A recent poll conducted by The Wall Street Journal and NBC News indicates Obamacare’s popularity is at an all-time low. As of this writing, this is the latest in frequent polling of Americans’ views regarding the controversial health care law. The poll indicates only a 37 percent approval rating. It seems to me poll numbers change more frequently than new information or changes in interpretation of the law would warrant. So what drives frequent changes in public opinion?
I believe the most widely-disseminated information regarding Obamacare comes either in the form of overly-optimistic praise extolled by its supporters or excessively dramatic, alarmist predictions by its detractors. Reporters, pundits and pollsters often have a bias or report information based on responses to loaded questions about the law’s perceived successes or failures. This legislation is inextricably linked to the current administration’s legacy. As such, perception is political reality. I believe an accurate representation of Obamacare’s true impact requires a more in-depth look into statistics and trends in the healthcare industry along with keen awareness of the ever-present specter of political posturing.
I spent a few years writing medical summary plan descriptions (SPDs) for clients of a third-party health plan administrator. (SPDs are the little benefit summary booklets employers give their workers). I think in many ways this experience helps me maintain an objective disposition in terms of whether Obamacare truly accomplishes its intended goals.
Obamacare’s Objectives
The main objectives of Obamacare, as outlined by the Department of Health and Human Services are listed here, along with some of my thoughts.
- Objective A: Make coverage more secure for those who have insurance, extend affordable coverage to the uninsured. – I’m guardedly optimistic that this objective will be achieved. Obamacare already expands coverage of dependent children to age 26 and prohibits pre-existing condition exclusions and lifetime benefit limits. States will roll out their insurance exchanges this October. All of these things extend and/or protect coverage. However, the notion of affordability will remain contentious for many until the exchanges demonstrate affordability. Covered California recently released a statement expressing belief that its exchange will be competitive with California’s current small employer market. If this turns out to be true, California’s success might be duplicated elsewhere.
- Objective B: Improve healthcare quality, patient safety. – Aside from increased oversight of Medicare and Medicaid, it’s difficult to argue substantial evidence of Obamacare’s impact on quality. The law calls for the establishment of a non-profit institute to examine and compare the effectiveness of medical treatments, but there is no mandate to change private sector practices pursuant to any of the institute’s findings. This, along with the fact that funding for such an institute must be allocated by a deeply divided Congress means this endeavor will likely fail.
- Objective C: Emphasize primary and preventive care linked with community prevention services. – Ben Franklin said, “An ounce of prevention is worth a pound of cure.” Medical science has confirmed this truth. When I wrote SPDs, it had not yet been determined whether some self-funded plans were required to cover preventive services. If they did offer preventive benefits, those services would have to be covered at no cost to the employee. While many employers complained about increased costs, I recall none who seriously considered opting out of preventive benefits. The cost of treating conditions that might develop because of a lack of prevention would have far outweighed the cost of expanding wellcare. Obamacare has succeeded in emphasizing preventive care, but linking this with community services continues to be problematic. Perhaps if Franklin were a current congressman, he might vote to fund Obamacare (at least in regard to community preventive programs and grants).
- Objective D: Reduce the growth of healthcare costs while promoting high-value, effective care. – Conservatives claim that health care costs are actually increasing under Obamacare. However, studies conducted by the Kaiser Family Foundation suggest health care premiums have risen steadily at an average annual rate of around 7.5 percent since 1999. This includes the much-maligned increase of 9 percent from 2010 to 2011, when the first phases of the law became effective. Interestingly, the increase from 2011 to 2012 was only 4 percent. While this data suggests that costs continue to steadily rise in spite of Obamacare rather than because of it, ultimately Obamacare has thus far failed to deliver on its promise of lower costs.
- Objective E: Ensure access to quality, culturally competent care for vulnerable populations. – Obamacare seeks to appropriate funds to help coordinate consortiums of medical providers for underprivileged segments of the population as well as expands CHIP, Medicaid and services under the Indian Health Care Improvement Act. Obamacare also mandated that the SPDs I wrote be translated into the native language of non-English speaking employees if those employees comprised a significant percentage of the workforce. I give Obamacare the benefit of the doubt and call this undertaking a success.
- Objective F: Promote the adoption and meaningful use of health information technology. – Obamacare mandates standardized electronic eligibility verification, premium payments, maintenance of claims information including referrals and authorizations and other tasks. Compliance with most of these guidelines will not be required until 2014, so gauging the success of this particular objective is not yet possible.
Success or Failure?
Since the 2008 presidential campaign, I’ve maintained a measure of optimism that these reforms will eventually begin to reap dividends toward the betterment of the U.S. healthcare system. I still believe this; however, my opinion is that there is presently as much failure as success. Obamacare has yielded neither substantial gains nor losses as of the first half of 2013, despite over-dramatized accounts by some media outlets.
