Horowitz: Obamacare Ain’t Easy to Kill

Tuesday, February 28, 2017

 

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Rob Horowitz

To borrow from Mark Twain, "Reports of Obamacare’s death may be greatly exaggerated.” The stepped up coverage of President Trump’s and the Republican Congress’ plans to repeal and replace the landmark health care law has paradoxically served to awaken the American public’s awareness of its many strengths.

A recent Pew Research Center poll shows that a majority of American adults now approve of the health care law with approval at an all-time high of 54%. Among those that disapprove of the law, more people want Congress to modify it than get rid of it entirely. Underlying these results is the fact than 6-in-10 Americans say the government should be responsible for ensuring health care coverage for all Americans, as opposed to less than 4-in-10 who say this should not be the government’s responsibility, according to another recent Pew Poll. This reflects a marked increase in the percentage of Americans who now believe that providing health insurance is an affirmative duty of the government.

This shift in public opinion is amplified by the intensity of feeling about keeping the law that many Republican lawmakers are experiencing first hand in town halls throughout the nation. The turnout of thousands of supporters to confront their members of Congress about the potentially disastrous consequences of repealing Obamacare, otherwise known as The Affordable Care Act, is having the desired impact on Capitol Hill where thoughts about the next election, now less than 2 years away, are always front and center.

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More people are waking up to the fact, that despite its many imperfections, the  law has substantively been a big success, providing health insurance to more than 20 million people and moving us much closer to the goal of universal coverage. Among other important features, it prevents insurance companies from denying insurance to people with pre-conditions; offers strong incentives for stepped-up primary care and preventive medicine; and puts in place needed cost-containment measures.

 As Dr Ezekiel Emanuel, one of the architects of the 2010 law accurately states, “By any metric — access, cost and quality — Obamacare has largely been successful. Cost increases in the system are lower. And Americans insured through the Affordable Care Act are largely happy with the service they receive.” 

As with any large-scale reform, Obamacare certainly needs tweaks. To examples of fixes are safeguards to minimize risks for health insurance companies need to be reauthorized and strengthened and increased government subsidies to lower insurance premiums are required to attract greater numbers of younger, healthier people to the program.

These kinds of fixes are where Congress should focus its energy, especially since none of the replacement plans advanced by the Republicans seem substantively workable without prohibitive new costs or many millions of people losing their insurance coverage. Right now, there is not a consensus among Republicans about a way forward, but there is a growing awareness of the political risks of repeal.  That is why there is already a move to maintain expanded Medicaid coverage—a feature of Obamacare many Republican Governors signed their states up for.

A move to reforming and fixing Obamacare would likely attract Democratic support. While it risks alienating some conservatives, it is where the political sweet spot is for Republicans in swing districts or states and for President Trump. While the rhetoric about a major overhaul is likely to continue, watch for the policy substance to move in this direction. Obamacare --or at least its main substantive underpinnings-- has a fighting chance to survive.

 

Rob Horowitz is a strategic and communications consultant who provides general consulting, public relations, direct mail services and polling for national and state issue organizations, various non-profits and elected officials and candidates. He is an Adjunct Professor of Political Science at the University of Rhode Island

 

Related Slideshow: Trump’s Win - What Does it Mean for Rhode Island?

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Jennifer Duffy

Cook Report

"We don't really know what a Trump presidency means for the nation, never mind the smallest state.  One of the unintended consequences of last night's results is that Sen. Jack Reed won't be chairman of the Senate Armed Services Committee.  Chalk that up as a loss for RI."

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Pam Gencarella

Head of Ocean State Taxpayers' Association

"Trump’s win means that his signature issue, illegal immigration, could have a big impact on RI, hopefully reversing our course as a sanctuary state and saving the state taxpayer millions of dollars.  While we agree with his 'repeal and replace' Obamacare stance, we have no idea what that means to the RI debacle known as UHIP.  It is not a stretch to believe that federal funding for this kind of system will be off the table so, will RI be stuck with this massively expensive system that still doesn’t work and that is expected to cost another $124 million to fix?  

Trump's belief that there is significant fraud in the Food Stamp program and the policies that may come from that belief could have a negative impact on RI's local economy since there are businesses in certain cities that rely heavily on this program, fraud and all. On the upside, we may be able to ditch the UHIP program if there is significantly less need for processing welfare program requests (ie. Medicaid and food stamps) resulting from fewer illegal immigrants and less fraud.  While we are ambivalent about his touted child care policies, if enacted, it may force our legislators to revisit the ever growing state cost of subsidies in this area and possibly reduce the fraud and abuse in this system." 

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Kay Israel

Professor at Rhode Island College

"With a Republican President and Congress, Rhode Island will probably be excluded from the 'fruits of victory."  

The congressional delegation will be able to vocally make their presence felt, but in the long term it's more symbolic than substantive.  

For Rhode Island it's a matter of holding on and waiting until '18 or '20 and a surge in Democratic influence."

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Jennifer Lawless

Professor at American University

"The RI congressional delegation just became even less powerful than it was. With unified government, Trump doesn’t need to quell Democrats’ concerns or acquiesce because he’s worried about a Democratically-controlled Senate.

His appointments will reflect that. His executive orders will affect that. And the conservative policy agenda he puts forward will affect that."

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Len Lardaro

Professor at University of Rhode Island

"Well there's a few things -- because there's not going to be gridlock, that's a big difference if it had been Hillary and a GOP Congress, in which nothing would got done. We'll at least get a half a billion in infrastructure that's going to pass which will have an impact.

I think you'll see there will be reduced reliance on government nationally -- and that's where we'll stick out like sore thumb. We've relied way too much on government -- and our government is highly inefficient and ineffective.  Maybe, just maybe, in this who cycle of things we might be forced to be small and more efficient for once.

A couple of other things -- interest rates jumped. The one to follow is the ten year government bond rate -- which is tied to mortgages. It went from 1.7% to 2.05% in one day. The point is -- if the ten year stays high, mortgage rates will start going higher -- and in the short time people will run to re-finance. 

That's the short term impact -- but then if rates stay hight, that will make mortgages more out of reach. And we just passed a bond issue to limit open space -- housing has limited upside here.
The next thing -- the Fed Reserve will go ahead with tightening next month. A strong dollar will hurt manufacturing. When the dollar is strong our exports become more expensive overseas. 

Our goods production sector -- manufacturing and construction -- in the near term will do a little better, but as time goes on will be more limited. But something you won't hear, is there are lags in fiscal policy, of six months to year. So we won't really see the effects until the third our fourth quarter of 2017, going into 2018."
 

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Mike Stenhouse

RI Center for Freedon and Prosperity

"As the unbelievable turned into reality this morning, it struck me that the presidential election was not really all about Donald Trump and Hillary Clinton. It was about a fed-up people, revolting against a corrupt system - the "beast" - that relentlessly favors insiders. Hillary personified the beast, while Donald personified the slayer.

Sadly, based on election results in our state, Rhode Island's version of the beast lives on. I fear our political class has not learned the lessons from the Bernie Sanders and Donald Trump movements - and will continue with their government-centric, anti-family, anti-business status quo."

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Kristina Contreras Fox

VP of Young Democrats of America

"A Trump Presidency means the validation of the ugliest part of America. In RI, as with the rest of the country, the hammer of his hatred will fall hardest on minority communities. Being a blue state doesn't make us immune from this danger.

Trump won over 35% (39.5) of the vote here! We need to look in the mirror, and not lie about what the reflection shows us. No more hiding underneath a blue blanket. I expect those who claim Democratic values to be true to those values. The gulf between words and actions have turned into fertile ground for Trump's message to grow here in RI. If you call yourself a Democrat, if you claim to stand in opposition to Trump, now is the time to prove it. Show up and fight back."
 

 
 

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