Obamacare: Mend it, don't end it
Thursday , October 31, 2013 - 2:13 PM
WASHINGTON — Obamacare is under attack. Its website is glitchy, its prices are uneven, and insurance policies that don’t meet its standards are being withdrawn. But President Barack Obama is sticking with it, scolding its Republican critics, and betting that in the long run, he’ll win. He may be right.
Obama’s bet, on a message level, is that the public likes the idea of the Affordable Care Act, even if they’re unhappy with its implementation or some of its features. He’s for something that addresses our health care needs. Republicans, lacking a plausible alternative, offer nothing but obstruction. The law is being implemented. The GOP can’t fight it without, in effect, rolling back coverage and benefits. Changing the law’s details is a popular position. Repealing it isn’t.
Look at the polls. In a CBS News survey taken Oct. 1-2, a majority of Americans — 51 to 43 percent — disapproved of the Affordable Care Act. Only 43 percent, however, said the law went “too far in changing the U.S. health care system.” Thirty percent said the law was about right, and 20 percent said it didn’t go far enough. The plurality supported the law or an extension of it. In an NBC News/Wall Street Journal poll taken Oct. 7-9, 43 percent of respondents said the law was a bad idea. Only 38 percent called it a good idea. But 50 percent opposed “totally eliminating federal funding” for it, compared with 39 percent who favored cutting off funds.
Twenty-one percent of Americans in a Gallup poll conducted Oct. 12-13 said they’d like major changes to the law. Ninteen percent said they’d like minor changes. But only 29 percent said they’d like the law to be repealed entirely — less than the 32 percent who took that position three years ago, and not much more than the 24 percent who said they’d like to keep the law as it is. When Gallup pressed further, asking respondents whether the changes they had in mind would scale the law back or expand it, 40 percent of those who wanted changes (and who answered the question either way) said they preferred to expand the law.
A CNN/ORC survey taken Oct. 18-20 found that respondents opposed the law, 56 to 41 percent. But when pressed further, 12 percent — nearly a quarter of those who opposed the law — said it wasn’t liberal enough. Only 38 percent of the entire sample — less than the number who favored the law — said it was too liberal. In a CBS News poll taken Oct. 18-21, a majority disapproved of the law, 51 to 43 percent. But when pressed as to why, the numbers turned upside-down. The percentage who said the law went too far dropped to 43. Twenty-nine percent said the law was about right, and 22 percent — nearly all of them Democrats and independents — said it didn’t go far enough.
Now comes a second NBC/Journal poll, conducted Oct. 25-28. The numbers look grim: Forty-seven percent say Obamacare is a bad idea, up from 43 percent in early October. When they’re asked whether the law “is working well the way it is,” “needs minor modifications to improve it,” “needs a major overhaul,” or “should be totally eliminated,” only 6 percent say it’s working well as is. But among the remaining options, 38 percent of respondents say the law needs minor modifications, 28 percent say it needs a major overhaul, and only 24 percent say it should be eliminated. The poll doesn’t ask those who favor a major overhaul whether the law should go further or be scaled back, so we don’t know whether, as in the other surveys, what looks like a majority for repeal or major rollback is really a minority. But the poll does ask whether Obamacare’s website problems “are short-term technical issues that happen in large projects like this and can be corrected” or “point to longer-term issues with the new health care law and its overall design that cannot be corrected.” On that question, 31 percent say the law’s faults can’t be corrected. Thirty-seven percent say they can, and 30 percent say it’s too soon to tell. There’s a majority for fixing or revising the program, but not for purging it.
This puts Republicans in a difficult spot. Their mantra, repeated over and over and over, is that the law must be “entirely repealed and replaced.” “One thing that all Republicans agreed on back in 2009 is that we thought Obamacare was a terrible mistake,” Senate Minority Leader Mitch McConnell, Ky., reminded the public on Oct. 20. “We still think that, and we’re going to do everything we can in the future to try to repeal it.” At a Tuesday press conference, House Speaker John Boehner agreed: “We want to repeal Obamacare and replace it with patient-centered healthcare.” When a reporter asked whether “Republicans would like to join in with some Democrats to change the law,” Boehner scoffed, “There is no way to fix this monstrosity.”
The polls don’t support that view. There’s a big gap between the public’s dissatisfaction and the GOP’s full-throated antagonism. Obama is filling that gap. He’s incorporating the dissatisfaction into his message of fixing, changing and improving the law. That’s why he went to Boston this week to tout the Massachusetts law on which the Affordable Care Act was modeled. Obama and Gov. Deval Patrick, D, recalled the early flaws in the Massachusetts program and how they were ironed out. Obama also told the story of President George W. Bush’s prescription drug program: “Once it was the law, everybody pitched in to try to make it work.” He conceded Obamacare’s troubles and promised, “We are going to keep working to improve the law.”
Obamacare’s problems could worsen. The public could turn against it. It could be repealed. But if its basic concept is as sound as the Massachusetts program — if it’s addressing a widespread problem and can be cleaned up with technical repairs and policy revisions — then the public will stick with it. And the GOP, eventually, will become the party of reform, not repeal.
Saletan (@saletan) covers science, technology and politics for Slate.