What the public knows

On the day the new health insurance exchanges made their debut in states across the USA, the public remains thoroughly confused about what the new health care law means. Teaching courses on health care reform, policy analysis, and health care in popular culture to savvy undergrads provides me with a small army of astute health care observers. Yesterday, six of my students shared the following video from Jimmy Kimmel with me:

The interviews presented in the video underscore the political problem facing the ACA. People’s views on health care reflect their partisan loyalties, ideology, and level of information. Most Americans still don’t understand the complexities of the law, how it will affect them, and what it means for the country. This is not simply a result of “misinformation” campaigns by opponents, although it’s clear that individuals’ perceptions of the law are shaped by their views of the President. Recent polls, however, suggest that “ObamaCare” can also have a positive impact on public perceptions, depending on whether respondents live in traditionally “red” or “blue” states. Support for the ACA/Obamacare, therefore, will remain mixed for the foreseeable future, and will vary widely from state to state. To change this state of affairs, supporters of reform must tell a new policy story that can bridge the gap between the insured and uninsured, and between businesses and employees. The rhetoric about health care reform continues to divide us, rather than bring us together. 

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Will coverage under the Affordable Care Act be ‘affordable’ enough?

The hazy, hot and humid days of summer led me to take some time off from blogging to go camping, and even catch Taylor Swift in concert at Gillette Stadium. Now that the heat wave is past, and cooler days and nights have arrived, it’s time to catch up on recent discussions of health insurance premiums. In July, I had a chance to sit down with Chrissy Centazzo from the PC Public Affairs office to chat about the debut of Rhode Island’s health insurance exchange, HealthSource RI. In recent weeks, President Obama and many state officials trumpetedlower than expected premiums for health insurance offerings under the new health insurance exchanges in states such as California, Maryland, Oregon, Tennessee, and Virginia, among others. Defenders of the ACA argue that premiums will be more affordable for uninsured families, and small businesses and individuals who will purchase coverage through the exchanges. The long term success of the ACA in expanding coverage and controlling costs, however, depends on signing up healthy young subscribers.

Selling the plans, however, will be a challenge. While projected premiums are lower than many forecasts, coverage through the state exchanges is not cheap. As Louise Radnofsky noted, individual premiums for twenty-five year olds who don’t smoke ranged from $117 per month in Tennessee to $156 per month in Baltimore. Will cash-strapped consumers opt to purchase coverage at an annual cost of at least $1400, or will they continue to rely on safety net providers and hospital emergency rooms for care? Since the annual penalty for not purchasing coverage ($95) is less than the cost of one month of the most affordable health insurance on the market, how many healthy young adults will choose to pay substantially more to purchase coverage, particularly when the “Bronze” level plans impose significant cost sharing for newly insured subscribers? As the Fall enrollment season approaches, both supporters and opponents of ACA will weave stories to define the success or failure of the individual mandate. Stay tuned… the debate over ObamaCare has just begun…