The Race Between Slander and Reality on Obamacare

Speaking of million pixel images, Sarah Kliff has an important piece at Vox today about perceptions of Obamacare five years in, and the big takeaway is how little has changed, in no small part because people with no direct experience of the new system have internalized the (mostly negative) propaganda they’ve heard. That is particularly true with respect to completely erroneous impressions of the net cost of Obamacare:

Forty-two percent of Americans think Obamacare has gotten more expensive over the past five years. Only 5 percent of poll respondents hit on the right answer: budget estimates for the Affordable Care Act have consistently fallen since it became a law.

Make no mistake: Obamacare spends a lot of money on its tax credits and Medicaid expansion. It recoups some, but not all, of that new spending with hundreds of billions of dollars in Medicare cuts, which reduce federal health spending. The bulk of the remainder is made up with tax increases. But back when the law was passing, Republicans argued up, down, and sideways that the Congressional Budget Office was sharply underestimating the amount of money Obamacare spends.

In fact, the CBO overestimated the cost of Obamacare — and by quite a lot. In April 2014, it marked down its Obamacare projection by more than $100 billion. Much of the revision comes down to the fact that health-care costs have grown very slowly during 2009, meaning it’s less expensive for the government to help millions of Americans purchase coverage. Just this month, CBO released new projections showing that Obamacare’s subsidies would cost 20 percent less over the next decade than initially expected.

The government is now spending less on health care than CBO had projected back in January 2010 — a projection that didn’t include any Affordable Care Act spending at all.

Another problem is that people attribute to the Affordable Care Act phenomena that would have occurred anyway, especially rising (though more slowly rising) premiums and disruption of individual insurance policies–and even the long, long trend away from fee-for-service medicine delivered by doctors of one’s own choice.

Assuming it is not crippled by the U.S. Supreme Court or repealed by a Republican Congress and president, Obamacare will slowly or surely chip away at the misconceptions. It is, sad to say, a sign of progress that (according to the Vox survey) that only 26% of self-identified Republicans believe in the “death panel” meme. The bigger question is how long it might take for Republican politicians to end their propaganda and treat Obamacare as part of the national landscape–as something to change, not kill–and whether that will precede their next turn in real power.

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.