Time to inject another set of data points into the "Obamacare is working well in the real world" debate. The president and his loyalists insist that their signature law is working as intended. The general public -- yet again -- disagrees, according to a new poll from Politico:
A plurality believes the quality of their care will deteriorate under Obamacare (perhaps due to access shock, doctor shortages, and government rationing decisions), while less than one-in-five expect improved care. On costs, a pitiful seven percent believe the 'Affordable' Care Act will reduce the amount of money they'll personally pay will decrease as a result of the law; a solid majority expect to shell out more for coverage. Democrats promised substantially reduced rates for "everybody." Just 17 percent of respondents said they'd like to see Obamacare kept intact, with the remainder split evenly between preferring alterations and full repeal. It's working. Incidentally, Politico's survey gives Democrats a three-point Congressional ballot edge, and shows President Obama's approval rating underwater by just six points (47/53). Democrats would likely minimize their losses if that's how the electorate ends up looking in two weeks. The Washington Post/ABC poll released late last week, by contrast, gave the GOP a seven-point generic ballot advantage, with Obama's approval upside-down by 18 points among likely voters. Circling back to Obamacare, the Wall Street Journal reviews the law's "failing cost control" provisions:
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A major claim of ObamaCare’s political salesmen is that it will reduce U.S. health spending. The heart of this claim is the Accountable Care Organization, or ACO, but already evidence is accumulating that it isn’t working. That’s the news in the recent Health and Human Services release of the results from the first two years of ACO experience under the Affordable Care Act. The much-delayed data received zero media notice despite a speech from HHS Secretary Sylvia Mathews Burwell citing “evidence that we have bent the cost curve.” The data show the opposite…The Medicare “Pioneer” ACO project originally featured 32 experienced health systems hand-selected by HHS because they had already made progress toward the ACO model. Thirteen—or one-third of the program—have since dropped out as they spent more than the old status quo. In year one, spending increased at 14 sites and only 13 of the 32 qualified for a bonus. In year two, spending increased at six of the remaining 23 and 11 received a bonus. Spending did fall somewhat overall, driven by a few high-performance successes. After netting out the bonuses and penalties, the Pioneer ACOs saved taxpayers a grand total of $17.89 million in 2012 and $43.36 million in 2013. All in, per capita spending was a mere 0.45% lower compared to ordinary fee for service Medicare.
The Journal argues that up-front costs have negated savings among the fraction of participants who received performance bonuses, meaning that the overall program is
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Patricia Wanderlich got insurance through the Affordable Care Act this year, and with good reason: She suffered a brain hemorrhage in 2011, spending weeks in a hospital intensive care unit, and has a second, smaller aneurysm that needs monitoring. But her new plan has a $6,000 annual deductible, meaning that Ms. Wanderlich, who works part time at a landscaping company outside Chicago, has to pay for most of her medical services up to that amount. She is skipping this year’s brain scan and hoping for the best. “To spend thousands of dollars just making sure it hasn’t grown?” said Ms. Wanderlich, 61. “I don’t have that money.” About 7.3 million Americans are enrolled in private coverage through the Affordable Care Act marketplaces, and more than 80 percent qualified for federal subsidies to help with the cost of their monthly premiums. But many are still on the hook for deductibles that can top $5,000 for individuals and $10,000 for families — the trade-off, insurers say, for keeping premiums for the marketplace plans relatively low. The result is that some people — no firm data exists on how many — say they hesitate to use their new insurance because of the high out-of-pocket costs.
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We repeat: Gaining 'coverage' is not the same thing as receiving care. The Times piece runs through other people experiencing similar sticker shock (quotes: “I mean, $6,000 — do they think I’ve just got that under my mattress?” and "[we received a bill] that could choke a horse"), then circles back to Ms. Wanderlich, and this depressing quote:
When the next open enrollment period begins on Nov. 15, Ms. Wanderlich said, she will probably switch to a plan with a narrower network of doctors and a smaller deductible. It will probably mean losing her specialists, she said, but at this point she is resigned. “A $6,000 deductible — that’s just staggering,” she said. “I never thought I’d say this, but how many minutes until I get Medicare?”
"It's working." I'll leave you with this sharp analysis from Noah Rothman flaying the MSM meme that Obamacare has receded as an issue in the midterms. It's receded for one party -- and for good reason.
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