Obamacare is up for grabs: Who wins in November?

House Energy and Commerce Committee Republicans seemed surprised recently when representatives of the insurance industry reported that they didn’t have enough data yet to forecast prices for next year’s health insurance exchanges, the market was not about to blow up, and that so far at least 80% of consumers have paid for the health insurance policies they purchased on the exchanges. The executives also reported there are still serious back-end problems with Healthcare.gov — particularly in being able to reconcile the people the carriers think are covered and the people the government thinks are covered.

The insurance companies are doing their best to make Obamacare work.


Because if they want to be in the individual and small group markets, Obamacare is the only game in town: It has a monopoly over these markets. The same rules that apply to the individual market also apply to the even larger small group health insurance market.

Unless Obamacare is repealed this is the business reality insurance companies have to deal with. So, you make the best of it.

Republicans are right to think Obamacare is unpopular. The latest RealClearPolitics average of all major polls taken since open-enrollment closed still has 41% of those surveyed favorable to the law and 52% opposed to the law: about as bad it is always been.

But Obamacare is not going to be repealed. The sooner Republicans come to understand that the better for them.

I really think Democrats have the potential to take back, or at least neutralize, the health care issue by the November elections if Republicans aren’t careful.

Most voters are still very unhappy about Obamacare. They hate the individual mandate and they find the health plans, with their after subsidy premiums still too high, the deductibles and co-pays way too big, and the narrow networks too confining, unattractive.

But most don’t want it repealed, they want it fixed. In the latest Kaiser poll 58% want the law improved and only 35% want it replaced.

Obamacare is up for grabs: Who wins in November?

But, the Republicans’ challenge is that they have painted themselves into a political corner by convincing their base Obamacare has to be repealed: Republicans want the law repealed and replaced by a margin of 62% to 31%. That means any Republican running in a contested primary has to continue the repeal and replace line.

But once in the general election, the tables turn on this argument.

Independents want the law improved by a margin of 56% to 39%. Repeal and replace is a loser issue in the general election.

Looking at what the independents have to say, the Republican repeal and replace strategy could well run into trouble come November if Democrats are able to convince voters they are the party that understands Obamacare needs fixing and they are the ones to do it.

Obamacare will certainly have to be fixed.

Amid all of the Democratic euphoria over “eight million enrollments” (which are really about 6.5 million enrollments once all of the premiums are finally paid) is the fact that only about a third of those eligible to purchase subsidized health insurance on the exchanges did so.

That means two-thirds did not.

In an earlier post, I recounted the old marketing story about the dog food company that pulled out all of the stops to create the best dog food ever. But the product didn’t sell because the dogs didn’t like it.

Obamacare is a product that is a monopoly: You can’t buy individual health insurance anywhere else. It is a product that about everyone would agree you are much better off to have than not have. It is a product that the government will pay a big part of most people’s cost. And, if you don’t buy it the government will fine you.

And only a third of the subsidy eligible signed up?

I will suggest that lost in the celebration over “eight million enrollments” is the fact that two-thirds of the consumers who were eligible for a subsidy didn’t buy it. And, according to my travels in the market, about half that did buy it in the insurance exchanges already had insurance.

A McKinsey survey done during April estimates that 74% of those who bought coverage inside and outside the insurance exchanges had been previously insured, which would be consistent with my finding.

Obamacare is up for grabs: Who wins in November?

Obamacare’s two biggest problems come down to this: Not enough people are signing up for it to be sustainable in the long-term because the products it offers are unattractive.

The polls and the market’s response to Obamacare are all consistent: The program is not attractive and needs some serious fixing but it isn’t going to be repealed.

Republicans can continue to exploit this issue only if they understand this.

And, Democrats can win the issue back, or at least neutralize it, if they can get beyond their current euphoria over “eight million” and get real about how unhappy people are with the program and the plans it offers — and come up with a plan to fix Obamacare.

I feel like I’m watching a football game here. The ball (Obamacare) has been fumbled. It’s bouncing down the field up for grabs. The Republicans are saying they don’t have to chase the fumble because, “We’re are so far ahead we’re going to win the game anyway.” The Democrats are saying, “What fumble?” They’ve got “eight million reasons why the ball hasn’t been fumbled.”

Going into November, Obamacare as a major political issue, is up for grabs.

It’s going to be interesting to see which side, if any, gets past its overconfidence by figuring that out and jumps on the ball first.

Robert Laszewski is president, Health Policy and Strategy Associates and blogs at Health Care Policy and Marketplace Review.

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  • Bradford Lacy

    The tradgedy in all of this is that both the Democrats and the Republicans are more concerned about your vote than the things that really matter, like the health and well being of the American patient (and at some point in time we will all be patients) and the well being of the clinicians that provide service to those patients.

  • Karen Ronk

    There was a recent article in my local paper that 90% of those enrolled in my state were receiving subsidies. The only way those numbers are sustainable is a massive rate hike or a bail out of the insurance companies. Tell me how you fix that.

  • Ava Marie Wensko George

    Americans need to travel outside of our country more. Health care around the world is people centered. If you’re sick, you go to the doctor. They have never had to choose between buying food or medicine. Americans are so uneducated when it comes to health care overall. It really is highlighted with our conversation about health care here in our country. Some people who are apposed to the ACA have insurance and will not need to look elsewhere. Some people who need insurance but could never afford it are against it because of their political point of view. Then, we have those who have always needed it, could not afford it or who were denied due to preexisting conditions, who now can afford it and achieve insurance coverage. I think we have to leave politics out and focus on what will make America a healthier nation – Universal health care is the way of the future.

  • Robert Luedecke

    As a physician who has been heavily involved in healthcare reform since, 2007, I believe this author is right on! The President did not keep his promise of “if you like your insurance, you can keep it.” I did not volunteer my time to promote the forced change of insurance plans and doctors for Americans. I was betrayed and the American people were betrayed. The Republicans are stuck in repeal and replace and the Democrats are stuck in congratulating themselves. Whoever wakes up first and works to fix this mess will be winners in the next election.

  • David Mokotoff

    The author leaves an important question unanswered. How many of the supposed 7 million folks who signed up for Obamacare were previously uninsured? Many allegedly lost their insurance due to the “one size fits all” restrictions of health insurance policies and then had to re-sign up for government subsidized, as in tax payer supported, Obamacare. Since the whole reason this awful bill was passed was because we were told repeatedly how horrible it was that 35-40 million people had no healthcare, the fact that they can only muster 7 million users, (allegedly), in and of itself points to the failure of this program for the population as a whole.

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