The Affordable Care Act was signed into law three years ago this week, and while a great deal has changed for American consumers and the nation's health care system, the politics of health care remains largely stuck.
Yesterday, for example, congressional Republicans voted for the 36th time to repeal "Obamacare," as part of a vote on the budget process, and today, they'll cast their 37th repeal vote. Apparently, old habits die hard.
But what about with the public at large? The Kaiser Family Foundation published its latest non-partisan report this week, and there were some striking details in the survey results.
There's quite a bit to chew on in the results, but this chart, published by the KFF in its report, struck me as the most interesting. Many provisions in the Affordable Care Act are extremely popular, enjoying at least two-to-one levels of public support, but (a) most Americans still have no idea what's in the law; and (b) the most popular provisions are the ones Americans don't know about, while the least popular provisions are the ones Americans do know about.
No wonder "Obamacare" isn't more popular. The mainstream doesn't yet have enough information to realize how much they support it.
Indeed, it appears the key takeaway from the latest survey is that confusion still reigns. Not only does much of the public not realize that popular ideas are included in the law, many Americans think imaginary provisions are included in the ACA -- 57% believe the law includes a public option (it doesn't); 47% believes it extends benefits to undocumented immigrants (it doesn't); 44% believe it cuts benefits for Medicare beneficiaries (it doesn't); and 40% believe death panels are real (they're not).
Some wealthy and powerful opponents of the White House invested heavily to make sure as many Americans are as confused about the Affordable Care Act as possible. Three years after the reform plan became law, they've clearly had a fair amount of success.
As long as we're on the topic, let's also note that Republican opponents of "Obamacare" used to talk quite a bit about a "repeal and replace" strategy. The idea was, Republicans realized that the American mainstream wants to see real improvements to the old, dysfunctional system that cost too much and covered too few, so they'd kill the ACA and replace it with a superior alternative.
In time, however, GOP officials effectively gave up on the "replace" part of the plan, and simply tried (and tried, and tried) to repeal the Democratic law. In theory, it's not too late -- Paul Ryan's House Republican budget repeals the parts of the Affordable Care Act that actually provide benefits to Americans, while keeping the parts of the law that generate revenue, and could theoretically point to Republican-friendly health care reforms. Some notable conservatives find it "rather odd" that GOP lawmakers refuse to outline a replacement for "Obamacare."
Jon Chait explained the other day that it's really not odd at all: "It's the furthest thing from odd. It's the House Republican ideology."
Putting into place some different plan to cover the uninsured would cost money. Republicans don't want to spend money covering the uninsured.
Now, it's true that they're happy to wave around vague plans to cover the uninsured as an effort to "show" that they have a plan of their own, as part of the effort to oppose health-care reform. I'm sure many Republicans actually agree with those plans, at least in the abstract. What they don't agree with is the idea that it's worth having higher taxes in order to subsidize access to health care for people too poor or sick to buy it themselves.
Let's just make this plain: Republicans don't see tens of millions of uninsured Americans as a problem. They don't see American families being pushed into bankruptcy -- the only advanced country on the planet that allows this -- as an issue in need of a remedy. They've admitted this many, many times.
Their plan for the future of health care is to repeal the Affordable Care Act, end Medicare, and allow free-market forces to magically meet consumers' needs.