With the reelection of President Obama, the Affordability Care Act known as ObamaCare will begin its implementation. The voters have ensured that ObamaCare will now move forward, even though this election was really not a referendum on the unpopular law; only five percent of voters ultimately said the ACA was the biggest factor in determining their vote for president, and the electorate, although divided, still generally opposes the law. Predictably, since the election, the president’s favorability ratings have improved, and along with that, the unpopularity of ObamaCare among Americans has diminished, with the margin of “for repeal” over “against repeal” narrowing down to single digits. Perhaps Americans are beginning to accept what seems inevitable, or maybe they are experiencing some fatigue about the political battles on this issue. Time will tell, and sooner than most voters realize, the next congressional elections and the chance to express an opinion where it counts will be upon us.
In the meantime, the battles over ObamaCare have not ended, particularly at the state government level. A significant number of states are led by governors who oppose the dramatic shift of authority from individuals to the federal government that is fundamental to ObamaCare. These governors understand the law’s destructive impact on health care access and quality, as well as on jobs and the economy, and instead they advocate for the individual choice and competition that come with free market reforms for America’s health care. Close to one-third of states have refused to set up health insurance exchanges; a similar number is contemplating the refusal of Medicaid expansion, another key provision of the new law. Thankfully, at least some of our elected officials understand the trade-offs between freedom and economic growth on one hand, and expansion of government authority masked as entitlements on the other.
But there also seems to be a naïve misunderstanding by many about the consequences of the state-by-state resistance. Regardless of who sets up the health insurance exchanges, the federal government will now define the details of coverage for the majority of health insurance policies. Massive taxpayer money will now be funneled into subsidizing health insurance, while medical care access will diminish with the reductions in payments to doctors and hospitals. More Americans will be shifted to Medicaid, even though some states will reject its expansion. More employers will reduce their health benefits or shift away from scenarios where they are required to offer the coverage. More employees will be forced to change their coverage and, necessarily, their doctors too. Many private health insurance options, including some of the most popular lower cost plans, will be eliminated by the actuarial and benefits-design dictates of the law. Most policy experts on both sides of the aisle understand these realities.