Category Health Care

It Doesn’t Matter If Virginia Was A Referendum On Obamacare

Danny Vinik 1 Comment

My post earlier focused on the fact that there were so many unique factors affecting Virginia’s gubernatorial contest that it was impossible to use the results as any indication of the national political sentiment. One area in particular that reporters have settled on is whether the election was a referendum on Obamacare, and if so, what it means. Michael Barone and James Hohmann think it was and that Obamacare almost cost McAuliffe the governorship. Ezra Klein and Greg Sargent disagree. Igor Volsky thinks Obamacare was the biggest winner from last night’s election.

Here’s my question: who cares?

I have yet to see anyone give a legitimate explanation for why it matters whether or not last night’s election was a referendum on Obamacare. It matters even less if Obamacare was a winner or a loser. Virginians elected a Democratic governor in an off-year election, but exit polls suggest that voters opposed Obamacare 53 to 45 percent. Those are the facts. Did Ken Cuccinelli’s last-minute decision to make Obamacare a focal point of his campaign increase his vote share? Maybe. I don’t know. There are no exit polls on it for us to find out.

But in the end, this doesn’t matter at all. Whether or not Virginians approve of Obamacare right now isn’t important, because the earliest Obamacare is on the ballot again will be November 2013, after the law’s been implemented, the insurance market has settled and millions more people have coverage. Maybe Americans will find they are paying more, have fewer choices of doctors and are paying for benefits they don’t need. Maybe they will love the subsidies, the increased security and the cheaper options. No one knows for sure how Obamacare is going to play out, but how it does will determine what people think of the law.

President Obama and Senate Democrats are not going to back down. After a Supreme Court challenge, the 2012 election and a government shutdown, we are just a few short months away from finding out if Obamacare works. We’re past the politics of it. It may have affected the Virginia election, but even if it did, does it matter? Opinions are going to change depending on whether the law fails or succeeds.

Neither party should look at last night’s election as evidence that they should use Obamacare in the 2014 election. Instead, they need to monitor public opinion over the next nine months. If people are happy with the law, Republicans are in trouble. If not, Democrats will be. Last night’s election has no bearing on that. The only exception to this, as Alex MacGillis points out, is that McAuliffe’s victory increases the odds that Virginia will expand Medicaid. That would certainly be a huge victory for Obamacare and for the 400,000 uninsured Virginians who fall into the doughnut hole. But nevertheless, that’s a policy outcome of the election. It’s not a political one. Obamacare is now the law of the land and how it works will determine its favorability. Whether or not Virginians voted on it last night means absolutely nothing going forward. Let’s stop pretending it does.

Why Middle Class Plan Cancellations and “Rate Shock” are the Big Stories

Danny Vinik 3 Comments

Jonathan Chait and Kevin Drum both have posts today that lament that media has focused on cases of “rate shock” amongst the middle class instead of necessarily focusing on the millions of people receiving subsidies and those with pre-existing conditions finally being able to purchase insurance. Here’s Chait:

Why has their plight attained such singular prominence? Several factors have come together. The news media has a natural attraction to bad news over good. “Millions Set to Gain Low-Cost Insurance” is a less attractive story than “Florida Woman Facing Higher Costs.” Obama overstated the case when he repeatedly assured Americans that nobody would lose their current health-care plan. There’s also an economic bias at work. Victims of rate shock are middle-class, and their travails, in general, tend to attract far more lavish coverage than the problems of the poor. (Did you know that on November 1, millions of Americans suffered painful cuts to nutritional assistance? Not a single Sunday-morning talk-show mentioned it.)

Drum adds:

In addition, I can only assume that writing about the people who are benefiting from Obamacare would strike DC reporters as a little too much like shilling for the Obama administration.

The real reason that the media has focused on the middle class has three reason. First, Obama lied to them about keeping their plans (Chait mentions this). Liberals continue to underestimate how infuriating this is to the average American. Obama sold the law on the premise that anyone who liked their plans would get to keep them. They would get to keep their network and doctors as well. This was a crystal clear message from the president so that people wouldn’t be spooked about change. This has nothing to do with whether this change is necessary (it is). The fact is Obama lied to get his law passed. The Americans he lied to are predominantly middle class ones who are purchasing insurance through the exchange and are not eligible for Medicare. Is it surprising that the media’s attention has been focused on the people Obama lied to in order to pass the Affordable Care Act?

Second, liberals bought into the framework that Obamacare would be judged based on “rate shock.” This isn’t necessarily a fair way to judge law. Some people will pay more for more comprehensive coverage, others will pay less for better coverage, some will pay more for worse coverage and others will have the chance to purchase insurance for the first time. The effects of Obamacare are more than just the sticker price of insurance, even after subsidies are factored in. The law requires insurers to cover 10 essential health benefits, places limits on the deductible, and eliminates the cap on lifetime costs. These are all important aspects of Obamacare that drive up rates.

The problem is that for months now, health wonks have spent most of their time arguing about rates under Obamacare. That’s been the focal point of discussion. Not surprisingly, the law is being judged based on “rate shock” now. However, to be fair to the law’s supporters, this was always going to put them at a disadvantage as the easiest way to evaluate Obamacare is by what happens with insurance rates.

Finally, the failures of HealthCare.gov have ensured that the focus will be on all those receiving cancellation letters. If the website functioned properly, many Americans who found out their plans were cancelled would log on to the federal exchange, see they are eligible for subsidies and cheaper plans, and become happy supporters of the law. Others would find out their plan is still more expensive and continue to be furious at the administration. But under that scenario, some of the stories of middle class Americans receiving notices that their plans were discontinued would be alleviated. That would help relieve much of the pressure that the White House is under. Unfortunately, they royally screwed up the website.

Thus, the media’s focus on middle class cancellation notices and “rate shock” is the result of Obama’s lie, a misleading framework for evaluating the law and HealthCare.gov’s catastrophic launch. Without the president’s deceit and the marketplace’s struggles, the media would have had many more opportunities to cover the law in a positive light. Unfortunately, the administration never gave them that opportunity.

Pro-tip for the White House: Just Be Honest!

Danny Vinik 2 Comments

I had a conversation on Twitter yesterday with Think Progress’s managing editor, Igor Volsky, about Obamacare and the enrollment numbers that the Obama administration continues to withhold. In a snarky tweet, Volsky asked how knowing daily enrollment data would actually help fix the website. Of course it won’t do anything to fix the website, but that’s not the point. The administration has lied, side stepped questions and been maddeningly vague since HealthCare.gov went online October 1st. Their refusal to release the numbers is just another example of it.

Over the past couple of weeks, administration officials have given “updates” on Obamacare that have said almost nothing. Finally, Jeff Zients, who was recently brought in to clean up this mess, provided more info and a more exact time frame, but it has still been like pulling teeth to get any more info from them. Josh Barro summed this up well a bit ago:

The administration is still behaving like it is trying to get Obamacare enacted, and therefore its top public relations task is to bury negative stories about the law and emphasize the upside, like heavy consumer interest. But this is a mistake. Obamacare is already the law, and its long term political success is going to be determined by its substantive policy success — including whether consumers are able to sign up and get the health coverage they want.

This is exactly right.

It’s not surprising that the administration does not want to release the enrollment figures. I’m sure they aren’t pretty. But so what? How Obamacare is treated in the media right now really doesn’t matter. If the website eventually works and people sign up, all of these initial reports will be forgotten. If it fails, then the law fails and that’s what will be remembered.

More importantly though, Obama has a new trust deficit with the American people. He promised them that if they liked their health care plans, they could keep it. Well, that has been revealed to be a complete lie. Americans are rightfully angry at having been misled so brazenly. Obama needs to regain that trust.

Releasing daily enrollment figures won’t have a major effect on the American people, but it will help around the edges. The president should give a forthright press conference where he levels with the public, accepts blame for HealthCare.gov’s issues and tells everyone its exact status. He should release figures on who has enrolled in the private market versus new Medicare signups as well.

The numbers may not look good, but the vague language that the administration has used to describe the website’s status only feeds the perception that they are hiding something. Why be so secretive right now? There isn’t a good reason unless there is a serious, potentially fatal problem with the law. In addition, this information is going to come out eventually. It’s smarter to release the data now while the coverage of the law is universally negative than to do so later when the law is working better and these reports will crowd out positive stories. Negative articles aren’t going to actually impact whether the law succeeds or not. People are either going to sign up or they won’t. News coverage won’t change that.

Yesterday, White House senior adviser Dan Pfeiffer seemed to back off the administration’s goal of signing up seven million people by March 31st. He instead said it was the CBO’s number and that the White House is trying to sign up as many people as possible. Yet again, the White House won’t give a straight answer. If they don’t think they’re going to hit their goal, say so. If they want to revise the number to shoot for something more achievable, just say it! Be honest! I repeat: unless the law has a major unknown problem, there is no reason to withhold this information. Releasing the figures and giving an honest update about the law will calm the furor over it and will help begin to repair the damage done by Obama’s lie. It’s extraordinarily frustrating that the White House refuses to do so.