Running from ObamaCare

The first of the “consumer protection” provisions of the Patient Protection and Affordable Care Act (PPACA) -- also known as “ObamaCare” -- recently went into effect. For one, insurers are no longer able to impose annual limits or lifetime caps on benefits, and they will face a higher standard before they can drop someone from coverage.

On their face, these provisions sound good and should be popular with consumers, who have a generally negative view of managed care. Who wouldn’t want uncapped benefits and the knowledge that you can’t be dropped from coverage? One might think that headlines like these would start to sway public opinion in favor of ObamaCare; that politicians facing difficult re-election campaigns would be trumpeting these benefits as part of their last-minute stumping; and that physician groups and others would now be finding the silver lining in what has otherwise been perceived as dismal legislation.

None of this has happened. In fact, the law is less popular today than when it was enacted six months ago. What was billed as the crowning achievement of the 111th Congress is turning into an issue its backers would rather simply ignore. And for good reason: In the latest Rasmussen Reports poll on ObamaCare, conducted in late September, 61 percent of respondents favored repeal of the bill. As Americans are “finding out what’s in the bill,” to borrow again from a now-infamous quote from Speaker Nancy Pelosi, they seem to like it less and less.

When the bill was hammered through a deeply divided Congress, Ms. Pelosi and others assured us that it would be a big win for all, and that many Democrats would run their reelection campaigns on the strengths of the legislation. That has not happened. With about 75 seats that may change hands in the House, and a handful that are currently toss-ups in the Senate, the fact is that Democrats can’t get far enough away from ObamaCare in the run-up to this election. Only Alan Grayson in Florida and Tom Perriello in Virginia are campaigning on the benefits of ObamaCare. Both are currently trailing their opponents. GOP and Tea Party candidates, meanwhile, are running aggressively on “repeal and replace” campaigns.

Physicians, also, have been skeptical about the law, despite the endorsement of the American Medical Association (AMA). Groups such as Docs4patientcare and Physicians Against ObamaCare have recently been formed to advocate against the Act.

What the AMA, the President, and lawmakers didn’t take into account is that Americans are paying attention. It’s always been an interesting phenomenon that while consumers don’t approve of managed care as a whole, they generally like their own health plans. Many are now worried that their current benefits will change. The President has tried many times to reassure consumers that if they like their plan, they can keep it, but many are skeptical of the idea that benefits could be expanded to include millions of people who aren’t currently covered without reducing their own benefits. Someone is going to have to pay this bill and consumers are worried that it will be them, either in the form of higher taxes or reduced benefits.

Those who have looked at the PPACA closely, including Medicare’s Chief Actuary Richard Foster, have noted that Medicare payment rates for doctors and hospitals serving seniors will be cut by as much as 30 percent over the next three years, and even more over the program’s first 10 years. (This is all in addition to the gutting of the Medicare Advantage plan that currently benefits thousands of seniors.) These cuts in payment will give physicians and hospitals -- many of whom already avoid Medicare and Medicaid patients, or take a loss on them due to low reimbursement and administrative hassles -- even less incentive to see these patients. The idea that all physicians would be forced to accept Medicare payments as a condition of licensure no longer seems so far-fetched.

The good news is that a restless public, fed up physicians, and anti-establishment politicians, among others, haven’t given up finding out what’s in this law. Those in Congress who voted for it won’t have any luck trying to run from it now. And perhaps a new group of lawmakers, increasingly familiar with the many faults of ObamaCare, can make some headway in pursuing major changes that would make the law more physician- and patient-friendly. Many of the principles I’ve espoused in previous editions of this column are, indeed, both.