Inside the Paradox

There’s a lot of interesting stuff in the latest poll (this one from Reuters-Ipsos) showing that Americans don’t like the Patient Protection and Affordable Care Act of 2010, but like nearly all of its component parts, some by overwhelming and bipartisan margins:

Fifty-six percent of people are against the healthcare overhaul and 44 percent favor it….

Support for the provisions of the healthcare law was strong, with a full 82 percent of survey respondents, for example, favoring banning insurance companies from denying coverage to people with pre-existing conditions.

Sixty-one percent are in favor of allowing children to stay on their parents’ insurance until age 26 and 72 percent back requiring companies with more than 50 employees to provide insurance for their employees….

A glaring exception to the popular provisions is the “individual mandate,” which requires most U.S. residents to own health insurance.

Sixty-one percent of Americans are against the mandate, the issue at the center of the Republicans’ contention that the law is unconstitutional, while 39 percent favor it.

So far that information is unsurprising, if highly annoying. But there’s this, too:

A good portion of the opposition to the healthcare law is because Americans want more reform, not less of it.

The poll found that a large number of Americans – including about one-third of Republicans and independents who disagree with the law – oppose it because it does not go far enough to fix healthcare.

Seventy-one percent of Republican opponents reject it overall, while 29 percent feel it does not go far enough, while independent opponents are divided 67 percent to 33 percent. Among Democratic opponents, 49 percent reject it overall, and 51 percent wish the measure went further.

We’re used to the realization that embedded in all the opposition numbers were a lot of progressives who favored something a lot strong, like a single-payer system or at least a public option. But nearly a third of Republicans are willing to say ACA “didn’t go far enough.”

Greg Sargent called up the pollsters and got more partisan breakdowns, and it’s interesting to see how far the “hate the whole, love the parts” sentiment penetrates into GOP ranks:

* Eighty percent of Republicans favor “creating an insurance pool where small businesses and uninsured have access to insurance exchanges to take advantage of large group pricing benefits.” That’s backed by 75 percent of independents.

* Fifty-seven percent of Republicans support “providing subsidies on a sliding scale to aid individuals and families who cannot afford health insurance.” That’s backed by 67 percent of independents.

* Fifty-four percent of Republicans favor “requiring companies with more than 50 employees to provide insurance for their employers.” That’s backed by 75 percent of independents.

* Fifty two percent of Republicans favor “allowing children to stay on parents insurance until age 26.” That’s backed by 69 percent of independents.

* Seventy eight percent of Republicans support “banning insurance companies from denying coverage for pre-existing conditions; 86 percent of Republicans favor “banning insurance companies from cancelling policies because a person becomes ill.” Those are backed by 82 percent of independents and 87 percent of independents.

Greg thinks these numbers simply reflect GOP opposition to the law on grounds that it’s Obama’s. That’s undoubtedly a big part of it, but a complete lack of understanding as to how insurance markets work is a factor as well. You can bet GOP pols will be telling their base and independent voters alike that can get all the rich chocolatey goodness of the above reforms via a somewhat different menu of individual tax credits, high-risk pools, interstate insurance sales, medical savings accounts, association health plans, and maybe tort reform. It would not be true by any stretch of the imagination, but so long as they can keep holding such “ideas” out as an alternative to reenactment of the popular provisions of ObamaCare, they might be able to keep their folks placated for a while, particularly if an eliminated individual mandate leads to higher premiums that can be blamed on the surviving parts of the law. In the end, though, the Republican “agenda” on health care will amount to a big bait-and-switch, even for Republican voters.

Unfortunately, one area where “the base” and their solons are more in synch is on Medicaid, with a majority of the rank-and-file opposing ACA’s expansion of benefits to families with incomes under $30,000 a year (you know, those people). So I’d guess that if the law survives sans mandate, that’s where Republicans might attack first, as an appetizer for their efforts in the Ryan budget to radically scale back Medicaid as it existed prior to ObamaCare. If Democrats don’t defend Medicaid til the last dog dies (and I fear some may not, mesmerized as always with the belief that Medicare’s the only real priority since its beneficiaries mostly vote), the whole effort to move towards universal access to affordable health care will fail, regardless of what happens on all the regulatory issues.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.