‘Obamacare’ was such a catchy nickname for the 2010 healthcare reform law. Headline writers love it and President Barack Obama decided to embrace it when his Republican enemies coined the term.
But the memorable handle may have done more harm than good for Obama’s signature policy, now in the process of being repealed before he even leaves office.
It’s provided an easy scapegoat for people suffering problems in a health care system that was a mess long before the Patient Protection and Affordable Care Act passed Congress in 2009 without a single Republican vote.
“Obama screwed up when he adopted it,” said George Lakoff, a cognitive linguist at the University of California Berkeley who takes a special interest in political messaging.
“It allows people to say that if you have got a problem with your health system, it’s because of Obamacare.”
Perhaps ironically, more Americans than ever support the reforms made by the Affordable Care Act, according to an NBC/Wall Street Journal poll released Tuesday. Of those polled, 45 percent say the law was a good idea, and finds 50 percent doubt the Republicans could come up with anything better.
But the GOP has already started a repeal of the law, and president-elect Donald Trump is pressing for repeal-and-replace as soon as possible.
Simply doing so will make people think things have improved, predicts Sherry Glied, Dean of New York University’s Robert F. Wagner Graduate School of Public Service and a former Health and Human Services Department staffer under Obama, as well as a health policy adviser to former president Bill Clinton.
“Let’s assume Congress doesn’t do anything. Six months from now if you went to people and said ‘Congress has repealed the ACA. Tell me what has happened to your health insurance,’ a lot of people would say, ‘oh things are much better now’,” Glied said.
“Most people’s perception that this law has destroyed the health system or whatever is completely based on their political perceptions of it.”
Liz Hamel, who directs polling for the independent Kaiser Family Foundation, found the name does tend to polarize people.
“There is some evidence there that, to a certain extent, views on Obamacare are a proxy for views on Obama,” Hamel told NBC News.
“When we said ‘health reform law’ they said they don’t know how they feel about it. When we said ‘Obamacare’, people more easily split into pro- and con- camps,” she added.
“I do think that people who don’t like the law are predisposed to blame other problems in the health care system on the law. When we ask people what about the law they don’t like, they say they believe it has increased health care costs.”
It’s true the law is complicated and hard to understand— and it touches many parts of an extremely complex health care system.
It created the health insurance exchanges for people who don’t have health insurance to buy private plans, and to perhaps get federal subsidies to help pay for it. It encouraged states to expand Medicaid to more people with low incomes, with the federal government paying for virtually all of the expansion.
It stopped health insurance abuses, such as policies denying health insurance to people with ‘pre-existing conditions’ and capping coverage for people whose care started to cost too much. It allowed adult children to stay on their parents’ policies until age 26; required certain employers to provide health insurance to workers; and started work on policies meant to cut health costs.
But long before Obamacare was an idea, health insurance premiums were rising for almost everyone and U.S. health care costs were already by far the highest per capita in the developed world.
Many doctors had already begun refusing to accept any health insurance at all because it was so troublesome and expensive to navigate the rules and paperwork, while health insurance companies had begun narrowing their networks, limiting which physicians and hospitals their customers could use.
Obamacare had only begun to scratch the surface of turning around one of the most obvious problems of U.S. healthcare: paying doctors only for procedures, tests, and in-person visits, instead of paying them to keep patients well.
“As long as you have fee-for-service medicine, you have misaligned financial incentives that prompt providers to do more, not necessarily to do better,’ said Ceci Connolly, president and CEO of the Alliance of Community Health Plans.
“We have not put a serious dent into waste in our health care system.”
Obama himself has admitted the law needs more work, and he joked — before the November election — that Republicans in Congress could even re-name it “Reagancare”.
Health policy experts disagree on whether the ACA had begun slowing the steady, annual rise in health care costs and whether the steady, annual rise in health insurance premiums was showing signs of turning around.
And now that repeal is under way, Democrats are rallying around the law and supporters are releasing reports predicting dire consequences unless whatever replaces the ACA is very similar.
What is clear is that “Obamacare” as a moniker is going away.
That may change the debate. “People’s brains have been changed by the Republican use of ‘Obamacare’,” Lakoff said.
But what may change is who gets blamed for the continued shortcoming of a U.S. health care system that’s a mash-up of government insurance such as Medicare, the VA and Medicaid, health insurance companies, big drug companies, independent providers and hospitals.
“This is not something that a slogan is going to fix,” Lakoff said.
“No matter who won the presidency or who took over the Congress, we had already been developing ideas for improvement and it was a good long list,” Connolly added.
“But it needs to be done thoughtfully, and folks need to recall that our health care system is like a massive 3-D jigsaw puzzle.”