It is the damndest thing. Trump voters who didn’t want to see the Affordable Care Act repealed seem to be coming out of the woodwork. It’s almost as if they didn’t see repeal coming. If only there had been some, sort, of, sign. While it might be tempting to laugh at the dissonance, and there will be some of that, it is everyone who is going to suffer.
The ACA in the Mind of the Public
The first Kaiser Health Tracking Poll since the 2016 election reveals a country at odds on the future of the ACA even though many of the law’s major provisions are popular regardless of party. It seems that the largest single thing that people object to is the individual mandate.
On an editorial note, it is the mandate that makes the whole thing work. You know it, I know it, the people who wrote the law knew it. Now if we could just, you know, use reason to make our arguments stick. Alas ...
from the Kaiser Family Foundation ...
The poll captures a slight uptick in the share of Americans who want lawmakers to scale back the law as well as a decrease in the share who want lawmakers to repeal the entire law.
This is largely driven by Republicans: About half (52%) of Republicans now say they want to see the Affordable Care Act repealed, down from 69 percent in October.
At the same time, a quarter (24%) of Republicans now want to see the law scaled back, up from 11 percent in October.
What About The Doctors?
A team of researchers recently surveyed Primary Care Physicians about the repeal of the ACA, aka Obamacare, and the findings would be somewhat amusing if they weren’t so sad. The results of the study were published in the New England Journal of Medicine this week. Only 15% of the 426 responses out of the 1,000 surveyed supported repeal of the law. That 15% is fully comprised of Trump voters but the odd thing is that only 38% of those Trump voters wanted the law repealed.
You heard that right. There are a bunch of Trump voting Primary Care Physicians out there who don’t support repeal of the ACA.
Unfortunately, the survey didn’t comprise a psychological or cognitive analysis of the respondents.
This is just me editorializing but I just don’t understand a vote for the Orange one if you don’t want to see the ACA repealed.
I guess the pundits were right about Trump voters taking him seriously but not literally. That might be forgiven for someone without the level of education and experience of a Primary Care physician. For someone with that education and experience however, it is absolutely inexcusable.
Anyway, back to the study. The respondents were also asked about which provisions of the act they supported. Even here, it seems that the changes they support look a lot more like reasonable fixes than the complete repeal that Trump has advocated and followed through on.
from the NEJM article ...
Physicians responded most favorably to policy proposals that might increase choice for consumers, such as creating a public option resembling Medicare to compete with private plans, providing tax credits to allow people who are eligible for Medicaid to purchase private health insurance, and increasing the use of health savings accounts
Physicians responded most negatively to policies that would shift more costs to consumers through high-deductible health plans. Less than half were in favor of proposals to decrease insurance-market regulations (by allowing insurance companies to sell across state lines), require states to expand Medicaid, or expand Medicare to adults 55 to 64 years of age.
And Then There’s Kentucky
So the physicians have weighed in, and many have been found lacking in reasoning. Is there anyone else out there who voted Trump, has some experience with the ACA, and still was surprised when the president issued an executive order to repeal the popular healthcare law? Well … yes.
Sarah Kliff of Vox did some reporting from Whitley County Kentucky over the last year. One of the people she interviewed was Kathy Oller who worked to enroll people in coverage plans under the ACA.
“I found with Trump, he says a lot of stuff,” she said. “I just think all politicians promise you everything and then we’ll see. It’s like when you get married — ‘Oh, honey, I won’t do this, oh, honey, I won’t do that.’”
“We all need it,” Oller told me when I asked about the fact that Trump and congressional Republicans had promised Obamacare repeal. “You can’t get rid of it.”
“It was Russian roulette,” Oller said of her vote. “But I felt that we needed change.”
Kliff met other Kentuckians who enrolled in and benefitted from the ACA. One person was Debbie Mills, enrolled in the program and supporter of Trump.
“I guess I thought that, you know, he would not do this, he would not take health insurance away knowing it would affect so many peoples lives. I mean, what are you to do then if you cannot pay for insurance?”
“It’s made it affordable,” Mills says of Healthcare.gov. This year, she received generous tax credits and paid a $115 monthly premium for a plan that covered herself, her husband, and her 19-year-old son.
“We were wanting change,” she said. “We’re in an area with a lot of coal. When people aren’t in the coal mines, they’re not spending and buying in our area.” She said she thought Trump, a successful businessman, would have a better shot at fixing all that.
I asked her if she had followed the campaign and heard the candidates talk about repealing Obamacare. “I did, yeah,” she said. “That was the only thing I did not like about him.”
So, Where Do We Go From Here?
I can’t tell you what is going to happen with the Affordable Care Act. If I could predict just how far the GOP will go to push it’s ridiculous agenda of free market everything with no protection for anyone I would have been screaming from the rooftops. I made the mistake of thinking that maybe there were just enough rational people in the country to keep me from having to ask these questions.
Will the Republican Congress look at polling numbers that show great support for the things that the ACA does? Will they use the repeal of the ACA as the reason to stop the Orange one? Will they simply replace the ACA with the same thing and call it something else?
There are a lot of questions and simply too few answers. The one thing that I know is that there are apparently a lot of Trump voters who liked the ACA and want to keep the “good parts” while getting rid of the individual mandate. Is it possible that the GOP will be hoist on it’s own petard? Sure. Because this election has proven that anything is possible. Of course it has also proven Barnum correct. No one ever went broke underestimating the intelligence of the American people.
The One Thing I Do Know
The GOP relies on fear and misinformation to get votes. We have a chance to tie the tire fire that will come to Trump and the party that nominated him. If we are smart we can paint the Republicans in the public mind as the vultures and jackals that they are. If we are lucky there will be enough of the country left to make the effort worth it.