Dan Morain

Dan Morain: Will public turn against Obamacare?

Dan Morain
Dan Morain

Rep. Ami Bera, one of two Democratic physicians in the House, doesn't want Obamacare to fail.

But the freshman member of Congress is worried about President Barack Obama's signature domestic achievement.

"I have been consistently concerned about the cost of care going up," said Bera, a former chief medical officer for Sacramento County and an assistant dean at UC Davis medical school.

Then there is Obama himself, speaking at a press conference last week: "The main message I want to give to the American people here is despite all the hue and cry if you've already got health insurance, then that part of Obamacare that affects you, it's pretty much already in place. And that's about 85 percent of the country."

Maybe Obama is right. Perhaps we'll all be happy that our kids can remain on our policies until they're 26, that preventative care such as colonoscopies and mammograms are free, and that we can buy coverage despite pre-existing conditions.

I worry that Sen. Max Baucus, the Montana Democrat who wrote much of the Affordable Care Act, was right when he confronted Kathleen Sebelius, Obama's Health and Human Services secretary, at a hearing last month.

"I just see a huge train wreck coming down," Baucus said to the glee of the Republican National Committee, which happily circulated a video of his comments far and wide.

Three years after passage of the Affordable Care Act, Americans who aren't confused take a dim view of Obamacare. A Kaiser Family Foundation poll last week found that 42 percent of Americans don't know that the act remains the law of the land, while a Quinnipiac University poll last month found that voters disapprove of Obamacare by a 46 percent to 41 percent margin.

The poll also found that 41 percent of voters don't believe the law will affect them. They could be in for a surprise – and people don't like surprises when it comes to their health care.

The very name, Affordable Care Act, is misleading. Health care costs aren't going down, at least not for the bulk of people who vote and certainly not before the 2014 election.

Because of federal subsidies, people whose income is 400 percent or less of the federal poverty level will see decreases in the amounts they pay for health care coverage. But costs will rise for people whose income is above that poverty level.

The Congressional Budget Office estimates that nationwide, premiums on the individual market would go up by 10 percent to 13 percent. The increases likely will be greater in California.

A report prepared in October by the consulting firm Milliman for the California Health Benefits Exchange estimated that individual health insurance premiums in California will rise 26 percent, driven in part by Obamacare. Rates for employer-paid insurance also will rise.

"Premiums are going to go through the roof," said Bill Dombroski, head of the California Retailers Association. He predicts some retailers will cut employees' hours to below 30 a week, avoiding the mandate that they provide coverage. "I'm just pointing out what should be obvious."

California has embraced the Affordable Care Act, and rightly so; people should not be denied health care because they are poor. To their credit, Gov. Arnold Schwarzenegger embraced the Affordable Care Act early, as did Jerry Brown.

One of Brown's very first appointees was California Health and Human Services Secretary Diana Dooley, a trusted aide from his first administration who later worked for hospitals. Dooley knows the nation will be watching how California implements the Affordable Care Act.

"There are people who are going to look for the weak places, for where we stub our toes," Dooley told me. "We're going to need to put some armor on to get through the first year."

Unlike many states, California is building a website where people seeking insurance will be able to buy it. The computer system supposedly is on track. But state government has never done well with big computer systems.

The task is daunting. On any given day, about 4.5 million to 5 million people in this state are without health insurance. The goal is to sign up as many of them as possible, starting in October.

Complicating matters, Senate and Assembly leaders are pushing to vastly expand the number of people covered by Medi-Cal, all the while knowing there aren't enough physicians to treat them.

Senate Health Committee Chairman Ed Hernandez, an optometrist, is pushing bills to expand the authority of nurse practitioners, pharmacists and optometrists to treat patients. Defending physicians' turf, the California Medical Association is opposing the bills.

A formidable force, the California Medical Association spent $2.9 million on lobbying in the 2011-12 legislative session. Doctors make powerful arguments, contending the Legislature should not establish a two-tier system in which poor people receive lesser care, although as it is, poor people often go without care.

All this has implications for Democrats hoping to reclaim the House of Representatives in 2014.

"The politics of it are that everybody's rates are going up," said Rob Stutzman, the Republican strategist whose candidate, Dan Lungren, was defeated by Bera last year.

The GOP targets Bera for defeat and will use Obamacare as an issue. Bera said he is less worried about voter backlash than he is about people's anger if they conclude Obama oversold the act.

"If this fails and blows up," said Bera, whose district runs south and east of Sacramento, "it is probably another decade if not longer before health care (reform), and we don't have another decade."

In time, the nation will benefit from improved care envisioned by the Affordable Care Act. People receiving regular care will make fewer costly emergency rooms trips. But that's a longer view. There are more pressing questions, like whether Americans will swallow short-term price increases and remain patient as tens of millions more people get coverage.

Bera isn't alone by faulting the Obama administration for failing to fully explain the act. I'm not sure the failure is unintentional. Perhaps the president hasn't wanted to level with people by telling them about coming cost increases.

Bera is correct on another point. If the public turns against the law, national health care will be set back years. That truly would be a failure.

Follow Dan Morain on Twitter @danielmorain.