive. Some people preferred to buy cheaper coverage without those certain things. Those people either lost coverage or are paying more. Either way, not happy.
Mortality rates among adults 18-64 have increased every year of Obamacare except 2012 and are now higher than at any time during the 2002-2010 period. Life expectancy has actually started decreasing. This is relevant because that age group is the most affected by Obamacare. Older than 65 are Medicare. Younger than 18 are only indirectly impacted (their parents may buy insurance for them through Obamacare).
Of course, this might be caused by something other than Obamacare. Correlation is not causation.
Obamacare charges some people more money without providing those people with more benefits that they wanted. It subsidizes other people. Unsurprisingly, the people who pay more either in taxes or in increased deductibles/copays don't like Obamacare.
It doesn't help that most of the people who benefit are Democrats while most of the people who pay are Republicans. People with incomes less than $50,000 were potentially helped by Obamacare and voted for Hillary Clinton. People with incomes greater than $50,000 vote for Trump and do not get Obamacare benefits but do pay Obamacare taxes. Example source.
You'll often see claims that poorer regions are are more Republican. This is true, but within the region higher income leads to more Republican support. This is also true of richer regions.
Note that one might argue that universal coverage in other places also transfers from some groups to pay for others. But it's not as explicit. With Obamacare, the people who pay the most now already had coverage. They didn't gain anything from Obamacare. In fact, they may have less coverage now. The people who get subsidized now mostly did not have coverage previously.
The US has the most expensive health care system in the world. This was true prior to Obamacare and hasn't changed. In fact, the US and state governments spend as much on healthcare as a percentage of GDP as the United Kingdom does. And of course the UK has universal coverage.
The US can't copy the UK though (example source). The UK employs all the healthcare providers directly and subsidizes schooling. The US has a system of private healthcare providers who aren't ready to take pay cuts to match UK wages. The UK also determines things like equipment spending at the national level. By contrast, each clinic or hospital chooses to buy or not buy in the US. And there are incentives to buy.
Equipment is a loss leader--many people prefer to go to the same hospital for all services. So going to a hospital for an MRI may mean that you continue to go to the same hospital for other things. Worse, even if the US adopted the UK system tomorrow, many of those expenditures have already been made. They can't really send back the MRI machine.
UK providers also have longer wait times for non-emergency services. In the US, a long wait time often results in choosing a different doctor. So doctors see fewer patients in the US. Similarly, US doctors are more likely to have schedules where they are available early in the morning (before work) or late afternoon/early evening (after work) or on weekends (no work). They may be sitting around the office doing nothing in the middle of the day, as there are no patients. But they had appointments earlier and will have more appointments later, so they can't really close up and go home enjoyably.
None of that applies to emergency care. In both countries, emergency care is well staffed and immediate. But there's a lot of non-emergency care where wait times have little impact on health but a lot of impact on costs.
`It doesn't help that most of the people who benefit are Democrats while most of the people who pay are Republicans.` - how is that?
Can you expand on how Democrats benefit more? I've always understood it as poorer people in rural areas benefiting the most, and also being mostly Republican voters. Which is ironic of course.
There's also a lot of odd factoids in here that I don't know (or have heard) are actually widespread 'reasons'. For instance, the mortality rate isn't something either party has made a big deal about, or is it even really all that relevant over the relatively short span of time (the main benefit of more access to health care is *long term* improvements...not instant cures to lifelong ailments). That said, maybe too many factoids is better than not enough. Overall, good answer.
@user1993 It's a factual error likely due to faulty reasoning. The source referenced gives stats for voters and conflates that to population. I bumped up these numbers to 2014 income statistics (best I could do) and the current population according to the Google, and I get 21/17% for C/T of people in under 50K households. For over 50K, it was 20/22%. So to say that "most of the people who pay are Republicans" etc. is not in that data.
In addition, just because someone voted for Trump doesn't make them Republican and voting for Clinton doesn't make you a Democrat. The answer also ignores the reality that people are more likely to support the ACA provisions if you don't refer to it as Obamacare.
Lastly, the West Coast and a number of states in the Northeast are home to a disproportionate number of high-income liberals. These states are also generally uncontested wins for the Democrat which tends to result in lower voter turnout. The upshot is the national voter statistics are a poor source for supporting the claim of who pays and who benefits by political alignment.
Walmart only cancelled health insurance for part-time workers, about 5% of their workforce. Obamacare requires companies with 50+ employees to offer health insurance to 95% of their full-time workers, that's the business mandate.
"The UK employs all the healthcare providers directly ...." This is not correct. The NHS (National Health Service) is a trust funded by the government and its employees could thus be regarded as government employees. However, there are many doctors and healthcare providers who have or work for private practices. And some who both work for the NHS and run a private practice. Google "Harley Street", for starters.
For the UK comparison, don't forget that "universal healthcare" doesn't necessarily mean "you can go to the doctor and get appropriate care". Some people can't afford to take time off work unless the illness is really serious (which of course means sick people often still go to work, spread the disease and potentially progress to more serious conditions). The poor wages and working conditions mean that there simply isn't enough healthcare workers to go around, and lots of their time may be occupied by people who have too much time on their hands.
@blip I've seen pundit bloggers claim the opposite about mortality rate, except they never link to stats and instead get there through a series of logical steps (which are obviously missing something due to the stats not matching their reasoning). It typically ends with something like "do they [anti-Obamacare people] want poor people to die?" and the comments eat it up.
By "Obamacare took several steps to make its deficit impact look lower than it was." Do you mean "The law made other changes to help fund it?" @Luaan Have you ever actually visited a GP in the UK? Getting time off work is often not a problem and there are a number of laws enshrining employees rights to take time off for health care, disabilities and extended recovery periods.
@Basic Congratulations if you're so lucky. It's not inherent in the system. I'm not talking about UK in particular; just the experience with *our* universal healthcare. For example, I get no compensation whatsoever for the first three days of illness (including the doctor's visit), and for the next week or two (can't remember - never used it), I get about 30% of my pay (which is then taxed as usual). Not to mention the fun part where you have to wait for hours in a room full of sick people because someone decided there's a perfect number of doctors per person and no more doctors are allowed.
@Basic In contrast, private insurance that I considered costs about one third of what I'm paying in mandatory insurance (and no, they don't get any of that money - my "public" doctor gets that money, even if I don't use him; and no, I can't opt out of the "universal care" even if I get private health insurance), and includes the doctor visiting *you* at home, and bringing you any medications you require, among many other benefits.
@Luaan a lot of what you keep bringing up doesn't have anything to do with the particular funding model, though. People wait in doctors offices--everywhere on the planet. That's just part of going to the doctor. Obamacare never claimed to directly fix that particular frustration of going to the doctor. And note your private options are *on top of* your public options...they're not dealing with the entirety of the system. Your complaints are valid, but aren't really germane to Obamacare in particular.
@Luaan We pay into the healthcare pot whether we use it or go private. (Called "National Insurance Contribution" over here). So that's the same. And yeah, private might mean you get surgery in 2 weeks instead of 4 months for non-critical things, but the standard of care is equivalent. One thing where we're definitely better off is time off work. We get all sick time paid, you need to get a note from a doctor for absences over 2 days (for many places). Shorter periods can be "self-certified". If you're ill/on maternity, that can't be used as a factor when assessing your employment.
@blip Which is exactly what I said originally - "universal healthcare doesn't necessarily mean you can go to the doctor and get appropriate care". Private systems have issues. Public systems have issues. There is a large overlap between both. The problem I have is that I can't opt out of the public system, regardless of whether it's beneficial to me or not. Would you be happy if it was mandatory to own e.g. the latest iPhone? Even if (say) 80% already have it, so "democratically" it would be perfectly fine? I wouldn't, even if I *did* own an iPhone.
@Luaan universal health care *does* mean you can go get care, though. Not something that was easy to do for everyone in the US a decade ago. As for the iPhone comparison, that's not a good comparison. A better comparison is roads. Why can't you opt out of paying taxes for roads if you don't ever drive or ride a bus? Well, that's just how large societies work. We all pay into a large pot and we all get something out of it. We all don't get the same out of it.
The part about "None of that applies to emergency care." needs to be changed. "None of that applies to emergency care. Ronald Reagan, the political figurehead for free markets, in a very uncharacteristic moment, actually made it a requirement that Emergency Rooms be required to provide emergency medical care regardless of ability to pay (although, he placed that burden on hospitals without suggesting any way to pay for it). But this policy hasn't gone well. Emergency Rooms have become the care of last resort. Indigents, homeless, undocumented immigrants, and poor people us ERs for...
primary care. This has led to the overburdening of those facilities with recurring patients (unable to pay), increased the already long wait times, and decreased the number of ERs." ERs in the US are an unmitigated disaster. I'm not sure why anyone would think otherwise. Now, I've never visited an ER in the UK, but I've experienced ERs in France, Hungary (before the wall came down), and Mexico, and I can tell you without a doubt that most ERs in the US are pretty bad (although, they're not equally bad, since some rich communities will keep their ERs open by making up the difference with taxes)
There's a couple of other factors in play here as well
Obama intentionally lied about the effects of the bill
A politician lying is nothing new, but your typical political lie is of the statistical variety. In other words, you oversell the benefits and undersell the impact and make it look like you're just arguing about numbers (Obamacare also sold a $2500 average annual savings which has not materialized). But Obamacare is mostly remembered (especially by Republicans) because Obama made a demonstrably false statement
Understand, this lie was repeated over and over, many of them in nationally televised speeches before Congress. More importantly, it was something President Obama knew it was false at the time (where he admits that at least 8-9 million would lose coverage). While he states afterward that he thought the exchanges would fill in the lost coverage, that was clearly not how it was sold.
The exchanges are in serious trouble
The exchanges were supposed to be the backbone of Obamacare, providing lower-cost insurance (provided you qualify for a subsidy) than insurance companies. Many have gone out of business
A July 2015 report from the Department of Health and Human Service's Inspector General warned that every single co-op except one was hemorrhaging money. More than half had net losses of at least $15 million in their first year. The IG also found that, despite those promises of price competition, many co-ops had set premiums higher than policies sold by commercial insurers.
A month later, Nevada's co-op announced that it was going out of business. Seven more followed suit in October.
At the start of this year, half the co-ops had failed, taking with them more than $1 billion in taxpayer loans.
The bleeding has continued. Four more are going under this year and will close by year's end. As happened last year, there could be a rash of closures this fall, before open enrollment starts. The co-ops that are still alive may decide that they can't afford to stay in business another year.
All told, some 800,000 people have been forced to give up health plans they liked and look for another insurance carrier following the demise of their co-op. In some cases, they don't have many other choices. On Connecticut's insurance exchange, for example, there are just two insurers left following the failure of HealthyCT. Both are asking for double-digit premium increases next year.
While nobody looks likely to be going without insurance, this doesn't help convince people that the law is working
One reason might be that many Americans apparently did not know that the vilified Obamacare is what is paying for their health insurance.
That's what happens if you don't actually differentiate in the cost how much the government paid for.
This answer is meant to supplement others here with some further reasons why conservatives are against the Obamacare system.
Obama falsely promised the public some critical things about the system that came to be called Obamacare:
...No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.
This promise was eventually rated by Politifact as "Lie of the Year". A lie of such magnitude that it is sometimes classed beside George H. W. Bush's "Read My Lips" tax promise. In reality, many individual coverage plans were dropped by insurance companies, leaving patients to have to enter the new state or federal exchanges to find new plans - which often meant changing networks of doctors.
law didDepartment of Health and Human Services issued a regulation to "grandfather" existing plans, it did not force insurance companies to continue all their coverage plans. Many insurance companies saw fit to terminate many of their existing plans in favor of the new ones. Ultimately, Obama did promise, "no matter what", and that turned out to be false.
Even for those who have now adjusted, it is hard to like a system that burned you on its way into your life.
Because only businesses with less than 50 full time employees (with "full time" redefined by the law as 30 or more working hours per week) are exempt under Obamacare from employer-provided coverage mandates, many small businesses restructured themselves and reclassified employees as part-time working less than 30 hours a week. This caused large numbers of non-college-educated working people, a largely Republican demographic, to change from working one job to working two or more, often with strange and stressful schedules, in order to preserve approximately the same income level. This is a huge and unpleasant societal change that was directly caused by the introduction of Obamacare.
Not only are premiums still climbing far above the rate of inflation on average from year to year after its passage, but under Obamacare deductibles are also climbing quickly from year to year. However, real wages are fairly flat. Many policy-holders report that their plan deductibles are so high, they cannot afford to go to the doctor any more because they would pay much of the cost out of pocket. The only reason for those people to continue to carry the policies is as a hedge against the astronomical cost of extended hospital stays and surgery. To the extent this is true, it works against the argument that getting people "covered" will encourage preventative care.
The "individual mandate" to purchase a health insurance policy is not the only affirmative mandate brought on by Obamacare. There is also the "employer mandate" that requires businesses by law to provide group health insurance plans for their employees. Only businesses with fewer than 50 full time employees are exempt. Most large employers did this already before, but now there is no choice except for the company to pay a heavy penalty.
There are also various mandates on the insurance companies, for categories of coverage that are considered "essential" in plans and make them more expensive. Obamacare opponents argue that some of these make no sense as universal mandates; for example, people who are unable to conceive plainly do not need maternity coverage. Many conservatives dislike these mandates on the basis of free-market principles.
Some "essential services" mandates have brought legal challenges. The mandate that employers provide insurance plans that include contraceptives, including the "morning after pill", was successfully challenged before the US Supreme Court. Conservatives now remember the "Hobby Lobby case" as one example of how "big government" can endanger liberty in unforeseen ways.
A constitutional challenge to Obamacare's "individual mandate" before the US Supreme Court, on the basis that the federal government has no power to compel citizens to engage in commerce, was defeated. The majority Court opinion appeared to concede the challenger's argument, but held that the individual mandate was as a matter of law a tax on a class of people (those who do not buy insurance), not an actual requirement or penalty.
This is despite many media statements by Obama and his allies that the mandate was not a tax. The ruling that the mandate is actually a tax is also curious because the Constitution requires tax laws to originate in the House of Representatives, but the Affordable Care Act originated in the Senate (depending on your point of view).
Many conservatives continue to resent not only the mandate itself but the "wrong" Supreme Court opinion that approved it, and by extension the Obamacare system itself, which even its defenders say cannot remain solvent without the individual mandate.
Much of the total Obamacare "system" is not set in black-letter law but in rulings by unelected federal agencies. Some of these agency rules are highly complex. Assuming the law remains unchanged indefinitely, future administrations or agency heads might change these rules, which can carry the force of law (in the sense of general obligation to follow them), without act of Congress. Obamacare critics say this possibility fosters a sense of anxiety, particularly among small business owners.
While this kind of rule-setting by federal agencies is not new with Obamacare, it has not helped public perception of the law. In some cases, agencies have made rulings that even contradict the written law, creating interesting legal questions and damaging to some degree the public trust. Critics accused the Obama administration of usurping Congress by rewriting the law.
"many individual coverage plans were dropped by insurance companies," because they did not include things the law mandated. A report by OMB (or some similar agency) warned in advance of "the lie" that this would happen. As for keeping your doctor, the government cannot force a doctor to contract with any particular insurance plan. You can keep your doctor if you are willing to pay when he is no longer "in network"
Re "If you like your doctor...", seems to me the assumption that I, or most healthy people, actually HAVE a doctor is one of the major conceptual problems here.
@WGroleau So I guess he should have said "You can keep your doctor [... as long as you're willing to pay exorbitant costs once this bill forces you into a plan that doesn't cover him]." Really rolls off the tongue.
Did the *law* grandfather plans? I seem to remember that when plans started getting cancelled in to anticipation of published regulations going into effect, that the *regulations were then changed* to not apply to plans that existed before the law was passed... but this didn't allow companies to "uncancel" plans, because the plan no longer met the grandfather requirement of having been continuously offered.
It's been a long time since I read that report, but I think there were some requirements that couldn't be waived by a grandfather clause.
@BenVoigt I believe you're right. I had forgotten that. Edited. That could be a point #6 I guess. So much of Obamacare is not black-letter law but a regimen of regulations. Some of which, I think, actually contradicted the law itself, as in postponing hard deadlines and "decline to prosecute" type declarations.
First, read @Panda's excellent answer.
Second, note that about 70% of Democrats, and 15% of Republicans favor the Affordable Care Act, and this has been consistent over the past couple of years. This partisan discrepancy is at the core of the problem.
Anything with any level of complexity has both costs and benefits. This is certainly true of the Affordable Care Act. The Democrats (along with liberal-leaning media outlets) will rightfully boast of the benefits while the Republicans (along with conservative-leaning media outlets) will rightfully complain about the costs. In a healthy democracy, this is a fantastic place to start a debate and discussion about whether the benefits of increased insurance coverage for a broader swath of the population are worth the increased cost to insure them. Honest and informed people can disagree on that while understanding and respecting the opposition. But in a fragmented partisan country where most people trust one side and distrust the other, ignorance of the whole story grows along with confidence in one's position. And when people typically get on TV based on their confidence in their opinion, rather than their justification for or understanding of it, it's a recipe for civil war.
The direct answer to the question is that a combination of all factors in Panda's post apply, but only in combination with our biases that cause each of us to see only the information that agrees with our pre-existing beliefs. The low level of informed, legitimate disagreement with portions of Obamacare can only have grown into a passionate, ignorant anger-storm with the support of dysfunctional partisanship.
Another reason, at least for some of us who think about these things instead of reacting with knee-jerk partisanship, is that it does nothing to address the underlying problems. Indeed, it seems to me (though I have no hard data) that it actually worsens those problems. Which are
1) Medical care, especially basic medical care, is too expensive. There are a lot of built-in incentives for both providers and patients to opt for more expensive treatments instead of cheaper but equally effective ones, because after all "my insurance will cover it".
2) It ignores the role of lifestyle choices in wellness, and so it taxes healthy people to pay for the often self-inflicted problems of others.
One thing that other answers have missed is that it doesn't actually fix anything. It was supposed to make health care more affordable, but it did nothing of the sort. Health care in the US is broken because of bad laws, a bad business environment, and a bad risk situation on many levels, throughout the industry.
Put simply, the risk, and therefore cost, of providing care in the US is too high and therefore makes the overall system cost too much. All Obamacare did was some hand waving to spread the costs around without fixing any underlying problems. It effectively took something that most people could afford while a tiny percentage could not and made it something nobody can afford instead. While it's important that we not just abandon that small percentage that couldn't afford it, it didn't really make it affordable for them and also made it unaffordable for the vast majority as well. The "cheap" plans just mean that you're going slightly less bankrupt if anything happens to you and now even middle class people who previously had OK plans will also likely go bankrupt with any major medical expenses as all, but the most premium plans have been forced to go the high deductible route with many deductibles so high that they still virtually guarantee financial insolvency.
The problem is that nothing about Obamacare addresses the risks and thus the costs remain just as unsustainably high (or even more so with the additional bureaucracy now thrown in the mix), but now instead of the industry ignoring the part of the population that it most couldn't support, it is being dragged down rapidly without any meaningful fixes to the underlying problems. It was a bit like going to the ER for a gunshot wound and being given an advil. It might make it feel like it hurts a bit less, but you're still bleeding out rapidly.
It probably *sounded like* it was meant to make health care more affordable, but there's probably no way to do that short of single payer, and who knows if that would even work. What I thought it was meant to do was *slow down the increase in cost*, which is may or may not have done, it's hard to say. Costs did go up. Would they have gone up more if the ACA hadn't been passed? Maybe, maybe not. The idea that costs "shot up" during the life of the ACA isn't true, though. Or at least, they didn't increase by any percent greater than some increases before the ACA was passed.
Health care premiums have risen significantly slower under ACA than they did in the previous decade. http://www.factcheck.org/2015/02/slower-premium-growth-under-obama/ The core purpose of ACA was to get more people insured, and it has largely succeeded at that goal. http://www.gallup.com/poll/201641/uninsured-rate-holds-low-fourth-quarter.aspx
@ToddWilcox It is true. My company had to drop their insurance plan a couple years after the law passed because it was going to jump up in price by a full 25% (both their contribution and the employee's). They found it cheaper to switch to a high deductible plan and then put cash in an HSA account for each employee instead, but the amount put into the HSA is less than a third of the deductible for an individual (as opposed to family) plan. Meaning that a single ER visit would now cost me thousands of dollars instead of hundreds. And my company certainly wasn't singled out.
I can only give you my reasons and examples that back them up.
Loss of the rite to choose level of care
First we have to look at the fact that with the transition to the ACA we lost the right to choose the level of care that we want. For many many years I had "Emergency care". It was cheap ($75 a month) and covered only emergency situations and resulting events. For example, if I needed coverage because I fell out of a tree and broke my arm, this would be covered. But a flu or normal care would not.
This was perfect for me as I rarely get sick, and while I never used the insurance, I felt better having it in case something did happen.
In this instance (emergency coverage) I was sold what I wanted, at the levels I wanted. I was always able to cover any of my own medical bills. However the ACA laws made this type of coverage unavailable.
Cost of Insurance is just plain too high
So I make enough that I do not qualify for any subsidies. My monthly insurance premium for my wife and I was $680 a month. This is an absurd amount. This coverage was also not great. Deductibles were higher then I would have liked, and co-pays were in the $80 range. This was just silly. There was no fair trade here.
As a self pay patient the local walk in clinic charges $75. But our co-pay is $80. We got no benefit from the insurance.
Cost to use the insurance was too high
My wife has RA. This is a long term condition that needs "constant" care. Once every 2 months she needs to have blood work and see a specialist. Once every year or so, she needs an iron infusion.
On insurance we paid (680 / 2) * 12 + 6 * 80 = 4,560 for her medical experiences, plus prescriptions (70 + 12 + 3 + 80) * 12 = 1980 for a total of $6,540 a year. Then her iron infusion was charged at 23,500 making it $30,040 (remember this but lets call it odd)
Without insurance as a self pay patent, we paid 120 * 6 = 720(visits) and (70 + 12 +3+82) * 12 = 2004 (prescriptions) + 125 * 6 = 750 (blood work) + $175 iron infusion. For a total of $3,649
Even without the odd ball iron infusion it was just cheaper to self pay.
We lost the ability to negotiate price
When your self pay, you have to pay up front, or at least make arrangements to pay up front. But with insurance we lost the ability to negotiate price. We have gone to the same facility for years for an iron infusion, and they always charged $175. The one time we had insurance they charged $23,500. The insurance paid $175, and we got stuck with the rest of the bill. But come to find out that because the insurance negotiated "on our behalf" we had a much harder time making any headway. The normal argument we got was "I don't know but your insurance agreed, this is what you owe".
Quality of care is rock bottom
I'm sure others will have other stories but the second we went to insurance we lost a ton of care options. We had to follow a prescribed path. It didn't matter that my Wife's RA was life long, and she had reached a balance. She had to switch drugs many time, adjust doses, and otherwise be put through the ringer to comply with the insurance policy.
Her long time doctor now had his hands tied, and could not do some of the more effective things to help her out.
Once we were self pay again, he had her setup almost instantly (some of the drugs had to be changed slowly) and now she is very happy and not at all in constant pain that she can't manage. The doctor can treat her and not just follow the insurance path.
Ohhh the lies
A personal gripe of mine is when I speak with her parents on the subject (or most anyone else). They all claim it's for the greater good and that people can not afford insurance that would not have had it before.
I point out that for many of the people getting "cheaper" insurance, it's still too expensive to use, and for the most part there not getting cheaper insurance there just deferring the cost till they get their tax returns. Instead of pointing this out though the exchanges and market places show listings like $40 a month. And totally gloss over the fact that they actually have to pay the same, or close to the same premium, they just won't be getting a tax return. This has gotten better, but is still a problem.
Doesn't fix a problem
There are good parts to the ACA. But the forced insurance does not fix a core problem. The insurance system in the US is greatly flawed. The idea behind it is flawed. We are trying to use it for something it is not meant for, and we keep shoe horning it in. Insurance is supposed to be about risk avoidance. However with medical insurance too many people use it as a monthly medical bill that entitles them to care.
In the same venue, the system is nearly criminal. A doctor has to charge more for an insured patient then for a self pay patient because there is that much overhead. At the same time they also have to file specific things. In the end the doctors are actually making less then with self pay (so I am told), and have to go through more hassle to get it, meanwhile the patients are generally paying more. There are exceptions, of course, but as a rule patients pay more, doctors earn less, and insurance companies gobble up the difference.
Why are so many Americans against Obamacare?
I guess you could say I'm against Obamacare, but I think it's more fair to say that I'm mad at the system, of which the ACA is a part. I want to give you a lot of personal details, with the hope that 1) you don't see me as just talking about this stuff as abstract political argumentation, and 2) maybe I get to contribute something new/different to a familiar debate.
Back in 2009/2010 when reform was being discussed, I was generally in favor of ACA legislation and the opinion that there were problems that needed to be fixed. I was just entering the full-time workforce around then, and I worked for a company that was big enough to provide good health insurance. I think I had $130 taken out of my paycheck per month, and I had a $500 deductible and low co-pays. This set my expectations for what healthcare looked like as an adult with my own plan.
Health care costs on the exchange
In 2014 I changed jobs. My company is small enough that offering health insurance isn't really a financial gain for anyone, so I went on the exchange. I picked a Gold plan that had a monthly premium of $169/month. It had a $1,200 deductible, a $3,700 max out-of-pocket, and reasonable co-pays ($20 for primary care). This was a slight increase across the board but very much within reach of what I previously had (and the job gave me a raise as well), so I signed up and was generally happy with the plan.
For 2015, the premium went up to $192.58/month. Not unreasonable. The only other change here was that they split their network into two tiers: "Enhanced" and "Standard". But my local services were in the good tier, so no big deal.
2016 was a different game because I had a lot of life changes that made thing less cut-and-dry. I'll skip the details in an attempt at brevity.
In 2017, if I had purchased a Gold plan for myself, I'd probably have picked the plan that looks like this: $332.63/month premium, $1,000 deductible, $6,500 out-of-pocket maximum. Almost twice as expensive as 2014 for two of those three metrics.
But I have other family members in the mix now and I think it would have been too expensive for all of us to have that plan, so we dropped to a Bronze tier plan. Our plan now has three "in-network" tiers instead of two. Our health providers are in the middle one, so I'll use those figures for pricing.
We are paying just under $700/month in premiums for four humans. If it was just me, I'd be paying $225/month. What does our $8,400/year get us? $13,600 family deductible ($6,800 is the individual deductible, for comparison), $14,300 max out-of-pocket ($7,150 individual), and a whopping $130 co-pay just to get in the door at a primary care place (it'd be $90 if I was willing to go to the 'preferred' places that are further away from me).
We don't qualify for financial assistance either, so that means that the architects of the current legislation think that we make enough money that this isn't a burdensome expense. And they may well be correct, in a sense. I don't think $700/month would be a terrible fee for healthcare, if it bought peace of mind that everything would be covered.
But it doesn't do that. A $130 copay means that when the kid is crying and you're thinking about going to the doctor, there's a 50/50 chance that you wasted the money because it was just a cold and not an ear infection. And even though you know you can get a free checkup every year, you don't go because you don't want to deal with turning down an extra test that might end up functionally being an out-of-pocket expense.
Why am I mad at the system?
If you think of buying health insurance like buying any other kind of insurance, you get maddeningly frustrated.
First, it's a boring product that you're forced to buy, so there's a similar level of interest as, say, buying a water heater. But even that's not a great analogy, because you could choose to not heat water in your home, or rent so you don't have to make that decision. While I fully understand (and don't necessarily disagree with) the notion that you need everyone to buy in to control costs for everyone else, the fact remains that being compelled to do something against your will doesn't jibe psychologically with humans . While I probably would never choose to go without health insurance unless I couldn't afford it, having the option means that I would have an actual choice.
Second, I have no control over costs. For car insurance (and most things that I buy, really), I have power to control my policy premium. I can tailor a plan to where I live, so an underwriter wouldn't factor in snow/salt damage to a car in southern California. I can install some device in my car so the insurer knows I'm a safe driver and lower my premium adjusted accordingly. If I don't get tickets or don't get in an accident, my premiums can go down. But for health insurance? I can be completely healthy and still have my premiums go up. I could theoretically rack up a bunch of expenses on injuries caused by reckless behavior, and no one's the wiser when it's time to pick a policy next year. I could live next door to the hospital, but I still have to buy a plan that covers ambulatory expenses. When those cost increases happen, there is nothing that I can do about it.
Third, it's a confusing place to do business. Every year you have to relearn what all the terms are and you have to figure out what the plans are actually offering. For example, I'm looking at plans available to me on the exchange right now. Two plans are from the same provider, both in the bronze tier, have the same deductibles and max out-of-pockets, but one costs $9.50 more per month. Presumably these plans both exist to serve different needs, but what are those needs? Time to read a bunch of documentation and learn how their networks operate. And even once you pick a plan, you have to watch out for gotchas, because if you don't know them you pay big time. For example, in 2016 my lack of understanding of my policy cost me $1,500 in unexpected expenses. Is that my fault? Ultimately, yes. But I'd like to think it could have been explained better to me.
Fourth, as a relative expense, it feels like a terrible value. $700/month is roughly equal to my mortgage, property taxes, homeowner insurance, and the electric bill. A roof over your head and the juice to power it, a tangible benefit that you get to enjoy every day. Compare this to health insurance: A product that you never want to use, and because the deductible is so high you only ever benefit from it when something catastrophic happens to you. Car insurance is similar, but we pay about $100/month for two people, which isn't a massive expense.
Fifth, the cost increases over four years of plans seem really crazy. Is that the ACA's fault? I don't know, but I know that (with few exceptions) I'm not allowed to shop anywhere other than the exchange. If I could only shop at Walmart and the prices are high at Walmart, it's certainly easier to be mad at Walmart than it is to be mad at someone further up the supply chain, even though it might not be correct to do so.
Sixth, the fact that employers offer insurance throws a few wrenches in the mix. First, I'm pretty confident that that $130/month I paid back in the day was subsidized, so I don't know the true cost of my plan. Second, I believe that was a pre-tax expense, so I saved money that way too. It'd be nice for contractors/consultants/small businesses to get the same benefits. Third, since a really high percentage of people get insurance like this through their work, they don't know what it's like to be on the exchange and often don't make good arguments about healthcare as a result.
Some discussion of these arguments
You could look at all of these complaints and contend that single-payer would address each one. I don't disagree. But when you go down that road you start to worry about what your government will choose to cover or not cover. Let's use euthanasia as an example (trying not to kick hornet nests in this post but I need something for this example) - some people want it, some people don't. I'm against it morally, but I know that the actuarial tables will make it look extremely tempting to an administration looking to reduce end-of-life healthcare costs.
So perhaps the fundamental flaws of the ACA are:
- It's trying to advance goals and ideology of universal healthcare through a system of purchasing a private insurance product. This creates cognitive dissonance.
- It's expensive! I've argued with my friends that if you surveyed every American and asked "Would you support universal healthcare if it cost you $20/month?" the results would be overwhelmingly in support. $20 for that random guy to have his cancer looked after? Absolutely! But when $8,400 a year disappears from my paycheck with only the vague promise that it'll keep me from bankruptcy if the unthinkable happens? It's harder to look past your family at that point.
- Lack of choice. If you view healthcare as a product similar to other types of insurance, then the restrictions of 1) being forced to buy something, 2) being more-or-less forced to buy it from one place, and 3) having limited buying options creates for a really unpleasant experience.
Excellent breakdown of the issues as seen by an individual. It's not that you are against healthcare but this implementation. Thank you for the clear and well thought out post.
@indigochild The question was "Why are so many Americans against Obamacare?" - I answered that question from the perspective of at least one of those Americans! If you think any argument I construct could be fleshed out better or reworded for clarity, I'd be interested in doing so.
@Brendan - The core problem is that your answer doesn't answer the question. It is only an anecdote, which is not sufficient evidence to provide a general answer. If this answer can be expanded to include "many Americans" (as the question says) it would be okay.
@indigochild Perhaps OP could enlighten us here. It seemed to me that this question is attracting many answers representing many Americans; I figured I was adding a data point to what's already here. OP also said "I find it very difficult to understand why so many people would vote this way" - so I was looking to answer in a way that could convey understanding. But if OP is specifically looking for survey data, then I agree that I'm off-topic here.
As one of the working people who were forced into obamacare, I agree completely. The idea isn't bad, it's the implementation that stinks. Right now, I'm paying $1800/month to cover a family of four, the only plan I could get, and I may lose that at the end of the year. Obamacare did nothing to address the very high cost... other than increasing it.