Monday, November 20, 2017

What Percentage of Americans Purchase Health Insurance Only Because of Individual Mandate?

With U.S. Senate Republicans leaning toward including a repeal of the Affordable Care Act's individual mandate in their upcoming tax bill, the question once again emerges of how much the mandate affects people's decisions whether or not to obtain health insurance. Should the mandate to have health insurance be repealed, some people who currently have insurance likely would drop it. Decisions of some individuals (presumably in good health) to drop coverage could well have implications beyond those individuals themselves. The fewer the healthy people in the insurance pool, after all, the less money available for insurers to pay the relatively expensive claims of less-healthy people.

But how many people actually would drop coverage if the mandate were to be repealed? According to a 2013 essay from conservative-libertarian group Freedom Works, "Forcing many of our citizens to buy expensive, unneeded and unwanted coverage, which, in turn, impairs every person's freedom to choose how they spend and use their money – [is] a total violation of our civil rights." One can only imagine health-insurance subscribers heading to the exits in drove.

Well, as I learned this morning from a New York Times article on the ACA mandate-repeal aspect of the GOP tax plan, an October poll from the Kaiser Family Foundation examined this issue and the answer is... 7 percent. Quoting from the Times, "the nonpartisan Kaiser Family Foundation found that just 7 percent of people who buy insurance on the individual market said they would go without coverage if the mandate were no longer enforced." The direct link to the Kaiser report is here; Figure 10 is where to look.

All the usual cautions about interpreting polls apply here. One in particular is that, whereas the full poll sample of roughly 2,500 has a narrow margin of error of +/- 2%, the subgroups of respondents for whom the question about dropping coverage is most relevant (i.e., those who bought their coverage via the ACA marketplaces or through all types of non-group-employer plans) have margins of error of +/- 9 and +/- 7, respectively (Kaiser methodology report).

The proportion of Americans who buy their health insurance on the ACA exchanges and who would drop this coverage if the individual mandate were lifted may thus actually by higher than 7%. It will still be a small minority of ACA customers.

Friday, September 29, 2017

Ezra Klein's "Why Obamacare Survived" Cites Public-Opinion Surveys

With Republican efforts to repeal and replace the Affordable Care Act stymied once again (for the short term, at least), Ezra Klein analyzes "Why Obamacare Survived" at Vox. The article cites and links to public-opinion surveys on consumers' satisfaction with the different types of health-care coverage they receive, and also provides several statistics on the costs of the ACA. All in all, Klein's article is a handy one to have, for analyzing health-insurance policy.

Wednesday, August 16, 2017

Robert Blendon and John Benson have a new piece in the New England Journal of Medicine, entitled "Public Opinion About the Future of the Affordable Care Act." Focusing on the aftermath of late July's failure of the U.S. Senate to pass an ACA "repeal and replace" bill, Blendon and Benson set out the following agenda in their article:

Our analysis of 27 national opinion polls by 12 survey organizations provides background on four critical issues relevant to the previous House and recent Senate health care decisions: the public favorability of the current law, the public values underlying the debate about the future, support for various health policy changes in the proposed Republican legislation, and support for the overall Republican proposals debated in the House and Senate.

Vox's Sarah Kliff writes about the Harvard study, focusing on the substantial rise in the percentage of Americans who believe the federal government has a duty to ensure that everyone has basic health insurance.

Another noteworthy finding I noticed is that the individual mandate, long the most unpopular feature of Obamacare, no longer appears to be so toxic. B&B note that: "...48% favored removing this requirement, whereas 50% were opposed" (from a March 2017 CNN/ORC poll).

A large amount of attention during this year's House and Senate debates focused on how the various Republican bills would treat people with pre-existing conditions. The House-passed bill featured the McArthur-Meadows amendment, which would allow states to opt out of some of the Obamacare coverage standards (including those protecting people with pre-existing conditions), as long as those states operated high-risk pools for this purpose. The Senate process included a proposed amendment by Ted Cruz, which would have allowed insurance companies to offer relatively cheap plans that did not comply with Obamacare standards, as long as they also offered plans that did.

Many have contended that high-risk pools typically are not funded well enough to help everyone with expensive illnesses and chronic conditions to treat, and that the Cruz plan would likely make things difficult for those with pre-existing conditions  because the ACA-compliant plans would become very expensive. Two pertinent findings from the Harvard authors were that:
  • "Approximately one third of the public (35%) believed that insurers should be allowed to offer health plans that cover fewer benefits than currently required"
  • " less than one fourth of the public believed that insurers should be allowed to charge more for people with preexisting conditions (24%)."
Kliff writes that "Blendon attributes the change in attitudes to Americans thinking through the consequences of repealing the Affordable Care Act, resulting in millions losing coverage." That seems as good as explanation as any.

Thursday, July 20, 2017

"The Most Unpopular Bill in Three Decades"

This is from about two weeks ago. Axios reported an analysis showing how public support for the Republicans' health care legislation compared to support for other controversial bills (including, but not limited, to health care) over the past 30 years (via Vox).

Monday, July 10, 2017

Medicaid Patients' Quality Ratings of Their Care

Medicaid patients appear to rate the health care they receive very favorably, according to this Huffington Post report. The article also contains statistics on doctors' willingness to take Medicaid patients.

Monday, June 26, 2017

Looking at Americans' Pro/Con Views of ACA to Anticipate How People Will Feel About Republicans' (Potential) Replacement

Over at FiveThirtyEight, Dan Hopkins attempts to connect reasons cited by respondents in the past for supporting or opposing the Affordable Care Act (aka Obamacare) to Americans' future attitudes toward a Republican replacement bill (should one pass). For example, the most commonly cited reason for supporting the ACA, endorsed by roughly 17% of respondents, was "increased access." Hopkins then invokes "initial analyses suggest[ing] that the proposed changes probably won’t cut out-of-pocket spending" and concludes, "if the reform reduces access to health insurance, it’s hard to envision the bill becoming more popular than the law it seeks to replace."

Wednesday, May 31, 2017

Single-Payer Proposal in California

The Los Angeles Times reports polling results from the Public Policy Institute of California, under the headline "Single-payer healthcare is popular with Californians — unless it raises their taxes."