Wednesday, August 16, 2017

Robert Blendon and John Benson have a new piece in the New England Journal of Medicine, entitled "Public Opinion About the Future of the Affordable Care Act." Focusing on the aftermath of late July's failure of the U.S. Senate to pass an ACA "repeal and replace" bill, Blendon and Benson set out the following agenda in their article:

Our analysis of 27 national opinion polls by 12 survey organizations provides background on four critical issues relevant to the previous House and recent Senate health care decisions: the public favorability of the current law, the public values underlying the debate about the future, support for various health policy changes in the proposed Republican legislation, and support for the overall Republican proposals debated in the House and Senate.

Vox's Sarah Kliff writes about the Harvard study, focusing on the substantial rise in the percentage of Americans who believe the federal government has a duty to ensure that everyone has basic health insurance.

Another noteworthy finding I noticed is that the individual mandate, long the most unpopular feature of Obamacare, no longer appears to be so toxic. B&B note that: "...48% favored removing this requirement, whereas 50% were opposed" (from a March 2017 CNN/ORC poll).

A large amount of attention during this year's House and Senate debates focused on how the various Republican bills would treat people with pre-existing conditions. The House-passed bill featured the McArthur-Meadows amendment, which would allow states to opt out of some of the Obamacare coverage standards (including those protecting people with pre-existing conditions), as long as those states operated high-risk pools for this purpose. The Senate process included a proposed amendment by Ted Cruz, which would have allowed insurance companies to offer relatively cheap plans that did not comply with Obamacare standards, as long as they also offered plans that did.

Many have contended that high-risk pools typically are not funded well enough to help everyone with expensive illnesses and chronic conditions to treat, and that the Cruz plan would likely make things difficult for those with pre-existing conditions  because the ACA-compliant plans would become very expensive. Two pertinent findings from the Harvard authors were that:
  • "Approximately one third of the public (35%) believed that insurers should be allowed to offer health plans that cover fewer benefits than currently required"
  • " less than one fourth of the public believed that insurers should be allowed to charge more for people with preexisting conditions (24%)."
Kliff writes that "Blendon attributes the change in attitudes to Americans thinking through the consequences of repealing the Affordable Care Act, resulting in millions losing coverage." That seems as good as explanation as any.

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