Trump voters covered by Obamacare don’t like the GOP’s health care ideas
The GOP’s plan takes away the things they like, and makes the things they dislike worse.
President Donald Trump made repealing Obamacare, also known as the Affordable Care Act, a key tenet of his campaign.
“We’re going to terminate Obamacare which has turned out to be a complete disaster …we’re going to terminate it and replace it with something that’s going to be great and a lot less expensive and a lot less expensive for the government,” he said at a rally in October 2015.
It’s a quote that could have come from any of his campaign rallies. Always, his audience rewarded the line with thunderous applause — even though many of his supporters depend on various parts of the law for their current health coverage.
Trump never made it clear what his “great” plan would look like, or how he would make it less expensive for everyone involved. Nor did congressional Republicans, who have been railing against Obamacare since its implementation but have yet to come up with a better alternative.
Now, however, both Trump and GOP lawmakers have to live up to their promises and take their turn at designing an alternative health care law. And the details they have provided aren’t looking so great to their voters, according to a new report from the Kaiser Family Foundation (KFF).
KFF’s issue brief relies on focus groups conducted in December in the swing states of Michigan, Ohio, and Pennsylvania. Researchers interviewed 48 people, some of whom relied on the Obamacare insurance marketplace and some of whom had benefited from the Medicaid expansion under Obamacare — and found they’re not excited about a lot of the GOP’s health care ideas.
Earlier this month, Republicans unveiled a vague plan for a potential Obamacare replacement. Key tenets of this plan include changing the way that the government subsidizes Medicaid and functionally reducing the number of people covered by the program, pairing high deductible plans with health savings accounts (HSA) to offset high out-of-pocket costs, and switching from an income-based tax credit to one based on age.
All of these policies were unpopular with the Trump voters whom KFF researchers surveyed.
Repeal and delay
One key takeaway from the focus groups is that most participants want a simultaneous repeal and replace of the health care law, fearing that without the law’s subsidies and benefits they’d be unable to afford insurance.
“I think it would be chaotic. Because what are we going to do? If we’re not employed, we’ve got to go and buy it privately and a lot of us can’t afford it,” one participant said about repealing Obamacare without a ready replacement.
Earlier this year, Republicans in Congress — who didn’t have a plan ready — floated the opposite approach. Calling it “repeal and delay,” they wanted to vote on a repeal immediately but delay its implementation for a few years, planning to use the interim time to craft and pass a replacement law. Backlash was swift, as health care experts pointed out that this would have a disastrous effect on the health insurance industry writ large.
Republicans still took the first steps toward repeal, though they thus far haven’t moved any further.
One of many participants’ chief complaints with the Obamacare marketplace plans was that they couldn’t afford the buy-in for more initially expensive plans, and were instead trading off low premiums for high deductibles. As a result, they were afraid to go to the doctor for fear of being hit with massive bills.
The current Republican plan would rely on these high-deductible plans.
“It would discourage our healthy nation. People would be resistant to go to the doctor, resistant to get the care they needed because it’s not covering anything and we would just be an unhealthier nation because of that,” one man in Pennsylvania said about the proposal.
Republicans have planned to offset those costs through health savings accounts (HSAs), which enable people to set aside money pre-tax to save for such health care emergencies. The pairing of the two is popular with conservatives because they say it encourages more “individual responsibility” for health care issues.
Many of those surveyed people, however, were confused as to what a HSA is. If they did understand it, they said that they wouldn’t have the extra cash to set aside. One participant, according to the report, said he could set aside the cash if he gave up eating for a year.
Block granting Medicaid
The plan unveiled by the GOP last week would drastically alter Medicaid. Eventually, it would undo Obamacare’s Medicaid expansion by giving each state a fixed amount for each beneficiary, or a lump sum known as a block grant.
Under Obamacare, the Medicaid expansion is left up to the states, and the states that choose to expand Medicaid coverage to more people are given extra funding from the federal government to accomplish this. Currently, the federal government pays more than 90 percent of the costs of people who are newly eligible for Medicaid.
Under the Republican plan, however, that share of costs would decline. States could choose to keep covering the people, but they’d have to fill the gaps on their own. Though Republicans insist they aren’t intending to “pull the rug out” from anyone who is now on Medicaid, functionally, experts say that reducing federal support for the program will result in fewer people being covered.
Michigan, Ohio, and Pennsylvania, the places where KFF surveyed, all opted for the Medicaid expansion. About half of those surveyed had benefited from it — and they were extremely happy with their care. They told KFF researchers that, thanks to the coverage they got through Medicaid, they were able to access doctors and afford medication that enabled them to live their lives, care for family members, and go to work.
“I’m insured for the first time in probably 15 years through Medicaid… It’s nice you can have a provider, and you have a connection, and you can go in and get some fairly decent health care,” a woman in Michigan said.
Another woman in Michigan said that she approved of the expansion, calling it “great” for helping out more people just above the bottom of the pay scale.
“Why not help them out, so they can better their lives in a way and afford a better car, so they can drive to work, so they don’t miss so many days, so they can work more? I’m not opposed to that cycle,” she said.
In fact, in a sharp contrast to the proposal currently on the table, most participants said they wanted to expand Medicaid coverage even further. Some people with marketplace coverage viewed Medicaid coverage as superior to their own options in the private insurance market.
Some of those surveyed hadn’t realized that they became eligible for Medicaid as a result of the ACA. Everyone on Medicaid voiced concerns about their care once they realized the connection between their coverage and the repeal of Obamacare.
“Someone in my position, with the health issues I have, if I couldn’t go to the doctor, I wouldn’t be able to get around or do anything,” said one woman in Ohio about the possibility of losing her access to Medicaid.
Restructuring tax credits
Another of the sharpest changes of the Republican plan would be a shift in how tax credits are applied. Under Obamacare, the tax credit that people receive to offset their health care costs is dependent on their income, which means that lower-income Americans receive a higher benefit.
But under the GOP plan, on the other hand, tax credits would be determined solely by age, and increase as people get older. That would mean that effectively, a 50-year-old corporate executive and a 50-year-old factory worker would qualify for the same tax break for their health care coverage — though one of them had far less to spend than the other.
All of those surveyed rejected this proposal, noting that age could often have little to do with income, and that the plan could end up saddling low-income people with greater costs.
“I just think if you’re poor, you shouldn’t get stuck paying for something you can’t afford. If it’s by income, you’ll get the subsidy, and you’ll get some help,” said one participant in Ohio.
High-income people, who currently don’t qualify for much of a tax break (if they qualify at all), would be the primary beneficiaries of the proposed GOP restructuring.
Why did people on Obamacare plans vote for Trump?
One of the biggest head scratchers among health reporters and policy wonks is why so many people voted for President Trump while simultaneously depending on the program he vowed to dismantle.
The answer, according to the KFF survey, appears to be a mixed bag. Some people didn’t connect their own health care, such as coverage through Medicaid expansion, to the Affordable Care Act. Others were frustrated by their health care costs, saying they were still unable to afford care.
Many also told KFF that health care hadn’t been a key factor in their vote, and they weren’t following the debate that closely. In general, they trusted Trump’s vague promises that he would make fix their current problems with health care — namely, by making it more affordable.
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“I can’t really think of what he said that he’s going to replace it with. I don’t really know what’s coming. I would think if it’s something affordable it could be better,” one participant in Pennsylvania said.
Trump’s vagueness played to his advantage — enabling him to make big promises that the current plan doesn’t currently meet.
When it comes down to the details, GOP health care proposals may not be that popular even among the people who tend to vote Republican.
Overall, the prevailing message from KFF’s focus groups is that people wanted a replacement plan that would lower out-of-pocket costs, not make them higher. Those with Medicaid coverage wanted to keep it, and some of those without Medicaid wanted the program to be expanded a bit more.
Some even expressed support for a single-payer plan — a progressive vision for health care coverage abandoned early in the process of crafting Obamacare as a legislative bargain with congressional Republicans.