This column by Drew Altman, president of the Henry J. Kaiser Family Foundation, highlights what appears to be a big disconnect between voters and lawmakers when it comes to repealing and replacing Obamacare. Trump voters and Republican lawmakers are united, it seems, in their dislike of the Affordable Care Act. Where they are divided is on what comes next. Research done by the Henry J. Kaiser Foundation indicates that the voters have pretty definite ideas on what they want to see as a replacement. Repeal does not seem as important to them except as necessary to fix the problems they are having.
Lawmakers, on the other hand, seem pretty eager to repeal Obamacare but are vague – and have been vague for seven years of opposing the ACA – on what comes next. Trump voters (and probably most voters) are going to be unhappy if lawmakers proceed on the path they appear to be on.
The study indicated that the primary concerns of these Trump voters were:
- A fear that they would be unable to afford coverage for themselves and their families.
- Anxiety about rising premiums, deductibles, copays and drug costs, and particularly surprise bills for services that turned out not to be covered.
- Resentment that poorer people, eligible for Medicaid, seemed to be getting a better deal than they were.
- Animosity toward drug and insurance companies.
- Frustration at being forced to change plans annually to keep premiums down, and losing their doctors in the process. (Surveys show that enrollees in the ACA marketplace generally are happy with their plans, but the average Trump voter seems to not have fared as well under Obamacare as the average citizen.)
- Dissatisfaction over losing an ability to purchase lower cost policies, even if that loss was cost-shifting that resulted in more and better coverage for others.
According to the column and the study:
If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.
The survey subjects were surprised and dismayed to hear about the current plans that had been floated. They recognized that “a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage” was “not insurance at all.” They were skeptical of the concept of health savings accounts.
But, they were confident in Mr. Trump’s ability to protect people with pre-existing conditions without imposing the un-American mandates. Because, in their mind, Mr. Trump is a smart businessman, he would not allow the chaos of a gap between the repeal and replacement of Obamacare.
Well, the election is over. They won this one. But, as the George Washington character says in Hamilton, “winning is easy, young man. Governing’s harder.”
