One thing red state voters don’t like about Obamacare is that it sucks

Matt Bruenig
Feb 2, 2017 · 3 min read

After the election, there was a spate of reporting about why lower class people in red states who benefited from Obamacare voted for Donald Trump. It turns out there are many reasons for this. But one reason that popped up in most of the stories was that the voters had completely legitimate grievances about how badly Obamacare is designed.

Sarah Kliff at Vox

Here’s the relevant part of Kliff’s story:

The woman was mad because her costs felt overwhelmingly expensive. These are some of the most common frustrations with the Affordable Care Act. Surveys show that high deductibles are the top complaint; 47 percent of enrollees told the Kaiser Family Foundation they were dissatisfied with their deductible.

A study from the Commonwealth Fund earlier this year found that four in 10 adults on Affordable Care Act plans didn’t think they could afford to go to the doctor if they got sick. Fewer than half said it was easy to find an affordable plan.

But her frustration isn’t just about the money she has to pay. She sees other people signing up for Medicaid, the health program for the poor that is arguably better coverage than she receives and almost free for enrollees. She is not eligible for Medicaid because her husband works and they are above the earnings threshold.

Olga Khazan at The Atlantic

Here’s the relevant part of Khazan’s story:

I heard this gripe from several people. Their health-care costs are skyrocketing, and meanwhile, there are people on Medicaid, which has its own issues, but looks like the lap of luxury when you have a five-digit deductible.

Drew Altman at The New York Times

Here’s the relevant part of Altman’s story:

They spoke anxiously about rising premiums, deductibles, copays and drug costs. They were especially upset by surprise bills for services they believed were covered. They said their coverage was hopelessly complex. Those with marketplace insurance — for which they were eligible for subsidies — saw Medicaid as a much better deal than their insurance and were resentful that people with incomes lower than theirs could get it.

Exact Same Grievance Again and Again

Each reporter set out to answer the same question: what do these people not like about Obamacare? And despite their diverse reporting strategies and populations, each managed to capture this exact same grievance.

In the post-Obamacare world, poor people can receive public health insurance through Medicaid provided their income is below a certain threshold (138% of the poverty line in Medicaid expansion states). As soon as their income goes over that threshold, they lose their Medicaid and are made to go out onto the Obamacare exchanges to buy insurance themselves.

If they are only slightly above the Medicaid cutoff, they receive hefty income-based subsidies to make it easier for them to pay their monthly premiums for their exchange-based insurance. But a heavily subsidized exchange plan still often comes with a high deductible that people just above the Medicaid cutoff do not have enough income to cover. So people in this situation have health insurance but they cannot afford to use it.

Say what you will about all the dumb reasons why lower class people find themselves mad about welfare programs. But this is not one of them. It is absurd that someone whose income is 130% of the poverty line can go to a doctor but someone whose income is 140% (or 150%, 160%, etc.) of the poverty line cannot. Yet that is the reality the design of Obamacare has created. This design generates enormous resentment because it is actually bullshit that making a little more money makes health care unaffordable.

What’s the alternative that doesn’t have this problem? Single-payer health insurance of course.

Matt Bruenig

Written by

Law and welfare knower.

Matt Bruenig

Written by

Law and welfare knower.

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