POLITICS
11/21/2016 10:00 pm ET Updated Nov 23, 2016

Republicans Who Think Nobody Would Miss Obamacare Should Ask People Who Depend On It

Millions value their coverage -- and worry what the GOP would do instead.

Some of the Republicans agitating to repeal Obamacare say they aren’t worried about taking health insurance away from more than 20 million people. Their theory: The program is wildly unpopular and even the people with coverage wouldn’t miss it, no matter what takes it place.

“People have crappy insurance,” Rep. John Shimkus (R-Ill.) told Politico last week. “This fear that they’re going to lose something that they don’t think they have anyway is crazy.”

Anna Meyers would beg to differ.

Meyers, 42, lives in the eastern part of North Carolina. She and her husband, 59, have been getting insurance through healthcare.gov for the last three years. Meyers also has a son, 14, who has autism. He gets coverage through Medicaid ― a program that Republicans say they would like to shrink just as soon as they are done with Obamacare.

Meyers works as an office manager for an accountant. Her husband does repair work for a company that manages rental homes. Between the two of them, she figures, their income is about $40,000 a year ― maybe less when his business is slow.

“We don’t get to go out to the movies a whole lot,” Meyers explained to me on the phone. “But we do travel a lot on the weekend, in our car, and see some of the bigger towns in the area just to get out.”

Also, there is date night once a week. They drop her son at her parents’ house, and then bring home takeout. Smithfield’s Chicken is a favorite.

Anna Meyers, with her son and husband
Anna Meyers
Anna Meyers, with her son and husband

Meyers has health insurance from Blue Cross Blue Shield of North Carolina. It’s covered their needs, she said, and she hasn’t had trouble finding a doctor. The premiums are going to be higher next year, as they are across the rest of the state. But her income qualifies for tax credits that, she said, will keep it within their budget.

“It’s pretty good insurance, we’re pretty happy with it,” she said. Although “the deductibles could always be lower,” she said, overall “it’s really helped. … I know it’s not the case for everybody, but it’s worked out OK for us.”

One reason Meyers may feel this way is that she knows what it’s like to be uninsured, because both she and her husband have had gone through periods without coverage before. “We can manage,” she said. “But it’s a scary proposition.” Her mother got in a car accident not too long ago, she explained, and her father has had a heart attack. “It’s one of those, ‘There but for the grace of God go I.’ Anything can happen.”

And if Medicaid for her son went away, too? “That would be a problem ― a real problem.” 

Stories like Meyers’ are not hard to find. They are already popping up in the national media and on the local news. There are going to be even more of them in the coming weeks, as the prospect of repealing Obamacare and gutting Medicaid gets more attention ― and, as a result, the possibility of losing coverage sinks in for more people. 

And the available survey data suggests these stories are not isolated. Many people are unhappy with Obamacare, yes. But many others value the coverage. On the whole, these people are not likely to get as much assistance or protection from a Republican replacement plan, and that’s assuming Congress can even pass one at all. 

The Majority Of People With Obamacare Seem To Value It

The popularity of Obamacare with its users may surprise not only Republicans, but also people who know about the law primarily through press coverage. One of the biggest myths about the law is that most people who have the coverage think it’s lousy.

This impression took hold in early 2014, when the law first took full effect, because insurers had to raise premiums or scrap old plans in order to comply with the law’s requirement that insurance be available to everybody ― and that policies always include comprehensive benefits. Some of the outrage that followed was ginned up by Obamacare opponents, but some of it was real, particularly since President Barack Obama had infamously promised that people who liked their old plans could keep them. 

Since that time, attention has shifted to the struggles of insurers that haven’t attracted enough healthy customers, and are now raising premiums or pulling out of markets altogether. The narrow networks of doctors and hospitals available on many plans has also been a subject of controversy ― particularly among those who were lucky enough to have coverage beforehand, and had policies with greater choice of providers.

But as is always the case, the full story about Obamacare is way more complicated than the media image conveys.

In just the last year, both the Commonwealth Fund and the Henry J. Kaiser Foundation have conducted surveys of people getting coverage through the law. The surveys studied different, overlapping groups. Kaiser looked at people buying coverage on their own, breaking out those who got coverage through one of the law’s exchanges and those buying directly from insurers. Commonwealth looked specifically at people who got insurance through the exchanges, as well as people who had enrolled in Medicaid.

The questions covered all the important issues, from premiums and deductibles to doctor choice. The results were remarkably consistent across the board. When asked to judge the plans overall, majorities rated their insurance as good, very good or excellent.

The Commonwealth Fund

This makes sense. People on Medicaid get their care nearly for free. Lower- and middle-income people who buy insurance on the exchanges qualify for subsidies that reduce premiums and, for the less affluent, reduce out-of-pocket costs as well. As the Obama administration keeps pointing out, three-quarters of people who now buy coverage through the exchanges will be able to find policies for less than $75 a month, although some would have to switch policies to do so. That’s several million people.

And even among those who don’t qualify for much or any financial assistance, there are some with preexisting conditions who, prior to Obamacare, couldn’t find comprehensive insurance at affordable prices, and in some cases they couldn’t find insurance at all. Like Anna Meyers, they are grateful to have Obamacare coverage ― both for the financial protection, and for the ability to see a doctor, get a test, or fill a prescription when they need it.

They are right to think these things matter, by the way. Studies have shown consistently that people who got insurance coverage have less exposure to crippling medical bills and better access to care, and the initial data on Obamacare suggests that is precisely what’s happening. Some studies have also shown people are healthier as a result, although that finding, however intuitive, is a lot more ambiguous.

Obamacare Has Problems, But A GOP Replacement Could Be Worse

To be clear, plenty of people have real, legitimate criticisms of Obamacare, and those concerns have grown as premiums and deductibles have risen since the program’s establishment. The Commonwealth and Kaiser surveys don’t break out responses by income, but it’s safe to assume that, among those who get little or no financial assistance, a much larger share of people are unhappy or even angry about what they are paying.

They are the ones who give their plans negative ratings ― which, in the surveys, is about one-third of the total. Some people are even going without insurance altogether, because they think the plans just aren’t worth the price. This is a real and serious problem, and one that has been getting worse.

But it’s not at all clear Republicans would offer better coverage instead. Six years after promising to replace the health care law, Republicans are still arguing over what their preferred system would look like. And while the proposals circulating among conservatives have different forms, one common element is that they all envision loosening the requirements on what benefits policies must include and how much financial protection they must provide. 

So, although the insurance under Republican replacement schemes might generally be cheaper for those who can get it, it’d also be less generous. As Jonathan Chait put it recently at New York magazine, the essence of Republican proposals is to replace the “crappy” insurance they like to deplore with something that, in terms of required coverage, would actually be “crappier.”

Would some people prefer and truly be better off with a Republican replacement, or even a repeal of Obamacare without a replacement? Sure. By and large, they would be among the ones who, by virtue of their relative health or wealth, were able to get decent coverage before Obamacare came along ― and who would happily take their chances with policies that had larger out-of-pocket spending or included fewer benefits.

But if Republicans think the majority of Obamacare users will be just fine without it, as some Republicans seem to think, they are kidding themselves. Obamacare was designed to bolster coverage for people who needed it, while making it more available to people who couldn’t afford it. Repealing the law would reverse that progress, in part or in whole. That would make a difference to Anna Meyers, and millions of people like her.

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