Friday, October 25, 2013

Obamacare/ACA Update

Andrew Sprung makes a good point:
@JBplainblog has warned: if ACA succeeds, no one will know it's "Obamacare." Thanks to disastrous rollout, all users'll know (by 25th try)!
I think that's mostly right. My sense of it has been that the sooner ACA simply becomes the way that people by insurance (on the individual market, which remember is only a slim percentage of all those who buy insurance), the less it becomes "Obamacare" in people's minds, and the more it's just a normal thing, and, for many people, the way things have always been.

The more that it calls attention to itself, then, the more users are apt to associate it with government, and with Barack Obama. That makes sense.

And the more that the rollout problems are a big news story, the more people are going to connect Obamacare with the exchanges -- something that really wasn't the case for most of the last few years.

So I think that's a fair comment, but with some caveats. One big one: low-information users may still not make the connection; after all, nothing at Healthcare.gov says "Obamacare." Indeed: outside of the .gov address, it doesn't really emphasize that it's a government program. So it is quite possible to use the marketplace, and even really hate the marketplace, without associating it with "Obamacare." Will that happen? I don't know.

The other important part: it of course matters how long the problems go on. If the visible problems are mostly gone in the next couple of months, then it also disappears as a news story.

And then we're back to where we were: Healthcare.gov becomes just the normal way that people have always bought insurance -- much better to go on that site and buy Blue Cross or whatever than to have to deal with Obamacare.

In other words...back to that if it works, Obamacare disappears.

9 comments:

  1. At this point, many people seem to be equating the program with the rollout of the website. If the ACA's critics now get caught up in attacking technical aspects of the rollout, does that put them de facto in a position of favoring a successful rollout? If so, will the eventual repair of the website undermine their continued opposition to the program?

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    1. Ezra Klein had a good piece the other day ripping into Republicans over this.
      http://www.washingtonpost.com/blogs/wonkblog/wp/2013/10/24/wonkbook-the-gops-obamacare-chutzpah/

      "But the GOP's complaints that their plan to undermine the law worked too well and someone has to pay border on the comic. If Republicans believe Sebelius is truly to blame for the law's poor launch, they should be pinning a medal on her."

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    2. If the ACA's critics now get caught up in attacking technical aspects of the rollout, does that put them de facto in a position of favoring a successful rollout? If so, will the eventual repair of the website undermine their continued opposition to the program?

      Yeah, if you think that Obama is always playing 11-dimensional chess, then this little gambit was pure genius. You bait your opponents into conflating the law with the website so their opposition is focused on something you can fix; then, you fix it. What do they complain about then, that you took away their trainwreck?

      Second genius move: Heavily publicize the fact that the exchanges are "Obamacare" by messing up the web rollout and making it a big story. Thus you help ensure that once it's all working, "Obamacare" doesn't just fade immediately into the wordwork, as it otherwise would have, but instead that people recognize it as a name for the system that allows them buy affordable insurance. Then, run lots of campaign ads around the country reminding them that Republcians tried to prevent this -- ads along the lines of, "Why did Congressman Soandso want to stop Mary and John here (or Maria and Juan) from getting health insurance for their delightful young family?"

      Third genius move: Use your powers of Kenyan voodoo telepathic suggestion to get Ted Cruz and his buddies to shut down the government to no purpose, thus discrediting them and their party just at the moment when your new program is most vulnerable to legitimate criticism. Oh, and since you've been playing many, many moves ahead: appoint an HHS secretary in 2009 who is not very appealing, well-spoken or telegenic, so that you've got someone in place who can become the personal face of the problems when they eventually surface.

      I mean, is this all a thing of beauty, or what? ;-)

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    3. Scott (and Jeff, too) -- I do think the right is simultaneously undermining their next round of argument, and overplaying the hand they think they have. The latest meme that I'm seeing emerge among right-leaning commenters is, "Wait til you all start getting the bills in January and see how much you're paying. Then the backlash will start!"

      This, obviously, overlooks a few things:
      1. The bill for many people will be lower than it has been, even without subsidies. (Platinum 90 coverage costs slightly less than my premium my state-government employer pays for my similar coverage.)
      1A. Many of those who receive subsidies will be getting a freaking outrageously good deal.
      2. Many of those who will be buying insurance would have previously been unable to purchase it at any price.

      So, in the 11-dimensional chess game, it looks to me like the next move the opposition is counting on is already poised to fail.

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    4. Unfortunately, the right has a good point. If most people signing up for ACA get a good deal it will fail. ACA will only work if a lot of healthy people check the exchanges, find it pricey, b**ch & complain and SIGN UP ANYWAY.

      It will be fascinating to see how both sides spin this.

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  2. Most people won't buy insurance on the website, though. Most people will still get it through their employers. It's only when they lose their employer health care that they'll go through the website. I suspect that the idea of getting individual insurance coverage through the website will be called "going on Obamacare". That's how I've started to talk about it, on the occasions when someone is concerned about losing their health care for one reason or another.

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  3. The tweet was inspired by about 30 attempts at signup drilling every detail of its layout into my memory. But of course most people won't do that...

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  4. Dr. B,

    I used to think you were right about this; now I don't think so. I think healthcare.gov will be the face of Obamacare. That's what it'll be when people think about it in the future. In the 34 states with a federal exchange, that'll certainly be the case. I can't say about the rest.

    Social Security isn't "Rooseveltirement". But when you see a blue card in someone's wallet, you know it's a Social Security card.

    In the 22nd century, a visible web presence is as real a presence as a thing can be. The federal government's healthcare buying site will be seen as "Obamacare". There's more to it, but there is more to Medicare than the part your average citizen interacts with as well.

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  5. Jonathan,

    I just recently found your blog and I have enjoyed reading your take on things. I found this post especially interesting. My husband and I had this very discussion not long ago. I still find it absolutely absurd that so many people are against the ACA simply based on their disdain for our president. I am certain that you are correct in that once this program is in effect and becomes the norm it will no longer be referred to as Obamacare.

    The ACA is obviously not perfect, but then what law is if you really examine every aspect of it? The healthcare system in this country needs fixing and while this may not be the answer to all of it, at least it is a step in the right direction.

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