Whither Obamacare?

[CountDeMoney]

While I obviously disagree with that individual's choice to vote for Trump, he was right on the basic point - voting isn't, or shouldn't be, simply based on "what's in it for me".

How about you go fuck yourself.

Hey, you know what, maybe you're right;  you going off and promptly fucking yourself is about more than "what's in it for me;" it's about the good of the Languish community.  THE GREATER GOOD

[HVC]

They were stupid enough to vote for the guy who told them to their face what he would do, so they're stupid enough to vote for the next guy too.

[Jacob]

If the new situation may ruin your financially or kill you, I think "what's in it for me" is a legitimate concern.

Indeed.

[garbon]

They were stupid enough to vote for the guy who told them to their face what he would do, so they're stupid enough to vote for the next guy too.

Without health insurance, they may not survive.

[CountDeMoney]

Or does the GOP manage to muddle along in a way where they keep people covered? And if so, can they find a way where they don't look like they went back on their promise.

That's the optimistic one. Maybe the "replace" part of Repeal and Replace will keep them covered.

People are assuming there will still be any insurance participants willing to stick around in dead marketplaces waiting a year or three for the "Replace" part.  There won't be. You can't set plans and premiums in a void.

The GOP will be fine; this is what their gerrymandered constituents want, and if they rip off the Band-Aid early enough, people will get over it by the midterms. And for the ones that won't? What's a few dead diabetic niggers to them anyway.  Dumbasses wouldn't have to worry about a lack of healthcare if they had jobs with employer-provided healthcare.  Talk about short-sighted AND EYE CARE ISN'T COVERED EITHER #LOLCLOWNZ

[grumbler]

Without health insurance, they may not survive.

The problem is that they are killing non-stupid people as well.  That's why my sympathy for them is low and my empathy non-existent,

[grumbler]

Or does the GOP manage to muddle along in a way where they keep people covered? And if so, can they find a way where they don't look like they went back on their promise.

That's the optimistic one. Maybe the "replace" part of Repeal and Replace will keep them covered.

Maybe, but unicorns haven't proven to be a reliable method of health care delivery.

[HisMajestyBOB]

While I obviously disagree with that individual's choice to vote for Trump, he was right on the basic point - voting isn't, or shouldn't be, simply based on "what's in it for me".

Apparently lower-class GOP voters are among the most selfless people on Earth, willing to die for the 1%'s tax cuts.

How noble.

[garbon]

Without health insurance, they may not survive.

The problem is that they are killing non-stupid people as well.  That's why my sympathy for them is low and my empathy non-existent,

True. Of course, I don't think I was evincing much sympathy or empathy when I said they'd likely die before voting in another stupid person.

[DGuller]

While I obviously disagree with that individual's choice to vote for Trump, he was right on the basic point - voting isn't, or shouldn't be, simply based on "what's in it for me".

He did what's best for the country:  shortening his own life expectancy.

[OttoVonBismarck]

Eh, the truth is the ACA was badly done from the start and is almost set up to fail politically. I'll explain:

1. It was never branded or sold well. No good marketing like "Medicare" and "Medicaid", in a way George W. Bush was wiser when he created Medicare Part D, because it's now commingled in senior voters minds with "Medicare", something that if you cut they vote you out of office. Obviously you couldn't ram the entire ACA reforms under the aegis of Medicare, but the reality is the exchanges and all the employer and individual market reforms were too complex for ordinary voters to understand. Part of the jobs of politics is boiling down complex ideas your side supports into buzzwords and simple explanations that ordinary people will understand. It's telling that a lot of Trump voters on Kynect (Kentucky's self-branded ACA exchange), who were interviewed post election didn't know their exchange plan was provided through "Obamacare." In a sense, because the healthcare reforms were successfully labeled "Obamacare" by the GOP, and the official exchanges and the various government websites never use that term (because Obama never really embraced it until the 2012 election debates, but it's obviously never been official terminology) a lot of people weren't making the connection.

This is one of those arguments that on its face is so stupid most people I feel wouldn't believe it. But if you look at how people actually talk about the healthcare act and their votes for Donald Trump, it's pretty obvious to me Obama was never able to sell his healthcare reforms as a comprehensive "idea" that people could buy into or reject. That's a problem. And part of why it's always been so easy to attack.

2. A lot of employer premiums went up during the Obamacare implementation. While some of them were to make the plans Obamacare compliant, some were just ordinary premium increases, some were employers reducing their share of paid premiums and etc. Almost universally, people were now blaming these premium increases on Obamacare, largely because the Republicans successfully sold that narrative, and the Democrats never figured out a good way to explain that what you're paying in employer provided healthcare, in terms of your premium, is incredibly complex and also based on decisions your employer makes about how much of your healthcare expenses they wish to cover. How that intersects with ACA reforms is again, quite complex, and at the end of the day very few people got much further than "premiums went up, Obamacare bad."

3. Finally, the real problem with Obamacare is that the way it affected people who already had insurance (the majority of voters, the vast majority) is that it reformed the "essential benefits" that health insurance is required to cover, and it eliminated lifetime maximums, raised the age at which dependents must be offered coverage on their parent's plan, and changed the percentage of "total costs" that the plan must cover.

What this did almost universally was raise premiums, but for the same reason a monthly car payment is higher on a BMW 5 series than on a Ford Fiesta. People were now getting, in whole, a more comprehensive set of benefits that better protected their total potential financial outlay in case of a catastrophic health issue, but what Obama and most policy wonks who are pro-ACA didn't factor in is most middle and lower income homes run their households based on their monthly bills and income. While it's nice that if dad needs a liver transplant, he doesn't have a plan that's capped at a $500,000 maximum, the fact is most middle income working people don't suffer catastrophic health problems. What they are is highly conscious of their monthly bills, and the ACA raised premiums for anyone who wasn't getting a subsidy. Particularly in the individual/exchange market, where non-subsidized plans went through the roof (although a large share of their increase was related to all the old and sick people who got into the exchange plans and made them almost actuarially impossible to make a profit from.)

If you're going to raise people's monthly bills, you need to have a good reason for it. While I'd guess society in whole is "probably" better off with the ACA than before it, it's "close" and when something is close, and people's monthly bills are going up a lot, I think it becomes a really hard sell.

I think the reforms of employer plans was in the whole, pretty damn good, particularly because employer plans have pretty good risk pools and didn't have to jack premiums up to anywhere near the degree we saw in the individual market. I think that employer mandates (about offering insurance and etc) are also good, because that's one of the bigger ways that Obamacare has expanded coverage. But I think Obama just did too much. He probably shouldn't stuck to reforming employer plans and expanding Medicaid a bit, along with passing some sort of actual cost control measures.

[11B4V]

They were stupid enough to vote for the guy who told them to their face what he would do, so they're stupid enough to vote for the next guy too.

Without health insurance, they may not survive.

Thinning the gene pool.

[Berkut]

While I obviously disagree with that individual's choice to vote for Trump, he was right on the basic point - voting isn't, or shouldn't be, simply based on "what's in it for me".

That wasn't his basic point though.

His basic point is that Trump is going to make the economy so Great that he won't even need Obamacare anymore.

That takes a special kind of ignorance to buy into.

[grumbler]

Otto, you make a lot of good points and I think you are correct on all of them.

The other problem with ACA was that the republicans sabotaged the health care reform by refusing to agree to correct problems/errors that arose.  They wanted their constituents to suffer, hoping to divert the blame for that suffering onto the House minority.  It was a bold gamble, but, in the end, they proved that no one can lose by underestimating the stupidity of that segment of Republican voters.

The PR side of things, and the perception side, you have well-described.  Thanks.

[Admiral Yi]

<snip.

One minor point I'd like to add is that in some respects Obamacare was politically wounded by the overshooting of new entrants into the insurance market who underpriced their premiums because they were new entrants to the market and/or because they were trying to game the "cost averaging" component of the bill (I might have the jargon wrong) which Rubio killed about 3 years into the program.  So reverting to trend after this overshoot was badly timed from an election cycle perspective.