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Horowitz: Obamacare Ain’t Easy to Kill

Tuesday, February 28, 2017


To borrow from Mark Twain, "Reports of Obamacare’s death may be greatly exaggerated.” The stepped up coverage of President Trump’s and the Republican Congress’ plans to repeal and replace the landmark health care law has paradoxically served to awaken the American public’s awareness of its many strengths.

A recent Pew Research Center poll shows that a majority of American adults now approve of the health care law with approval at an all-time high of 54%. Among those that disapprove of the law, more people want Congress to modify it than get rid of it entirely. Underlying these results is the fact than 6-in-10 Americans say the government should be responsible for ensuring health care coverage for all Americans, as opposed to less than 4-in-10 who say this should not be the government’s responsibility, according to another recent Pew Poll. This reflects a marked increase in the percentage of Americans who now believe that providing health insurance is an affirmative duty of the government.

This shift in public opinion is amplified by the intensity of feeling about keeping the law that many Republican lawmakers are experiencing first hand in town halls throughout the nation. The turnout of thousands of supporters to confront their members of Congress about the potentially disastrous consequences of repealing Obamacare, otherwise known as The Affordable Care Act, is having the desired impact on Capitol Hill where thoughts about the next election, now less than 2 years away, are always front and center.

More people are waking up to the fact, that despite its many imperfections, the  law has substantively been a big success, providing health insurance to more than 20 million people and moving us much closer to the goal of universal coverage. Among other important features, it prevents insurance companies from denying insurance to people with pre-conditions; offers strong incentives for stepped-up primary care and preventive medicine; and puts in place needed cost-containment measures.

 As Dr Ezekiel Emanuel, one of the architects of the 2010 law accurately states, “By any metric — access, cost and quality — Obamacare has largely been successful. Cost increases in the system are lower. And Americans insured through the Affordable Care Act are largely happy with the service they receive.” 

As with any large-scale reform, Obamacare certainly needs tweaks. To examples of fixes are safeguards to minimize risks for health insurance companies need to be reauthorized and strengthened and increased government subsidies to lower insurance premiums are required to attract greater numbers of younger, healthier people to the program.

These kinds of fixes are where Congress should focus its energy, especially since none of the replacement plans advanced by the Republicans seem substantively workable without prohibitive new costs or many millions of people losing their insurance coverage. Right now, there is not a consensus among Republicans about a way forward, but there is a growing awareness of the political risks of repeal.  That is why there is already a move to maintain expanded Medicaid coverage—a feature of Obamacare many Republican Governors signed their states up for.

A move to reforming and fixing Obamacare would likely attract Democratic support. While it risks alienating some conservatives, it is where the political sweet spot is for Republicans in swing districts or states and for President Trump. While the rhetoric about a major overhaul is likely to continue, watch for the policy substance to move in this direction. Obamacare --or at least its main substantive underpinnings-- has a fighting chance to survive.


Rob Horowitz is a strategic and communications consultant who provides general consulting, public relations, direct mail services and polling for national and state issue organizations, various non-profits and elected officials and candidates. He is an Adjunct Professor of Political Science at the University of Rhode Island


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