Obamacare users see system collapsing -- but say it's still working for them now

WASHINGTON — A majority of people who rely on Obamacare insurance agree with Republican critics that the health insurance markets created by the Affordable Care Act are collapsing, according to a new poll.

But most of those surveyed also said their premiums are either lower this year than they were last year, or about the same, and they’re likely to continue buying insurance even though Congress has eliminated the ACA’s penalty for going without coverage.

The poll, conducted by the nonpartisan Kaiser Family Foundation, also found that Obamacare enrollees are not interested in switching to the skimpier, short-term plans, touted by the Trump administration, which have fewer benefits and lower premiums.

Liz Hamel, director of public opinion and survey research for the Kaiser Family Foundation, said the poll results highlight the contradiction between political rhetoric and reality.

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"When the president is saying things like, `The ACA is failing. Things are collapsing,' people hear that," Hamel said. "So they may be answering that question not necessarily based on their own experience this year."

Republicans tried unsuccessfully to repeal the ACA last year, arguing the markets created for those who aren’t offered insurance through an employer or a government health care plan like Medicare or Medicaid were failing. The plans cost too much, deductibles were too high, and the number of insurers willing to sell plans was shrinking, GOP lawmakers said.

“Obamacare is collapsing, and we must act decisively to protect all Americans,” Trump said in his first address to Congress in 2017.

About half of the public — and 60% of those who use the Obamacare marketplaces — told pollsters they think the marketplaces are "collapsing." 

Democrats charge that any problems with the marketplaces have been exacerbated, if not created, by Republicans in an attempt to undermine the law. Most significantly, the Trump administration ended reimbursements to insurance companies to cover the discounts they’re required to give low-income customers. The administration also shortened the sign-up period for 2018 plans and cut outreach funding.

"When you mix indifference, cruelty, complicated and sabotage, this is what you get....Trumpcare," Andy Slavitt, who had a lead role in implementing the ACA during the Obama administration, tweeted last month.

Premiums went up in 2018, in part because of the Trump administration's move to cut reimbursements to insurance companies.

But one-third of those surveyed said they’re paying about the same this year, and one-fourth said they’re paying less.

People earning up to four times the federal poverty level qualify for federal subsidies that reduce their premiums. Because the subsidies are tied to the cost of a mid-priced plan, those eligible for help were insulated from effects of the rising premiums. Some subsidies even increased enough that they covered the full cost of the least generous plans.

Although Republicans failed last year to repeal the ACA, they did end the tax penalties the ACA imposed on most people who go without insurance. That effectively killed the ACA’s individual mandate, which had been included in the law to prevent healthy people from waiting until they got sick to purchase insurance.

The individual mandate was the most unpopular part of the ACA, but most people surveyed by the Kaiser Family Foundation did not know it has been repealed, effective in 2019.

And 90% of people who purchase insurance on their own say they will continue to do so despite the mandate’s repeal. Most see health insurance as something they need. For those who go without insurance, many said it's because they can’t afford it.

"We know that people say that health insurance is important. They want it and they need it," Hamel said. "The mandate isn’t the main reason that they’re getting it." 

Trump has directed the U.S. Department of Health and Human Services to make it easier for people to buy short-term plans — something the Obama administration limited. Such plans tend to cost less, but provide fewer benefits and often do not cover pre-existing conditions. The vast majority (84%) of those who buy insurance on their own said they would prefer to keep their current plan rather than switch to short-term insurance.

But at least half are worried that there will be no insurance companies left selling plans in their area in the future. And even more fear that premiums and deductibles will become unaffordable.

That's another reason why respondents may have said the marketplaces are collapsing.

"They still may worry about the future," Hamel said.

The survey was conducted by telephone in February and March. The margin of error is plus or minus 2 percentage points for all respondents, and plus or minus 9 percentage points for people who buy individual insurance through an exchange.