221

What is it about Obamacare that so many Americans are against such that it became an election pledge to repeal it?


I could understand a candidate promising tax cuts and then after being elected scrapping Obamacare to pay for them. But this was not the case. It was a specific election promise to leave 10 million fellow Americans with no health coverage.

As someone who comes from a country where universal health care is taken as granted (perhaps even taken too much for granted) I find it very difficult to understand why so many people would vote this way.

And, it is not as if they voted for other policies and had to go along with this to get them because it was such an essential part of Trump's campaign.

  • 40
    The answers here are good, but it's key to remember not to confuse ACA with universal healthcare. The ACA plan I have costs me and my employer thousands a year, requires me to make co-pays/deductible, requires me to jump through hoops to get anything covered, may or may not work when I need it... oh, and from '16 to '17 increased in price by 50%+. It's a very different beast than what Australians or English are used to. – NPSF3000 May 6 '17 at 5:47
  • 52
    I can't answer this for real but anecdotally, from personal experience: I had great affordable healthcare. When Obamacare rolled out my healthcare company folded and my plan was cancelled. Then I had to use the incredibly broken (at the time) and confusing (still is) healthcare.gov to buy a new plan. It was really hard to find appropriate plans. The cheapest new plan I found was 3x what I used to pay, and I've only made one claim in the last three years and it was denied (routine bloodwork, cost me $3800 on top of my monthly premiums). So I used to have good affordable healthcare. Now I don't. – Jason C May 6 '17 at 13:19
  • 20
    Meanwhile, I've got no-income friends getting $$$ elective work fully covered with ACA subsidies. I think maybe the middle class kind of got the bad end of the deal with Obamacare, but a lot of campaigns and media focus more on lower vs. upper class. Again, just personal opinion, not a real answer, and by no means am I necessarily representative of the system as a whole. Also large healthcare companies have been pulling out of the marketplace in recent years, e.g. Aetna. – Jason C May 6 '17 at 13:20
  • 6
    I echo the sentiment of the previous comment; fwiw I can think of at least one American (me) who believes that Obamacare didn't hit the root and that controlling healthcare provider costs would be more helpful to me. Unfortunately that solution is hard to achieve. You'd have to go right down to the roots of medical device and tool costs, lab equipment production costs, etc. a hard problem. Then again, there's a reason doctors are stereotyped as high-income professionals; the richest folks I know are surgeons, that could probably be controlled. And yes, I'm sick of the GOP having no real plans. – Jason C May 7 '17 at 18:01
  • 16
    @luann the current for-profit system in the US also has no incentive to reduce costs. In fact, there's often incentives to increase. – user1530 May 7 '17 at 23:22

15 Answers 15

200

These are a few reasons why each group is against Obamacare.


With individuals

— It requires nearly all Americans to get health insurance.

Some do not think that the government should force citizens to buy health insurance and penalise them if they do not do so. There are taxes that Americans have to pay should they not buy health insurance. This is also one of the main reason Americans are against Obamacare.

Some are just against the fact that the government is ordering everyone to purchase coverage.

— The premiums are hefty for those who can afford it.

Americans who can afford to buy insurance directly from a provider are charged higher premiums so that they could assist in paying for the subsidies provided to those who buy their coverage from government-run marketplaces.

Thus, some view Obamacare on a whole as a welfare scheme and the Medicaid expansion and subsidies for low- and moderate-income enrollees as an entitlement program that uses taxpayers' money to help people they consider undeserving.

Furthermore, the premiums are set to rise by an average of 22% in 2017.

— People are angry with cancellations of their existing plans.

Obamacare changed the rules of the types of public insurance that people can directly buy, thus some insurers cancelled their old plans and charged higher premiums for the new plans to existing customers. Thus, these group of people doesn't really benefit from Obamacare and thus they are upset about it.


With insurers

— Insurers have lost money.

Some insurers lost money as the customers are sicker than they expected. Thus, the cost would have to be covered by better-off Americans. This will deter healthy, young Americans from signing up, resulting in an increase in prices of premiums.


Partisanship

— Republicans uniformly oppose it.

Some oppose it simply because it's a Democratic healthcare plan and it was passed when both the House and the Senate were under Democratic control.

Only one Senate Republican, Olympia J. Snowe (R-ME) voted the bill out of the Finance Committee while another Republican in the House, Rep. Joseph Cao (R-LA 2nd District), voted for the initial version in 2009. No Republicans voted for the amendment in 2010.

The majority of the Republicans have been consistent in their opposition towards Obamacare.


Survey

Below is a graphic from Vox that shows the percentage of Americans who agrees with each statement listed:

Image 1


Articles worth checking out:

  • 2
    Comments are not for extended discussion; this conversation has been moved to chat. – Sam I am May 10 '17 at 3:28
61

Tax cuts

I could understand a candidate promising tax cuts and then after being elected scrapping Obamacare to pay for them.

Obamacare repeal includes tax cuts:

  • .9% Medicare tax surcharge on high income Americans
  • 2.9% Medicare tax on capital gains, dividends, etc.
  • Medical devices tax
  • Individual mandate
  • Business mandate

And it expands certain tax credits for Health Savings Accounts and individual purchases of insurance.

No universal coverage

Obamacare does not actually offer universal coverage. It made certain kinds of coverage more expensive while using subsidies to pay for Medicaid expansion and subsidies for individual health plans. Also, because its subsidies were only available to individual purchasers, some employers (e.g. Wal-Mart) canceled their employer-based plans so that their employees could access the subsidies of the individual health plans.

Obamacare covered less than half of the uninsured, mostly through Medicaid expansion.

Obamacare relies on insurance companies registering for the exchanges, but it doesn't actually fund them adequately. The result is that in some counties only one insurer participates, and there have been more and more threats for the last insurer to drop out. It was in response to these reports that Donald Trump was promising to repeal Obamacare shortly before the election.

Increased deficit impact

Obamacare took several steps to make its deficit impact look lower than it was.

  • It assumed that it would be successful in restraining costs and convinced the Congressional Budget Office (CBO) to go along.
  • A catastrophic insurance plan that was supposed to collect premiums in the first decade and not start paying until the second decade. That proved unreasonably optimistic, and it was already canceled as too expensive in the short term.
  • Inclusion of student loan reforms that were intended to bring down net costs by allowing the government to collect the entire interest payment instead of just guarantee fees.
  • An unpopular tax on individuals doing contract work (since canceled).
  • An unpopular tax that was to take effect in 2018 on "Cadillac" health plans. Retained but delayed in repeal for the same reason (it makes the second decade costs look better).
  • Cuts in Medicare spending were double counted. They counted them once as increasing the size of the Medicare trust fund and a second time to pay for Obamacare.

Increased deductibles and copays

One of the ways that Obamacare makes the numbers work is that it made insurance cover less. It effectively increased the minimum amount below which people pay all their health care costs (the deductible) and increased the shared fees for services (copays). Thus for many people, insurance is more expensive under Obamacare than it was prior to that.

May be exacerbated by general trends. I.e. people may be blaming Obamacare for something that would be happening anyway.

Required services

Obamacare requires coverage for certain things. Those certain things are expensive. Some people preferred to buy cheaper coverage without those certain things. Those people either lost coverage or are paying more. Either way, not happy.

Increased mortality

Mortality rates among adults 18-64 have increased every year of Obamacare except 2012 and are now higher than at any time during the 2002-2010 period. Life expectancy has actually started decreasing. This is relevant because that age group is the most affected by Obamacare. Older than 65 are Medicare. Younger than 18 are only indirectly impacted (their parents may buy insurance for them through Obamacare).

Of course, this might be caused by something other than Obamacare. Correlation is not causation.

Transfer

Obamacare charges some people more money without providing those people with more benefits that they wanted. It subsidizes other people. Unsurprisingly, the people who pay more either in taxes or in increased deductibles/copays don't like Obamacare.

It doesn't help that most of the people who benefit are Democrats while most of the people who pay are Republicans. People with incomes less than $50,000 were potentially helped by Obamacare and voted for Hillary Clinton. People with incomes greater than $50,000 vote for Trump and do not get Obamacare benefits but do pay Obamacare taxes. Example source.

You'll often see claims that poorer regions are are more Republican. This is true, but within the region higher income leads to more Republican support. This is also true of richer regions.

Note that one might argue that universal coverage in other places also transfers from some groups to pay for others. But it's not as explicit. With Obamacare, the people who pay the most now already had coverage. They didn't gain anything from Obamacare. In fact, they may have less coverage now. The people who get subsidized now mostly did not have coverage previously.

Other countries

The US has the most expensive health care system in the world. This was true prior to Obamacare and hasn't changed. In fact, the US and state governments spend as much on healthcare as a percentage of GDP as the United Kingdom does. And of course the UK has universal coverage.

The US can't copy the UK though (example source). The UK employs all the healthcare providers directly and subsidizes schooling. The US has a system of private healthcare providers who aren't ready to take pay cuts to match UK wages. The UK also determines things like equipment spending at the national level. By contrast, each clinic or hospital chooses to buy or not buy in the US. And there are incentives to buy.

Equipment is a loss leader--many people prefer to go to the same hospital for all services. So going to a hospital for an MRI may mean that you continue to go to the same hospital for other things. Worse, even if the US adopted the UK system tomorrow, many of those expenditures have already been made. They can't really send back the MRI machine.

UK providers also have longer wait times for non-emergency services. In the US, a long wait time often results in choosing a different doctor. So doctors see fewer patients in the US. Similarly, US doctors are more likely to have schedules where they are available early in the morning (before work) or late afternoon/early evening (after work) or on weekends (no work). They may be sitting around the office doing nothing in the middle of the day, as there are no patients. But they had appointments earlier and will have more appointments later, so they can't really close up and go home enjoyably.

None of that applies to emergency care. In both countries, emergency care is well staffed and immediate. But there's a lot of non-emergency care where wait times have little impact on health but a lot of impact on costs.

  • 7
    Great answer. Could you point the sources of your data? – Mindwin May 5 '17 at 12:11
  • 50
    It doesn't help that most of the people who benefit are Democrats while most of the people who pay are Republicans. - how is that? – user1993 May 5 '17 at 12:18
  • 50
    Can you expand on how Democrats benefit more? I've always understood it as poorer people in rural areas benefiting the most, and also being mostly Republican voters. Which is ironic of course. – aw04 May 5 '17 at 13:24
  • 4
    @user1993 It's a factual error likely due to faulty reasoning. The source referenced gives stats for voters and conflates that to population. I bumped up these numbers to 2014 income statistics (best I could do) and the current population according to the Google, and I get 21/17% for C/T of people in under 50K households. For over 50K, it was 20/22%. So to say that "most of the people who pay are Republicans" etc. is not in that data. – JimmyJames May 5 '17 at 21:25
  • 6
    Lastly, the West Coast and a number of states in the Northeast are home to a disproportionate number of high-income liberals. These states are also generally uncontested wins for the Democrat which tends to result in lower voter turnout. The upshot is the national voter statistics are a poor source for supporting the claim of who pays and who benefits by political alignment. – JimmyJames May 5 '17 at 21:44
40

There's a couple of other factors in play here as well

  1. Obama intentionally lied about the effects of the bill

    A politician lying is nothing new, but your typical political lie is of the statistical variety. In other words, you oversell the benefits and undersell the impact and make it look like you're just arguing about numbers (Obamacare also sold a $2500 average annual savings which has not materialized). But Obamacare is mostly remembered (especially by Republicans) because Obama made a demonstrably false statement

    If you like your plan, you can keep your plan

    Understand, this lie was repeated over and over, many of them in nationally televised speeches before Congress. More importantly, it was something President Obama knew it was false at the time (where he admits that at least 8-9 million would lose coverage). While he states afterward that he thought the exchanges would fill in the lost coverage, that was clearly not how it was sold.

  2. The exchanges are in serious trouble

    The exchanges were supposed to be the backbone of Obamacare, providing lower-cost insurance (provided you qualify for a subsidy) than insurance companies. Many have gone out of business

    A July 2015 report from the Department of Health and Human Service's Inspector General warned that every single co-op except one was hemorrhaging money. More than half had net losses of at least $15 million in their first year. The IG also found that, despite those promises of price competition, many co-ops had set premiums higher than policies sold by commercial insurers.

    A month later, Nevada's co-op announced that it was going out of business. Seven more followed suit in October.

    At the start of this year, half the co-ops had failed, taking with them more than $1 billion in taxpayer loans.

    The bleeding has continued. Four more are going under this year and will close by year's end. As happened last year, there could be a rash of closures this fall, before open enrollment starts. The co-ops that are still alive may decide that they can't afford to stay in business another year.

    All told, some 800,000 people have been forced to give up health plans they liked and look for another insurance carrier following the demise of their co-op. In some cases, they don't have many other choices. On Connecticut's insurance exchange, for example, there are just two insurers left following the failure of HealthyCT. Both are asking for double-digit premium increases next year.

While nobody looks likely to be going without insurance, this doesn't help convince people that the law is working

  • 1
    Comments are not for extended discussion; this conversation has been moved to chat. – Philipp May 9 '17 at 12:01
29

One reason might be that many Americans apparently did not know that the vilified Obamacare is what is paying for their health insurance.

  • That's what happens if you don't actually differentiate in the cost how much the government paid for. – Joshua May 5 '17 at 19:00
  • 6
    According to the article you posted, more republicans know that "Obamacare=ACA" than democrats. You could make the argument that the people more ignorant about the law are in favor of it; those that are more knowledgeable about the law are opposed to it. – Ben Miller May 15 '17 at 14:19
28

This answer is meant to supplement others here with some further reasons why conservatives are against the Obamacare system.

  1. Obama falsely promised the public some critical things about the system that came to be called Obamacare:

    ...No matter how we reform health care, we will keep this promise: If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.

    This promise was eventually rated by Politifact as "Lie of the Year". A lie of such magnitude that it is sometimes classed beside George H. W. Bush's "Read My Lips" tax promise. In reality, many individual coverage plans were dropped by insurance companies, leaving patients to have to enter the new state or federal exchanges to find new plans - which often meant changing networks of doctors.

    While the law did Department of Health and Human Services issued a regulation to "grandfather" existing plans, it did not force insurance companies to continue all their coverage plans. Many insurance companies saw fit to terminate many of their existing plans in favor of the new ones. Ultimately, Obama did promise, "no matter what", and that turned out to be false.

    Even for those who have now adjusted, it is hard to like a system that burned you on its way into your life.

  2. Because only businesses with less than 50 full time employees (with "full time" redefined by the law as 30 or more working hours per week) are exempt under Obamacare from employer-provided coverage mandates, many small businesses restructured themselves and reclassified employees as part-time working less than 30 hours a week. This caused large numbers of non-college-educated working people, a largely Republican demographic, to change from working one job to working two or more, often with strange and stressful schedules, in order to preserve approximately the same income level. This is a huge and unpleasant societal change that was directly caused by the introduction of Obamacare.

  3. Not only are premiums still climbing far above the rate of inflation on average from year to year after its passage, but under Obamacare deductibles are also climbing quickly from year to year. However, real wages are fairly flat. Many policy-holders report that their plan deductibles are so high, they cannot afford to go to the doctor any more because they would pay much of the cost out of pocket. The only reason for those people to continue to carry the policies is as a hedge against the astronomical cost of extended hospital stays and surgery. To the extent this is true, it works against the argument that getting people "covered" will encourage preventative care.

  4. The "individual mandate" to purchase a health insurance policy is not the only affirmative mandate brought on by Obamacare. There is also the "employer mandate" that requires businesses by law to provide group health insurance plans for their employees. Only businesses with fewer than 50 full time employees are exempt. Most large employers did this already before, but now there is no choice except for the company to pay a heavy penalty.

    There are also various mandates on the insurance companies, for categories of coverage that are considered "essential" in plans and make them more expensive. Obamacare opponents argue that some of these make no sense as universal mandates; for example, people who are unable to conceive plainly do not need maternity coverage. Many conservatives dislike these mandates on the basis of free-market principles.

    Some "essential services" mandates have brought legal challenges. The mandate that employers provide insurance plans that include contraceptives, including the "morning after pill", was successfully challenged before the US Supreme Court. Conservatives now remember the "Hobby Lobby case" as one example of how "big government" can endanger liberty in unforeseen ways.

  5. A constitutional challenge to Obamacare's "individual mandate" before the US Supreme Court, on the basis that the federal government has no power to compel citizens to engage in commerce, was defeated. The majority Court opinion appeared to concede the challenger's argument, but held that the individual mandate was as a matter of law a tax on a class of people (those who do not buy insurance), not an actual requirement or penalty.

    This is despite many media statements by Obama and his allies that the mandate was not a tax. The ruling that the mandate is actually a tax is also curious because the Constitution requires tax laws to originate in the House of Representatives, but the Affordable Care Act originated in the Senate (depending on your point of view).

    Many conservatives continue to resent not only the mandate itself but the "wrong" Supreme Court opinion that approved it, and by extension the Obamacare system itself, which even its defenders say cannot remain solvent without the individual mandate.

  6. Much of the total Obamacare "system" is not set in black-letter law but in rulings by unelected federal agencies. Some of these agency rules are highly complex. Assuming the law remains unchanged indefinitely, future administrations or agency heads might change these rules, which can carry the force of law (in the sense of general obligation to follow them), without act of Congress. Obamacare critics say this possibility fosters a sense of anxiety, particularly among small business owners.

    While this kind of rule-setting by federal agencies is not new with Obamacare, it has not helped public perception of the law. In some cases, agencies have made rulings that even contradict the written law, creating interesting legal questions and damaging to some degree the public trust. Critics accused the Obama administration of usurping Congress by rewriting the law.

  • 5
    "many individual coverage plans were dropped by insurance companies," because they did not include things the law mandated. A report by OMB (or some similar agency) warned in advance of "the lie" that this would happen. As for keeping your doctor, the government cannot force a doctor to contract with any particular insurance plan. You can keep your doctor if you are willing to pay when he is no longer "in network" – WGroleau May 6 '17 at 0:34
  • 3
    Re "If you like your doctor...", seems to me the assumption that I, or most healthy people, actually HAVE a doctor is one of the major conceptual problems here. – jamesqf May 6 '17 at 3:53
  • 3
    @WGroleau So I guess he should have said "You can keep your doctor [... as long as you're willing to pay exorbitant costs once this bill forces you into a plan that doesn't cover him]." Really rolls off the tongue. – JLRishe May 6 '17 at 20:15
  • 2
    Did the law grandfather plans? I seem to remember that when plans started getting cancelled in to anticipation of published regulations going into effect, that the regulations were then changed to not apply to plans that existed before the law was passed... but this didn't allow companies to "uncancel" plans, because the plan no longer met the grandfather requirement of having been continuously offered. – Ben Voigt May 6 '17 at 20:36
  • 2
    @BenVoigt I believe you're right. I had forgotten that. Edited. That could be a point #6 I guess. So much of Obamacare is not black-letter law but a regimen of regulations. Some of which, I think, actually contradicted the law itself, as in postponing hard deadlines and "decline to prosecute" type declarations. – wberry May 8 '17 at 14:56
23

First, read @Panda's excellent answer.

Second, note that about 70% of Democrats, and 15% of Republicans favor the Affordable Care Act, and this has been consistent over the past couple of years. This partisan discrepancy is at the core of the problem.

Anything with any level of complexity has both costs and benefits. This is certainly true of the Affordable Care Act. The Democrats (along with liberal-leaning media outlets) will rightfully boast of the benefits while the Republicans (along with conservative-leaning media outlets) will rightfully complain about the costs. In a healthy democracy, this is a fantastic place to start a debate and discussion about whether the benefits of increased insurance coverage for a broader swath of the population are worth the increased cost to insure them. Honest and informed people can disagree on that while understanding and respecting the opposition. But in a fragmented partisan country where most people trust one side and distrust the other, ignorance of the whole story grows along with confidence in one's position. And when people typically get on TV based on their confidence in their opinion, rather than their justification for or understanding of it, it's a recipe for civil war.

The direct answer to the question is that a combination of all factors in Panda's post apply, but only in combination with our biases that cause each of us to see only the information that agrees with our pre-existing beliefs. The low level of informed, legitimate disagreement with portions of Obamacare can only have grown into a passionate, ignorant anger-storm with the support of dysfunctional partisanship.

19

Another reason, at least for some of us who think about these things instead of reacting with knee-jerk partisanship, is that it does nothing to address the underlying problems. Indeed, it seems to me (though I have no hard data) that it actually worsens those problems. Which are

1) Medical care, especially basic medical care, is too expensive. There are a lot of built-in incentives for both providers and patients to opt for more expensive treatments instead of cheaper but equally effective ones, because after all "my insurance will cover it".

2) It ignores the role of lifestyle choices in wellness, and so it taxes healthy people to pay for the often self-inflicted problems of others.

  • 1
    Comments are not for extended discussion; this conversation has been moved to chat. – Philipp May 9 '17 at 12:01
14

One thing that other answers have missed is that it doesn't actually fix anything. It was supposed to make health care more affordable, but it did nothing of the sort. Health care in the US is broken because of bad laws, a bad business environment, and a bad risk situation on many levels, throughout the industry.

Put simply, the risk, and therefore cost, of providing care in the US is too high and therefore makes the overall system cost too much. All Obamacare did was some hand waving to spread the costs around without fixing any underlying problems. It effectively took something that most people could afford while a tiny percentage could not and made it something nobody can afford instead. While it's important that we not just abandon that small percentage that couldn't afford it, it didn't really make it affordable for them and also made it unaffordable for the vast majority as well. The "cheap" plans just mean that you're going slightly less bankrupt if anything happens to you and now even middle class people who previously had OK plans will also likely go bankrupt with any major medical expenses as all, but the most premium plans have been forced to go the high deductible route with many deductibles so high that they still virtually guarantee financial insolvency.

The problem is that nothing about Obamacare addresses the risks and thus the costs remain just as unsustainably high (or even more so with the additional bureaucracy now thrown in the mix), but now instead of the industry ignoring the part of the population that it most couldn't support, it is being dragged down rapidly without any meaningful fixes to the underlying problems. It was a bit like going to the ER for a gunshot wound and being given an advil. It might make it feel like it hurts a bit less, but you're still bleeding out rapidly.

  • 3
    Could you quantify "a tiny percentage"? – Dan Getz May 7 '17 at 14:41
  • It probably sounded like it was meant to make health care more affordable, but there's probably no way to do that short of single payer, and who knows if that would even work. What I thought it was meant to do was slow down the increase in cost, which is may or may not have done, it's hard to say. Costs did go up. Would they have gone up more if the ACA hadn't been passed? Maybe, maybe not. The idea that costs "shot up" during the life of the ACA isn't true, though. Or at least, they didn't increase by any percent greater than some increases before the ACA was passed. – Todd Wilcox May 10 '17 at 22:17
  • 2
    Health care premiums have risen significantly slower under ACA than they did in the previous decade. factcheck.org/2015/02/slower-premium-growth-under-obama The core purpose of ACA was to get more people insured, and it has largely succeeded at that goal. gallup.com/poll/201641/… – Timbo May 11 '17 at 2:05
  • @ToddWilcox It is true. My company had to drop their insurance plan a couple years after the law passed because it was going to jump up in price by a full 25% (both their contribution and the employee's). They found it cheaper to switch to a high deductible plan and then put cash in an HSA account for each employee instead, but the amount put into the HSA is less than a third of the deductible for an individual (as opposed to family) plan. Meaning that a single ER visit would now cost me thousands of dollars instead of hundreds. And my company certainly wasn't singled out. – jpmc26 Aug 16 at 2:57
14

I can only give you my reasons and examples that back them up.

Loss of the rite to choose level of care

First we have to look at the fact that with the transition to the ACA we lost the right to choose the level of care that we want. For many many years I had "Emergency care". It was cheap ($75 a month) and covered only emergency situations and resulting events. For example, if I needed coverage because I fell out of a tree and broke my arm, this would be covered. But a flu or normal care would not.

This was perfect for me as I rarely get sick, and while I never used the insurance, I felt better having it in case something did happen.

In this instance (emergency coverage) I was sold what I wanted, at the levels I wanted. I was always able to cover any of my own medical bills. However the ACA laws made this type of coverage unavailable.

Cost of Insurance is just plain too high

So I make enough that I do not qualify for any subsidies. My monthly insurance premium for my wife and I was $680 a month. This is an absurd amount. This coverage was also not great. Deductibles were higher then I would have liked, and co-pays were in the $80 range. This was just silly. There was no fair trade here.

As a self pay patient the local walk in clinic charges $75. But our co-pay is $80. We got no benefit from the insurance.

Cost to use the insurance was too high

My wife has RA. This is a long term condition that needs "constant" care. Once every 2 months she needs to have blood work and see a specialist. Once every year or so, she needs an iron infusion.

On insurance we paid (680 / 2) * 12 + 6 * 80 = 4,560 for her medical experiences, plus prescriptions (70 + 12 + 3 + 80) * 12 = 1980 for a total of $6,540 a year. Then her iron infusion was charged at 23,500 making it $30,040 (remember this but lets call it odd)

Without insurance as a self pay patent, we paid 120 * 6 = 720(visits) and (70 + 12 +3+82) * 12 = 2004 (prescriptions) + 125 * 6 = 750 (blood work) + $175 iron infusion. For a total of $3,649

Even without the odd ball iron infusion it was just cheaper to self pay.

We lost the ability to negotiate price

When your self pay, you have to pay up front, or at least make arrangements to pay up front. But with insurance we lost the ability to negotiate price. We have gone to the same facility for years for an iron infusion, and they always charged $175. The one time we had insurance they charged $23,500. The insurance paid $175, and we got stuck with the rest of the bill. But come to find out that because the insurance negotiated "on our behalf" we had a much harder time making any headway. The normal argument we got was "I don't know but your insurance agreed, this is what you owe".

Quality of care is rock bottom

I'm sure others will have other stories but the second we went to insurance we lost a ton of care options. We had to follow a prescribed path. It didn't matter that my Wife's RA was life long, and she had reached a balance. She had to switch drugs many time, adjust doses, and otherwise be put through the ringer to comply with the insurance policy.

Her long time doctor now had his hands tied, and could not do some of the more effective things to help her out.

Once we were self pay again, he had her setup almost instantly (some of the drugs had to be changed slowly) and now she is very happy and not at all in constant pain that she can't manage. The doctor can treat her and not just follow the insurance path.

Ohhh the lies

A personal gripe of mine is when I speak with her parents on the subject (or most anyone else). They all claim it's for the greater good and that people can not afford insurance that would not have had it before.

I point out that for many of the people getting "cheaper" insurance, it's still too expensive to use, and for the most part there not getting cheaper insurance there just deferring the cost till they get their tax returns. Instead of pointing this out though the exchanges and market places show listings like $40 a month. And totally gloss over the fact that they actually have to pay the same, or close to the same premium, they just won't be getting a tax return. This has gotten better, but is still a problem.

Doesn't fix a problem

There are good parts to the ACA. But the forced insurance does not fix a core problem. The insurance system in the US is greatly flawed. The idea behind it is flawed. We are trying to use it for something it is not meant for, and we keep shoe horning it in. Insurance is supposed to be about risk avoidance. However with medical insurance too many people use it as a monthly medical bill that entitles them to care.

In the same venue, the system is nearly criminal. A doctor has to charge more for an insured patient then for a self pay patient because there is that much overhead. At the same time they also have to file specific things. In the end the doctors are actually making less then with self pay (so I am told), and have to go through more hassle to get it, meanwhile the patients are generally paying more. There are exceptions, of course, but as a rule patients pay more, doctors earn less, and insurance companies gobble up the difference.

  • 5
    Thank you for bringing up the cost of blood work. One part of the ACA requires insurance companies to spend 80% of premiums collected on healthcare. This creates a perverse situation where if you want to increase profits, you have to increase cost. – A Bailey May 9 '17 at 14:01
8

The US missed the last boat to get to an easy implementation of a universal healthcare system in the 1970s. We can read here:

Over time, Kennedy realized his own plan couldn’t succeed. Opposition from the insurance companies was too great. So Kennedy dispatched his staffers to meet secretly with Nixon’s people to broker a compromise. Kennedy came close to backing Nixon’s plan, but turned away at the last minute, under pressure from the unions. Then Watergate hit and took Nixon down. Kennedy said later that walking away from that deal was one of the biggest mistakes of his life.

“That was the best deal we were going to get,” Kennedy told me before he died. “Nothing since has ever come close.”

The healthcare industry has grown enormously since that time, for the US this means that their healthcare industry has its own economic interests. Many people are employed today within that system who could not have been employed had the US implemented a universal healthcare system back in the 1970s or earlier. The costs of the US healthcare system are then much higher than in other Western countries because of the economic needs of the system. The fact that these costs are hardwired into the system makes the US system very hard to reform toward a universal healthcare system.

Obamacare could only have succeeded if it was implemented as the first step toward major reforms that would have taken decades to implement, requiring a large consensus in society. Many new laws would need to have been passed to fine tune the system throughout that period, political debates about such issues can be helpful only if they are constructive debates about the substance. Nothing of the sort happened in the US, the country was divided about whether or not to go ahead with Obamacare even after it was adopted in Congress.

The decision to go ahead would, of course, always have been controversial, but what then matters is what happens after a decision is made. E.g. in case of the hugely controversial Brexit, the debate in Britain about whether or not to go ahead with this has been closed after the referendum. All political parties, including those that were vehemently opposed to Brexit, are now accepting that Brexit is a reality. With the political debate about whether or not to leave the EU closed, one can concentrate on the best way to implement Brexit.

Because this did not happen with Obamacare, it was doomed to fail. So, fundamentally the problem was not about many people being against Obamacare, it's purely a failure to get to an agreement to move the country in a new direction that necessarily requires a large fraction of the country to agree to disagree and work constructively toward implementation. Then with the implementation of the Obamacare de-facto sabotaged, the problems associated with it increased over time, which gave the opponents a lot more ammunition to argue against it. These arguments are, of course, totally irrelevant to understanding how the opposition against Obamacare took hold and how it ultimately got repealed.

  • 1
    ...Excellent +1 – Venture2099 May 6 '17 at 7:46
  • 3
    Those people wouldn't have been employed at all? The 1970s was a long time ago. I'd imagine the jobs would have just shifted to some other industry. Is there something else behind that analysis? – indigochild May 6 '17 at 18:14
  • 1
    @indigochild The fastest-growing job sector in the US (and indeed, the fastest growing economic sector in the us) is currently healthcare. This wouldn't and couldn't be true with private healthcare. (note: this is not an argument pro or anti private healthcare, just a partial answer to your question) – Dewi Morgan May 6 '17 at 20:56
8

Why are so many Americans against Obamacare?

I guess you could say I'm against Obamacare, but I think it's more fair to say that I'm mad at the system, of which the ACA is a part. I want to give you a lot of personal details, with the hope that 1) you don't see me as just talking about this stuff as abstract political argumentation, and 2) maybe I get to contribute something new/different to a familiar debate.

Background

Back in 2009/2010 when reform was being discussed, I was generally in favor of ACA legislation and the opinion that there were problems that needed to be fixed. I was just entering the full-time workforce around then, and I worked for a company that was big enough to provide good health insurance. I think I had $130 taken out of my paycheck per month, and I had a $500 deductible and low co-pays. This set my expectations for what healthcare looked like as an adult with my own plan.

Health care costs on the exchange

In 2014 I changed jobs. My company is small enough that offering health insurance isn't really a financial gain for anyone, so I went on the exchange. I picked a Gold plan that had a monthly premium of $169/month. It had a $1,200 deductible, a $3,700 max out-of-pocket, and reasonable co-pays ($20 for primary care). This was a slight increase across the board but very much within reach of what I previously had (and the job gave me a raise as well), so I signed up and was generally happy with the plan.

For 2015, the premium went up to $192.58/month. Not unreasonable. The only other change here was that they split their network into two tiers: "Enhanced" and "Standard". But my local services were in the good tier, so no big deal.

2016 was a different game because I had a lot of life changes that made thing less cut-and-dry. I'll skip the details in an attempt at brevity.

In 2017, if I had purchased a Gold plan for myself, I'd probably have picked the plan that looks like this: $332.63/month premium, $1,000 deductible, $6,500 out-of-pocket maximum. Almost twice as expensive as 2014 for two of those three metrics.

But I have other family members in the mix now and I think it would have been too expensive for all of us to have that plan, so we dropped to a Bronze tier plan. Our plan now has three "in-network" tiers instead of two. Our health providers are in the middle one, so I'll use those figures for pricing.

We are paying just under $700/month in premiums for four humans. If it was just me, I'd be paying $225/month. What does our $8,400/year get us? $13,600 family deductible ($6,800 is the individual deductible, for comparison), $14,300 max out-of-pocket ($7,150 individual), and a whopping $130 co-pay just to get in the door at a primary care place (it'd be $90 if I was willing to go to the 'preferred' places that are further away from me).

We don't qualify for financial assistance either, so that means that the architects of the current legislation think that we make enough money that this isn't a burdensome expense. And they may well be correct, in a sense. I don't think $700/month would be a terrible fee for healthcare, if it bought peace of mind that everything would be covered.

But it doesn't do that. A $130 copay means that when the kid is crying and you're thinking about going to the doctor, there's a 50/50 chance that you wasted the money because it was just a cold and not an ear infection. And even though you know you can get a free checkup every year, you don't go because you don't want to deal with turning down an extra test that might end up functionally being an out-of-pocket expense.

Why am I mad at the system?

If you think of buying health insurance like buying any other kind of insurance, you get maddeningly frustrated.

First, it's a boring product that you're forced to buy, so there's a similar level of interest as, say, buying a water heater. But even that's not a great analogy, because you could choose to not heat water in your home, or rent so you don't have to make that decision. While I fully understand (and don't necessarily disagree with) the notion that you need everyone to buy in to control costs for everyone else, the fact remains that being compelled to do something against your will doesn't jibe psychologically with humans [citation needed]. While I probably would never choose to go without health insurance unless I couldn't afford it, having the option means that I would have an actual choice.

Second, I have no control over costs. For car insurance (and most things that I buy, really), I have power to control my policy premium. I can tailor a plan to where I live, so an underwriter wouldn't factor in snow/salt damage to a car in southern California. I can install some device in my car so the insurer knows I'm a safe driver and lower my premium adjusted accordingly. If I don't get tickets or don't get in an accident, my premiums can go down. But for health insurance? I can be completely healthy and still have my premiums go up. I could theoretically rack up a bunch of expenses on injuries caused by reckless behavior, and no one's the wiser when it's time to pick a policy next year. I could live next door to the hospital, but I still have to buy a plan that covers ambulatory expenses. When those cost increases happen, there is nothing that I can do about it.

Third, it's a confusing place to do business. Every year you have to relearn what all the terms are and you have to figure out what the plans are actually offering. For example, I'm looking at plans available to me on the exchange right now. Two plans are from the same provider, both in the bronze tier, have the same deductibles and max out-of-pockets, but one costs $9.50 more per month. Presumably these plans both exist to serve different needs, but what are those needs? Time to read a bunch of documentation and learn how their networks operate. And even once you pick a plan, you have to watch out for gotchas, because if you don't know them you pay big time. For example, in 2016 my lack of understanding of my policy cost me $1,500 in unexpected expenses. Is that my fault? Ultimately, yes. But I'd like to think it could have been explained better to me.

Fourth, as a relative expense, it feels like a terrible value. $700/month is roughly equal to my mortgage, property taxes, homeowner insurance, and the electric bill. A roof over your head and the juice to power it, a tangible benefit that you get to enjoy every day. Compare this to health insurance: A product that you never want to use, and because the deductible is so high you only ever benefit from it when something catastrophic happens to you. Car insurance is similar, but we pay about $100/month for two people, which isn't a massive expense.

Fifth, the cost increases over four years of plans seem really crazy. Is that the ACA's fault? I don't know, but I know that (with few exceptions) I'm not allowed to shop anywhere other than the exchange. If I could only shop at Walmart and the prices are high at Walmart, it's certainly easier to be mad at Walmart than it is to be mad at someone further up the supply chain, even though it might not be correct to do so.

Sixth, the fact that employers offer insurance throws a few wrenches in the mix. First, I'm pretty confident that that $130/month I paid back in the day was subsidized, so I don't know the true cost of my plan. Second, I believe that was a pre-tax expense, so I saved money that way too. It'd be nice for contractors/consultants/small businesses to get the same benefits. Third, since a really high percentage of people get insurance like this through their work, they don't know what it's like to be on the exchange and often don't make good arguments about healthcare as a result.

Some discussion of these arguments

You could look at all of these complaints and contend that single-payer would address each one. I don't disagree. But when you go down that road you start to worry about what your government will choose to cover or not cover. Let's use euthanasia as an example (trying not to kick hornet nests in this post but I need something for this example) - some people want it, some people don't. I'm against it morally, but I know that the actuarial tables will make it look extremely tempting to an administration looking to reduce end-of-life healthcare costs.

So perhaps the fundamental flaws of the ACA are:

  1. It's trying to advance goals and ideology of universal healthcare through a system of purchasing a private insurance product. This creates cognitive dissonance.
  2. It's expensive! I've argued with my friends that if you surveyed every American and asked "Would you support universal healthcare if it cost you $20/month?" the results would be overwhelmingly in support. $20 for that random guy to have his cancer looked after? Absolutely! But when $8,400 a year disappears from my paycheck with only the vague promise that it'll keep me from bankruptcy if the unthinkable happens? It's harder to look past your family at that point.
  3. Lack of choice. If you view healthcare as a product similar to other types of insurance, then the restrictions of 1) being forced to buy something, 2) being more-or-less forced to buy it from one place, and 3) having limited buying options creates for a really unpleasant experience.
  • 2
    Excellent breakdown of the issues as seen by an individual. It's not that you are against healthcare but this implementation. Thank you for the clear and well thought out post. – Kelly S. French May 8 '17 at 20:37
  • 3
    This answer is just an anecdote with lots of opinion thrown in. – indigochild May 8 '17 at 20:53
  • 3
    @indigochild The question was "Why are so many Americans against Obamacare?" - I answered that question from the perspective of at least one of those Americans! If you think any argument I construct could be fleshed out better or reworded for clarity, I'd be interested in doing so. – Brendan May 8 '17 at 20:59
  • 1
    @Brendan - The core problem is that your answer doesn't answer the question. It is only an anecdote, which is not sufficient evidence to provide a general answer. If this answer can be expanded to include "many Americans" (as the question says) it would be okay. – indigochild May 8 '17 at 21:05
  • 2
    @indigochild Perhaps OP could enlighten us here. It seemed to me that this question is attracting many answers representing many Americans; I figured I was adding a data point to what's already here. OP also said "I find it very difficult to understand why so many people would vote this way" - so I was looking to answer in a way that could convey understanding. But if OP is specifically looking for survey data, then I agree that I'm off-topic here. – Brendan May 8 '17 at 21:41
7

It's mostly simple partisanship, actually. The entire concept that "Obamacare" is based upon, particularly the mandate, is a Republican/Conservative plan/idea put forward by the uber-conservative Heritage Society after Clinton attempted and failed to overhaul health care.

Forbes: How A Conservative Think Tank Invented The Individual Mandate

Immediately after Obama was sworn in, the Republican leadership got together and swore not just to oppose Obama's stated agenda, but anything he agreed with, to obstruct him and prevent him from having any policy victories.

PBS: The Republicans' Plan For The New President

How else does one explain lockstep opposition and demonization of a conservative, Republican proposal? Personal opposition to the president, for the most part.

You could also see it when Republicans would vote against their own amendments and their own bills, even the authors of the bills, as soon as Obama stated that he was willing to go along or even supported their measures.

10 Ideas Republicans Loved Until Obama Became President

Most of the claims about harm done by Obamacare are overblown and based on ignorance. Leading up to full implementation and just after, you'd hear a lot of horror stories, but most of them did not hold up to scrutiny when they were examined or fact-checked. But, as most things intended as partisan propaganda, the truth of it really had no effect on whether the claims would be repeated as fact.

LA Times: Maybe There Are No Genuine Obamacare Horror Stories

Rates went up, at a faster rate, before ACA was passed. The cheap "coverage" that could no longer be offered were essentially garbage plans that collected premiums and had no chance of actually paying any claims. Insurance companies changed plans, changed covered and preferred providers, and employers changed insurance plans to ones with different networks and coverage before the ACA, so the fact that something that has always happened still happened could hardly be blamed on the ACA.

  • 7
    The question isn't about the political parties reasons for disliking the healthcare law. It's about Americans' reasons for disliking the healthcare law. The only evidence you provide a link discussing the origins of the mandate, the GOP's plan for Obama, an article about GOP ideas changing in response to Obama, and an editorial hypothesizing that no one suffered any negative effects by cherry picking a select few stories and spinning them. This answer could be improved by answering the question and using relevant sources – A Bailey May 5 '17 at 15:03
  • 12
    @ABailey - You think a constant barrage of partisan misinformation, propaganda and talking points has no influence on what people think is true and factual? I have some great swamp land to sell you if that's your mindset. When the people answer polls stating reasons that have no basis in fact, but parrot partisan talking points, it's difficult to imagine why someone would think these are somehow not related. – PoloHoleSet May 5 '17 at 15:14
  • 9
    How does your answer explain Democrats who opposes the ACA? How does your answer address Libertarians or Green party members who don't support the law? Do they only oppose the law because of the GOP? Dems + GOPs != All Americans. Edit: There are GOP voters that support the law as well. Party policies are a great place to see WHAT people think, but they rarely cover the spectrum of WHY people think that way – A Bailey May 5 '17 at 16:20
  • 5
    @ABailey - Democrats and Greens mostly feel it didn't go far enough. Libertarians believe that people should be left to eat the weaker for sustenance. Feeling it didn't go far enough is not the same as "opposing" it vs the previous status quo. The vast majority of the opposition we see is covered by my answer. You'll notice that I used the term "mostly," not "all." Most who currently call themselves Libertarians back the GOP in our two-party system. Most who currently call themselves Libertarians are simply uber-conservative Republicans who have attempted to re-brand themselves. – PoloHoleSet May 5 '17 at 16:46
  • 4
    @Luann - sorry, you're right. Not the weaker. The poor and the poorer. – PoloHoleSet May 8 '17 at 14:36
6

Because they are unfamiliar with George Bernard Shaw's Preface on Doctors (1909), which encapsulates the conflicts of interest inherent in privatized healthcare?

It is not the fault of our doctors that the medical service of the community, as at present provided for, is a murderous absurdity. That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity. But that is precisely what we have done. And the more appalling the mutilation, the more the mutilator is paid. He who corrects the ingrowing toe-nail receives a few shillings: he who cuts your inside out receives hundreds of guineas, except when he does it to a poor person for practice.

  • 6
    I downvoted because it's somewhat absurd to suppose that being familiar with a play is the causal reason why someone believes something (or doesn't). – indigochild May 6 '17 at 18:16
  • 1
    Upvoted because if you look at the numbers, results do not lie. The US has by far NOT the best healthcare system, but spends absurd amounts of money in it - due to a very vested conflict of interest. Chck the graph at pbs.org/newshour/rundown/… for an idea how absurd high the american health care cost is. TWICE that of germany, roughly. Nearly 80% higher or so than Switzerland. And still a lot of americans have no coverage - where does all that money go? – TomTom May 7 '17 at 12:10
  • 3
    @indigochild you may be reading this answer too literally. – user1530 May 8 '17 at 6:13
  • @indigochild, (a) I think you misunderstood me :) (b) your comment denies the antecedent (c) your conclusion is questionable: cf. 1 2 3 4 5. – sampablokuper May 11 '17 at 14:49
4

I can't speak for all Americans, but I can speak for myself. I was forced onto obamacare when my employer was allowed to drop the mandatory health care coverage. The cost is staggering... $1800/month to cover a family of four. It's bleeding me dry. And that's an HMO plan that's not very good.

My personal objection to obamacare is that it did nothing to address the staggering cost, other than send it higher. Three years ago, it was $800/month, Then $1000. Then $1300. and now $1800. What will next year bring? It may bring no coverage at all: the one insurer that covers my state is indicating that it may discontinue that in 2018. What does that mean for me and my family? I don't know, other than I am accelerating my search for a job that has a health care plan.

Obamacare has a flawed economic model. You don't have to buy into it. Yes, there is an IRS penalty, but it's paltry compared to the cost. When you combine that massive hole with a good requirement: the requirement to cover any existing condition, you get... a lot of people not buying health insurance until they get sick. That accounts for a good deal of the cost rise: largely sick people signing up, while healthy people coast by. This is somewhat akin to not having to buy car insurance until you had a wreck. Wouldn't that be great? Of course, you can imagine what the cost would shoot up to.

Ironically, the US has a health care system somewhat similar to the UK's NHS: it's called Medicare, and it covers anyone over the age of 65. Funded by payroll deductions from working people. Why they don't just extend that to cover all people is beyond me. Why the democrats didn't do that in 2008-2009 is even more beyond me. I would love to hear their explanation. (the real one is probably insurance company money)

Even more ironically, there was a proposal in the 2016 election to open Medicare up to people over the age of 55. The cost would have been around $10k/year for a family of four, a lot less than I'm paying now. And the person who made this proposal? Hillary Clinton. That sensible idea got lost in all the shouting. As much as I detest her for being obviously dishonest and graft prone, that was a good idea.

That is my opposition to Obamacare. It sucks. It has eliminated my retirement fund contributions, and college fund contributions for my kids. And what did I get in return? A worse health care plan than I had before. Obamacare has been the first time in my 50+ years, that my government did something that genuinely hurt me.

-2

I am going to answer this based on my personal experience with what the ACA did to my family:

In 2013 my family's health insurance through my employer cost me around $450/month and our deductible was $1000/year

In 2014 my plan was altered and the cost skyrocketed. It went to $1350/month with a $5,000 per year deductible. We could no longer afford to purchase it for the whole family. So my wife & I decided to drop the plan & pay the penalty and pay for our healthcare out of pocket.

At the end of the year after paying our 'fine' and paying out of pocket for our healthcare the total cost was about 1/2 of what it would have been if we had paid the premiums all year.

Our investment plan now encompasses a separate set of funds set up for potential 'catastrophic' care and we continue to pay out of pocket. You kind of get raped paying out of pocket, but as long as you're reasonably healthy the "raping" isn't as severe as paying the premiums now.

I believe that this scenario happened to many middle-class Americans, but the media doesn't mention it. This is why it was such a popular topic.

  • 3
    How did the ACA make your rates skyrocket? Who is your employer, where do you live, and who was your insurance provider, before and after? Claims like this usually fall apart when fact-checked. – PoloHoleSet Jan 7 at 17:50

protected by Philipp May 5 '17 at 23:40

Thank you for your interest in this question. Because it has attracted low-quality or spam answers that had to be removed, posting an answer now requires 10 reputation on this site (the association bonus does not count).

Would you like to answer one of these unanswered questions instead?

Not the answer you're looking for? Browse other questions tagged or ask your own question.