There has arguably not been a more hot-button issue on Capitol Hill this year than healthcare reform, and it's not hard to understand why. Heading into the Oval Office, Donald Trump had pledged throughout his campaign to repeal and replace Barack Obama's signature health law, the Affordable Care Act (ACA), which is best known as Obamacare.
Trump also strongly believed he had the votes to make such a repeal happen, with members of the GOP in the House voting to repeal Obamacare on more than 60 occasions during the Obama presidency. But when push came to shove, no deal was made, and Obamacare looks to remain the health law of the land for at least a few months longer.
Obamacare repeal efforts fail, but the public is probably thrilled
While the GOP has to be disappointed with its efforts to reform healthcare, the American public doesn't share its sentiment, at least according to a new survey from Quinnipiac University. In September, independent pollster Quinnipiac surveyed more than 1,400 people, asking them a variety of questions concerning immigration reform, climate change, and healthcare reform. The particular question and response that stood out was the following:
"Do you approve or disapprove of the way the Republicans in Congress are handling healthcare?"
The public's response? Just 11% approved, compared with 81% who disapproved. Another 7% either didn't know or refused to answer.
If this study is representative of the U.S. as a whole, and we utilize the U.S. Census Bureau's adult population estimates from July 2016, this implies that just over 202 million Americans disapprove of the way the GOP is approaching healthcare reform. Compared with its August-released survey, the percent who approved fell by 4 percentage points, while the percentage who disapprove rose by 1 percentage point.
Why is the American public so opposed to the GOP's handling of healthcare reform? It probably boils down to three proposals that are at the core of Republicans' reform efforts.
Here's why Americans probably dislike the GOP's handling of healthcare reform
First, there's been a lot of pushback with regard to the GOP's efforts to cut Medicaid spending. Republicans viewed reducing the amount spent on Medicaid as a critical way to save money over the next 10 years. These savings were expected to be needed in their efforts to pass comprehensive tax reforms at the individual and corporate level.
More specifically to the public, though, shifting to either a block-grant or per-capita funding system for Medicaid would have probably pushed more payment responsibility to states or the consumer. Projections from the Congressional Budget Office suggest that we'd have seen a net loss of insured people as a result.
The proposed elimination of subsidies also didn't sit well with the public, and even with some moderate Republicans, which doomed any ACA repeal efforts from passing. Currently, the Advanced Premium Tax Credit and cost-sharing reductions help to lower the respective costs of premiums and associated medical care costs such as copays and deductibles, for low- and middle-income individuals and families. Removing these subsidies by 2019 or 2020, as the GOP's healthcare reform plans had implied, would have led to a large increase in the uninsured rate and made it difficult for low-income folks to get coverage and/or receive medical care.
Lastly, Americans probably weren't too thrilled with provisions in numerous Republican healthcare reform proposals that would have allowed insurers to charge seniors more. Under the ACA, insurers are capped at charging seniors aged 50 and up no more than three times what they charge young adults. Under multiple Republican proposals, this ratio would have been adjusted upward to 5-to-1. Considering how poor saving rates are in the U.S., sapping seniors of their cash before retirement could have proved devastating.
Obamacare has problems, too
However, in spite of the backlash from the public toward Republicans' proposals, we also can't overlook that Obamacare itself has a number of issues that need fixing.
A good example is Obamacare's lack of attracting healthy young adults. It was expected that the shared responsibility payment (SRP) -- the penalty that consumers are supposed to pay for not purchasing health insurance – would coerce young adults to enroll, helping to counteract an influx of sicker enrollees. But as steep losses from insurance companies have shown, this hasn't been the case, with young adults mostly sticking to the sidelines.
The issue? Look no further than the actual SRP itself. Whereas HealthPocket's analysis of bronze-tier plans (the cheapest plan tier) found that the average unsubsidized individual would pay more than $3,700 in premiums in 2017, the average household SRP In 2016, according to estimates from the Kaiser Family Foundation, was just $969. In other words, healthy adults could simply choose to remain uninsured and keep the difference.
What's more, with Trump passing an executive order in January that alleviates the burdens of Obamacare, taxpayers can now turn in their tax forms without filling in line 61, which details what a consumer paid in penalties if not insured. This problem isn't going to fix itself, and insurers absolutely need young adults to enroll if they have any hope of operating sustainably in the ACA marketplace.
A lack of reforms also won't address the insurer exodus. Since 2016, the largest insurer in the U.S., UnitedHealth Group (NYSE:UNH), has cut its coverage from 34 states to just three, while Aetna (NYSE:AET) and Humana (NYSE:HUM), which had regulators nix their merger, have both announced their planned exit from Obamacare next year. Even Anthem (NYSE:ANTM), a company that was perfectly positioned to benefit from an influx of government-sponsored consumers (e.g., Medicaid expansion and subsidized consumers), has announced that it's pulling out of numerous ACA marketplaces in the coming year. With less in the way of competition, and insufficient leverage from each states' Office of the Insurance Commissioner, consumers can expect higher premium prices.
In short, we're in a tough spot here. It's clear that Americans don't want to lose the certainties they've become accustomed to with Obamacare, but it's also pretty evident that no change at all could result in things getting worse for insurers and consumers. A bipartisan solution is needed, but with the parties so divided on Capitol Hill, it's nothing more than a long shot at this point.