The Trump administration announced it will argue in federal court that ObamaCare’s preexisting‐conditions provisions are unconstitutional. Supporters of the law, including many reporters, are beside themselves with glee. Republican fools! Everyone knows ObamaCare’s preexisting‐conditions provisions are the most popular part of the law! (Democrats, crush them!!)
ObamaCare’s supporters have this one exactly backward. The law’s preexisting‐conditions provisions are not popular. They are wildly unpopular. Supporters of the law believe they are popular — and have fooled even Republicans into believing the same — because they have been drinking a strong brew of economic ignorance, shoddy polling, and bad journalism.
In response to the Trump administration’s announcement, Kaiser Family Foundation president Drew Altman wrote:
Protections for people with pre‐existing conditions are hugely popular, and the administration may have handed Democrats their strongest health care weapon yet — because now they can make the case that the administration has gone to court to take away protections for people with pre‐existing medical conditions.
The case is also likely to drag on, so it could be the political gift that keeps on giving through 2020, even if it is eventually thrown out.
The Washington Post’s Paige Winfield Cunningham wrote:
The Trump administration has given Democrats a generous political gift
Preexisting conditions health coverage is very popular.
President Trump has given Democrats the political gift that Capitol Hill Republicans were too smart to grant them last year. And Republicans know all too well it could be disastrous…
Dismayed, top Republicans have been moving quickly to put space between themselves and the administration on the matter, anxious to distance themselves from such popular consumer protections…
Politicians and policymakers are well aware that preexisting protections [sic] poll extremely well with Americans. Seventy percent of respondents to a Kaiser Family Foundation poll last year — including 59 percent of Republicans — said the federal government should continue prohibiting insurers from charging these folks more for coverage.
Less smart than Capitol Hill Republicans? Them’s fightin’ words.
The reason Altman, Cunningham, and almost everyone else in Washington believe ObamaCare’s preexisting‐conditions provisions are popular is because they conduct (in the case of Altman) and rely on (in the case of Cunningham) poll questions that ask only about the presumed benefits of those provisions – as if those provisions have only benefits, and no costs. Here is the Kaiser Family Foundation poll question both of them cite.
The question basically asks whether respondents want the federal government to guarantee that sick people will pay no more for health insurance than healthy people pay. It asks only about the intended benefits of ObamaCare’s preexisting‐conditions provisions: lower premiums for the sick.
Kaiser Family Foundation scholars from Altman all the way down to the lowliest research assistant, as well as seasoned health‐policy journalists like Cunningham, know full well that requiring insurers to charge healthy and sick enrollees the same entails significant costs as well as benefits. And they know what those costs are. But while I have seen Kaiser Family Foundation polls ask respondents to offer opinions informed by both the benefits and the costs of a certain policy, I have never seen them do so with regard to ObamaCare’s preexisting‐conditions provisions.
Fortunately, we at the Cato Institute have done so. The results may shock you!
In 2012 and again in 2017, Cato scholars fielded surveys that sought to get a more accurate picture of public attitudes toward these provisions. On both occasions, we learned that when pollsters ask voters about both the benefits and the costs of ObamaCare’s preexisting‐conditions provisions, voters really don’t like them.
Take our most recent series of poll questions, conducted last year. When we asked voters essentially the same benefits‐only question the Kaiser Family Foundation asked, we got essentially the same response: 2 – 1 support for ObamaCare’s preexisting‐conditions provisions. But when we asked whether voters would still support those provisions if they increased premiums or taxes, support flipped to opposition.
But those are not the only costs of those provisions. In this blog post at Health Affairs, I discuss research showing that ObamaCare’s preexisting‐conditions provisions are reducing the quality of coverage for patients with many expensive conditions. Believe it or not, and even ObamaCare’s architects know this to be true, ObamaCare’s preexisting‐conditions provisions provisions literally punish insurers who offer high‐quality coverage for the sick.
When we asked voters if they would still support ObamaCare’s preexisting‐conditions provisions if those provisions reduced quality, voters opposed those provisions by a 2 – 1 margin. That’s right: the impact ObamaCare’s preexisting‐conditions provisions have on quality caused initial 2 – 1 support for those provisions to flip all the way to 2 – 1 opposition.
This huge swing occurs because the impact that ObamaCare’s preexisting‐conditions provisions have on quality causes even Democrats to turn against them.
Have a look at the below chart. Unlike Republicans and independents, Democrats are willing to endure the higher taxes and health‐insurance premiums associated with those provisions — but not reductions in quality, which cause 41 percent of Democrats to flip from supporting those provisions to opposing them.
More Good Polling
The polling that Altman conducts and Cunningham cites on ObamaCare’s preexisting‐conditions provisions has almost no connection to the reality of how those provisions operate, and therefore paints a misleading picture of public attitudes toward those provisions.
More responsible polling suggests not only that these provisions are unpopular, but that Republicans could turn opposition to those provisions to their political advantage – if they learn how to talk about how those provisions affect quality.
In fact, I’m so confident that ObamaCare’s preexisting‐conditions provisions are unpopular, I will bet Drew Altman $100 that if the Kaiser Family Foundation polls both the benefits and costs of those provisions, their poll will show those provisions are unpopular too. What do you say, Drew?