As President Obama and his allies gear up to defend the landmark healthcare law he signed two years ago, they confront an unforgiving math problem: Just a tiny fraction of Americans has experienced a major benefit from the law.
At the same time, tens of millions have continued to see insurance premiums and medical bills rise as they did before the legislation was signed.
That reflects the design of the complex law, in which many of the key provisions were delayed in a bid to hold down costs and minimize disruptions while new systems are put in place to expand coverage. The law will not guarantee insurance to all Americans until 2014, and may take many more years to rein in healthcare costs.
But the president and congressional Democrats had nonetheless hoped that a handful of early benefits — such as allowing adult children to remain on their parents’ health plans until age 26 — would rally the public behind the law by now.
That hasn’t happened, surveys indicate. “The law is still not real for the vast majority of Americans,” said Mollyann Brodie, polling director for the nonprofit Kaiser Family Foundation.
Two-thirds of Americans say they haven’t been personally affected by the law, according to the latest Kaiser tracking poll. By contrast, just 1 in 7 say they have experienced something positive from the law.
Even more ominously for the president and supporters of the law, few people have much confidence the law will ever help them. Sixty-seven percent say they believe the law will leave them worse off or won’t make much of a difference, the Kaiser survey indicates. Just a quarter believe it will improve their lives.
In the 2010 midterm election, Republicans exploited this skepticism to win control of the House. This year, GOP presidential candidates have once again made repealing the law a centerpiece of their campaigns.
But Republicans could have a harder time winning the healthcare debate in 2012.
Most Americans prefer to leave the law alone or modify it rather than throw it out entirely, surveys show. At the same time, the GOP — including former Massachusetts Gov. Mitt Romney, the front-runner for the party’s presidential nomination — has embraced controversial proposals to largely privatize Medicare by giving seniors vouchers to shop for commercial insurance.
That has buoyed Democrats, who are already campaigning in defense of Medicare, a government health program that remains highly popular with seniors.
Meanwhile, the White House and its allies also are trying to find ways to convince Americans that the healthcare law will deliver important benefits. That strategy will highlight personal stories from people who have already been helped.
Among them is Sonji Wilkes of Colorado, whose family twice lost its health insurance because the cost of medication for her son with hemophilia hit lifetime coverage caps. Such caps were common before they were banned by the law.
“We were so relieved when the Affordable Care Act passed because it meant we could care for our child,” said Wilkes, who is participating in a “Thanks Obamacare” project organized by liberal activists in Colorado.
But supporters of the law acknowledge that winning over the rest of the country is a long-term project.
“I’m confident the Affordable Care Act will be an extraordinarily popular piece of legislation such that the term ‘Obamacare’ will be a badge of distinction,” said Families USA Executive Director Ron Pollack, a leading consumer advocate. “But that will take time.… It will not all happen by November.”
For example, although more than 100 million Americans are now in health plans that no longer have lifetime caps, only about 20,000 people a year typically hit those limits, according to administration estimates.
Fewer than 50,000 people now benefit from new high-risk insurance plans designed to help Americans who had been denied coverage for preexisting medical conditions.
Just 228,000 small businesses took advantage of new tax credits designed to help provide health coverage to their employees, far less than the 4.4 million that had been hoped.
Other benefits have had a slightly greater impact. About 2.5 million young Americans have been able to stay on their parents’ health plans.
And last year, 3.6 million seniors and people with disabilities saved $2.1 billion on prescription drugs thanks to a provision that gradually closes the gap in Medicare drug coverage.
But many protections, including bans on co-pays for preventive services such as cancer screenings and physicals, have a relatively small effect on most Americans’ checkbooks.
Others, such as new regulations requiring insurers to spend more of their customers’ premiums on medical care rather than administrative expenses, are little understood by consumers.
And some of the law’s most important provisions, including initiatives to improve the quality of medical care and control costs, will probably take years to bear fruit. Many healthcare experts believe these efforts are crucially important.
They could not be put in place quickly, however. Nor could a huge expansion of insurance coverage that requires sweeping changes on the state and federal levels. “Implementing additional benefits before they could be cost-effectively administered would have backfired,” said Chris Jennings, a healthcare consultant who was a top Clinton administration healthcare aide.
For now, costs continue to rise. The average annual premium for an employer-provided family health plan jumped 9% last year, to $15,073, according to a survey by the Kaiser Family Foundation and the Health Research & Educational Trust. Approximately 150 million people get insurance through their employer.
Although new benefits in the law probably account for some of that, most experts agree the increase reflects other factors, such as rising medical costs and profit-taking by insurers.
Nevertheless, many Americans simply aren’t convinced the law will do much to help them.
“I suppose there may be trickle-down effects someday,” said Melissa Gay, a Louisiana mother of four who said her grandfather still has trouble affording his prescriptions. “I just don’t see them.”