It's no secret that Obamacare, known officially as the Affordable Care Act, is a polarizing law that has drawn a pretty strict divide between supporters and those who oppose it.
According to the Kaiser Family Foundation's Health Tracking Poll, which takes a somewhat regular look at the public's opinion of Obamacare, as of September 47% of respondents had an unfavorable view of the law, 35% a favorable view, and 19% were undecided or simply refused to answer. The unfavorable view percentage was down 6% from July, but the favorable view also fell 2%.
Glass half full versus glass half empty
Americans who favor Obamacare tend to focus on the ACA's easier access to health insurance. In the 28 states that have chosen to expand Medicaid, lower-income citizens who were previously out in the cold now have access to covered medical care for the first time in their life. Additionally, those who favor the law prefer the beefed up minimum benefit requirements that insurers are to provide, as well as the fact that those with preexisting conditions can't be turned down.
On the flip side, Obamacare's opponents don't like the idea of being required to purchase health insurance, which is especially true for a younger generation of adults that feels invincible and is unlikely to utilize their physician or a hospital often. Also, some question whether or not Obamacare will really slow the rise in insurance premiums. Keep in mind the ACA wasn't implemented to stop medical costs and health insurance premiums from rising, but merely to control the rate of inflation at which they rise.
Politics, of course, is one of the more common reasons cited as to why a majority of Americans oppose Obamacare. While there are some clear party divides on who likes Obamacare and who doesn't, I don't think this properly encapsulates why the law is viewed so unfavorably by the majority of Americans. Instead, I'd turn to a recent study from The Associated Press-NORC Center for Public Affairs Research to get a more complete answer as to why Americans dislike Obamacare.
The real reason Americans dislike Obamacare
AP-NORC's 1,004-person poll conducted between July and September focused on two key questions:
- If offered a choice between the following to health insurance plans, which would you prefer: Option A, a plan with a relatively low monthly premium but higher out-of-pocket costs if you need healthcare. Option B, a plan with a relatively high monthly premium but lower out-of-pocket costs if you need healthcare.
- How confident are you that you could pay for medical care if you or someone in your family had an unexpected medical expenses?
In response to the first question, 52% of respondents chose Option B (the plan with a higher monthly premium and lower out-of-pocket costs), 40% chose option A, and the remainder either didn't know or refused to answer. For the second question, 36% noted that they felt "very confident" in paying for unexpected medical expenses, 39% were "somewhat confident," and 25% were "not confident."
The initial takeaway from this study is that at least one in four Americans (based on question two) find Obamacare to be unaffordable. An additional 39% are also in in a gray area of being "somewhat confident." Furthermore, of the Americans that AP-NORC polled that had switched plans within the past year, 45% noted that they were paying more than they previously were prior to the ACA being implemented, 29% said they were paying less, and just 11% of respondents believed they were getting better value for their healthcare dollar. The implication here is pretty simple: Americans are unhappy with the price of their plan.
Plan cost is a big problem
As noted by the answers to the first question, more than half of the respondents would prefer a higher premium plan that would result in lower out-of-pocket costs should medical care be needed.
A typical bronze plan, the cheapest of the Obamacare tiered plans on a monthly premium basis, has an annual deductible of around $6,000. By comparison, the average silver plan has an out-of-pocket annual deductible of closer to $3,100, which is probably why it was by far the most selected plan in 2014. In other words, the more people pay upfront, the lower they'll pay out of pocket should medical care be needed.
Yet herein lies the dilemma: not everyone can afford a gold or platinum plan. In fact, it would seem based on this poll that a good chunk of Americans (25% who are "not confident" and 39% who are in the gray area) are having a questionable time simply keeping up with their current plan, which is likely of the silver and bronze variety (these two tiers accounted for more than 80% of total plans sold in 2014).
Of course, AP-NORC's findings also clearly showed that the inability to meet medical bills, or the need to make financial trade-offs in order to pay medical costs, is more pronounced in Americans with high-deductible plans.
Two interesting insurance implications
AP-NORC's survey results may also have some unexpected implications for the health insurance industry.
On one hand, this survey has to instill some degree of concern in insurers like WellPoint (NYSE:ANTM) and Centene (NYSE:CNC), which have not been shy about targeting lower-income consumers. Thankfully, both companies netted a substantial number of government-sponsored enrollees via the Medicare expansion in slightly more than half of all U.S. states, but there's clearly the potential here that consumers could run into issues paying their end of out-of-pocket costs should a medical emergency arise. That could leave insurers footing hefty consumer bills, or simply cause consumers to drop their coverage altogether, which would be bad news for these companies and the entire industry.
But if consumers trade up to higher premium, lower out-of-pocket plans it could also wind up stinging insurers. The initial inference would be that higher premiums would lead to healthier insurance profits. However, lower premium and higher out-of-pocket plans are actually bigger margin boosters for insurers since they require less initial money to come out of insurers' pockets. In reality, silver and bronze plan sales are fantastic for insurers who stand to reap solid rewards as long as Americans continue to pay their bills.
In short, it's going to be interesting from both an investor and consumer perspective to see whether consumers are able to successfully and affordably move toward higher premium plans in 2015, as well as determine whether or not consumers continue to stay current on their out-of-pocket obligations.