If you want to know whether people in Washington state like or loathe Obamacare, you could just ask them which political party they prefer.
That’s because 80 percent of Democrats surveyed approve of health-care reform while 80 percent of Republicans don’t, according to an Elway Poll of Washington voters conducted on behalf of The Seattle Times. Independent voters are the wild card, with 41 percent in favor and 46 percent against the overhaul, formally known as the Affordable Care Act.
The Elway survey of 406 Washington voters earlier this month asked about their personal experiences with health care and their opinion of the Affordable Care Act (ACA), which kicks into high gear Oct. 1 with the launch of insurance marketplaces called exchanges.
Overall, blue-leaning Washingtonians in the survey view Obamacare more favorably than Americans as a whole, as measured by a recent national Gallup poll.
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Red, blue or independent, we all get sick and see the doctor now and then. What makes the health-care act so politically polarizing — as exemplified by a move last week by U.S. House Republicans to strip funding for the act?
“Each side has a reason,” said William Rorabaugh, a history professor at the University of Washington. “It’s not just ideology.”
Republicans don’t like the reform for many reasons: the provision requiring people and businesses to buy health insurance; concerns that medical costs will continue to soar while the quality of care declines; its expansion of entitlements; and the belief that it trumps personal freedom while giving the federal government too much control over health-care decisions.
Democrats, on the other hand, might not love every feature of the Affordable Care Act, but many support it for bringing medical care to more people.
“The issue has been in Democratic Party circles for a long time,” Rorabaugh said.
“This is the last big missing piece of social legislation,” he said. If you look at democracies worldwide, they all have free education, retirement and welfare systems, and — except for America — national health care.
The health-insurance exchanges opening next month — including this state’s Washington Healthplanfinder — will sign up the uninsured and provide new policy options for people who aren’t covered by an employer. The ultimate goal of Obamacare is for most everyone to either have health insurance or have coverage under a federal program such as Medicare, Medicaid or the military.
The plan is for health-care costs to come down. That happens by paying for preventive medical treatments, shifting to a system that rewards doctors and hospitals that actually make people well rather than those that provide the most procedures, and expanding the pool of who is insured — in part by adding more young and healthy people.
The challenge of enrolling the uninsured will be easier in this state than in many other places. In Washington, 45 percent of those surveyed in the Elway poll approve of the overhaul, while 41 percent of Americans overall like the changes. On the flip side, 42 percent of voters here disapprove of the law while 49 percent of the U.S. population do, according to an August poll by Gallup.
The Elway poll, conducted Sept. 3-5, has a margin of error of plus or minus 5 percent.
The poll also found:
•While the ACA is the biggest overhaul of American health policy since Medicare began in 1965, almost half of the people surveyed said it either won’t make much difference in their lives, or they don’t know whether it will.
• Slightly more than half of the people who say they are familiar with the ACA also say they approve of it. The approval rating is 38 percent among those who say they are unfamiliar with it.
• Forty-one percent of people in households earning $50,000 or less annually approve of the ACA, while 58 percent of respondents in households making $100,000 or more say they like Obamacare.
• The people who will likely feel the biggest impact of the new insurance exchanges — those who are currently uninsured or have individual insurance — are also those who least like the ACA, with 37 percent in favor and 47 percent disapproving.
Strong feelings about purchase requirement
Carol Sterling is among those who are uninsured. The single mom from Lynnwood could get insurance through the nursing facility where she works, but she can’t afford her share of the premium. Sterling’s two children get insurance coverage through their dad.
“I can pay for my rent and make sure my kids have food on the table, or I have insurance,” Sterling said. “There are no two ways about it, my kids come first.”
Sterling, 42, says she’s in excellent health. She said her own health-care knowledge, combined with that of family members who also work in medicine, provides the information she needs to stay healthy and treat some ailments.
She recoils at the notion that come Jan. 1, she needs to buy health insurance or pay a fine for failing to do so. That’s because, except in certain situations, the ACA requires the uninsured to buy insurance or pay a fine of $95 per adult the first year, $325 in 2015 and $695 in 2016 and beyond, with additional fines for each uninsured child up to a limit.
“I don’t agree with the flippin’ government telling me we have to do something,” Sterling said. “What happened to freedom of choice?”
While the Affordable Care Act requires the vast majority of the uninsured to buy insurance, it does offer subsidies to pay insurance premiums, based on income and family size. A family of four earning up to $40,000, for example, could be eligible for approximately $426 a month in tax credits. That would bring down the cost of a middle-of-the-road insurance plan to about $164.
Additionally, Washington is one of the states that opted under the Affordable Care Act to expand Medicaid, the state-federal program that covers health-care costs for low-income people. These residents won’t need to buy additional health insurance, and neither do those who are Native American or are covered by Medicare, the military or other specific exemptions.
Nearly two-thirds of the uninsured people surveyed in the Elway poll said the reason they don’t have health insurance is because they couldn’t afford it.
Depending on what her work-provided insurance costs, Sterling could be eligible for a tax credit to help her buy her own coverage. She doesn’t like the idea, but she might have to take it.
“It’s more of a pride thing,” she said. “I was raised in a family that worked hard and you don’t ask for handouts.”
Seeing plan as “critical infrastructure”
Like Sterling, David Baer identifies himself as a Republican. But Baer, who lives in West Seattle and works as a senior finance manager at Boeing, is a rare member of the GOP who approves of the Affordable Care Act.
Baer relates to more moderate Republican leaders of the past, including Dan Evans, a former governor and U.S. senator, and Slade Gorton, a former state and U.S. senator.
“There was this conservative group within the Republican party that recognized there are certain things you don’t want to privatize, that there is critical infrastructure that the government should fund,” he said. “That is where I come from.”
Baer sees a moral obligation to provide basic health care to Americans. “We have to find a way to provide the basic necessities of life,” he said.
In addition to making it easier for low-income people to get insurance, the ACA requires insurance companies to provide coverage beginning in 2014 to adults with pre-existing health problems. The provision covering children with pre-existing conditions started in 2010.
There’s still strong opposition to the health-care overhaul, with the Republican-led U.S. House passing a spending bill last week that would strip funding for the ACA — a move that pundits say won’t pass the Senate and will ultimately fail.
Experts say as people start seeing their family and neighbors benefiting, support will likely build.
The UW’s Rorabaugh predicts that unlike Medicare, it won’t take a full decade for the ACA to gain acceptance. The tide of public opinion could shift in favor of the law in five years or less, he said.
But the ACA is far from perfect, Rorabaugh said, and he hopes lawmakers will study the range of health insurance and treatment strategies already in place in America and abroad to fine-tune health-care reform.
“The problem is figuring out how to make it work,” Rorabaugh said. “If you do this wrong, people will die.”