Pew Research just released another new survey about the Affordable Care Act, and like several other recent ones, the turnaround regarding public opinion on the ACA has shifted dramatically...just in time for it to (supposedly) be repealed (maybe).
As I noted earlier, much of this falls into the category of "You don't know what you've got 'til it's gone". Fully 85% of Democrats and 53% of Independents now "approve" of the ACA, with only 2% and 15% wanting to scrap it. Meanwhile, while Republicans still don't like Obamacare as it stands now much at all (only 10% want to keep it), only 44% of them now want it fully repealed.
Overall, 54% now say they approve of the ACA...and only 17% now want to pull it out "root and branch", to use Mitch McConnell's phrasing. A stunning reversal of fortune.
The wild card, of course, is the 25% who say they want to "make modifications" to the law. This includes 10% of Democrats, 29% of Independents...and a whopping 42% of Republicans.
It's important to step back and take a closer look at the "modifications" question. Here's the actual wording of the question:
"Republican leaders in Congress should focus their efforts on making modifications to the law.": 25%
That's it. Nothing else.
The problem with this should be obvious: "Making Modifications to the Law" could mean practically anything. Here's some modifications I'd like to see made:
- Beef up the APTC and CSR subsidies and raise the FPL income cap from the current 400% / 250% up to 600% / 400%.
- Fix the "Family Glitch" which currently prevents family members from receiving APTC/CSR if one of the breadwinners is covered by a group policy.
- Fix the "Skinny ESI Plan" glitch by raising the AV threshold of a standing ESI plan left on the table by a large/small company employee which currently prevents them from receiving APTC/CSR on the exchanges
- Make good on the Risk Corridor payments which the GOP insisted be scrapped back in 2014 (and which are legally owed anyway).
- Make good on CSR reimbursements on a permanent basis
- Rework the Risk Adjustment formula to be more fair to smaller carriers
- Find a way to get the remaining 19 GOP states to actually agree to expand Medicaid under the ACA.
- Add a Public Option (what the hell...as long as I'm requesting "modifications"...)
...and so on. Every one of these would strengthen the Affordable Care Act, and therefore really belongs on the support/approve side.
On the other hand, "modifications" could also mean:
- repealing Medicaid expansion.
- getting rid of the individual mandate penalty
- getting rid of the employer mandate
- increasing the Age Ratio from the current 3:1 to 5:1 or 6:1
- scrapping the (absurdly) "controversial" birth control coverage provision
- reducing the Essential Health Benefits required to be included with all plans
...and so forth. Most of these would weaken the Affordable Care Act, although I'm willing to be convinced that going to, say, 4:1 on the Age Ratio might not be a terrible thing, and I'm increasingly thinking that it might actually not be a bad idea to, yes, scrap the employer mandate altogether--but only if the funding provided by that mandate penalty is made up elsewhere, and only if the individual market exchanges are fully supported at the same time.
If you assume that the "Make Modfications" respondants are split equally along these lines, this means that the support/oppose lines are really more like:
- Approve/Support: 54% + 12.5% = 66.5%
- Disapprove/Oppose: 17% + 12.5% = 29.5%
...or basically a 2:1 ratio in favor of keeping or strengthening the Affordable Care Act.
Even the worst case scenario here (if all 25% really do want to weaken/minimize the law) would still be 54% approval, 42% disapproval...still an amazing swing from just a few months ago.
UPDATE: A couple of people have pointed out that I used some acronyms which might not make sense to people:
There are two types of federal financial assistance provided to ACA exchange enrollees: Advance Premium Tax Credits (APTC) and Cost Sharing Reductions (CSR).
- APTC are the “subsidies” that most people think of when it comes to the ACA exchange plans. These reduce the cost of your monthly premiums if you earn between 100% — 400% of the federal poverty level (FPL)...between $12K — $48K for an individual, or $24K — $96K for a family of 4. Around 9 million exchange enrollees receive APTC assistance.
- CSR are the other type of subsidies. These go to pay a big chunk of the deductibles and co-pays for exchange enrollees earning between 100% — 250% of the FPL. The only catch is that CSR is only available for Silver plans (not Bronze, Gold or Platinum). Roughly 6 million exchange enrollees receive CSR.
- ESI: Employer-Sponsored Insurance. This is just an insurance policy provided by your employer, whether Large Group (companies with more than 100 employees) or Small Group (companies with fewer than 100 employees). The ACA requires companies with at least 50 employees to cover all of them or face a financial penalty