The Good News from the King v. Burwell Ruling

These may seem like the darkest of days for proponents of free-market health reform.

The Supreme Court ruled in King v. Burwell that ObamaCare’s subsidies can flow to states that don’t set up their own exchanges, and a poll out last week found supporters of the law narrowly outnumbering opponents for the first time in years.

But a closer look at those poll results offers not only hope for a revival of free-market aims but a path forward.

First, the CBS News/New York Times poll appears to be an outlier. Real Clear Politics lists 21 other opinion surveys taken this year, and all found more opponents than supporters of the law by no fewer than six percentage points and some by as many as 20 points. It’s only the second poll since 2011 to find support outweighing opposition, and the other also came from CBS News and The New York Times.

So that makes one other finding of the last week’s poll even more interesting: In only the second poll since early 2011 to find more Americans in favor of the law than opposed, Americans don’t seem to have too favorable an impression of how the law is working.

The survey asked this question: What should happen to the health care law? And possible answers were: Working well, keep as is; Good things, but changes needed; Needs to be repealed entirely. Only 9% of respondents of the poll – the first poll all year to show Obamacare support outstripping opposition – thought the law was working well and should be kept as is.

More importantly, only 15% of Democrats and 8% of independents thought the law was working well and needed no changes. More than half of all respondents and nearly two-thirds of Democrats said the law needed changes to work properly. Interestingly from an electoral standpoint, 55% overall and 55% of independents agreed the law needs changes.

Moreover, 55% of Republicans favor full repeal, so the issue will continue to resonate with the base through 2016.

In one sense, the King decision will give free-market reformers more room to maneuver.  If the Supreme Court had struck down subsidies in states without their own exchanges, nearly two-thirds of voters would have favored changing the law to allow them. Moreover, 70% of independents and more than 40% of Republicans would have been in that camp.

Without the pressure to deal with immediate upheaval in state health insurance markets, policymakers can focus on the real roadblocks ObamaCare creates.

For example, the employer mandate says that all employees who work 30 hours per week must be considered full-time, and employers must provide them with ObamaCare-compliant health insurance or pay a fine. This provision is extremely unpopular and will become more so when it takes full effect in January 2016. A February 2014 report by the Congressional Budget Office said that, by 2017, this one rule will mean 2.5 million fewer full-time workers in America.

The court ruling could, in some ways, provide impetus for real reform.

For one thing, the top line of the CBS/New York Times poll notwithstanding, the nation still seems solidly against the law. The very same poll, taken a month earlier, found opponents outnumbering proponents by 9%, and the Real Clear Politics average of polls still shows 7.8% more people opposing the law than supporting it.

For another, Americans want lower costs – 59% say the top priority should be reducing costs, and only 35% say it’s more important that everyone have coverage.

The 11 million people who have gained either a policy through an exchange or Medicaid coverage are using emergency rooms at a 40% greater rate than their non-insured counterparts. Why? Because it’s not easy to find doctors who take Medicaid, make appointments that may mean missing work or deal with the unfamiliar paperwork of insurance and doctors.

The finding-the-doctor part is made harder by Medicaid’s regulations and reimbursement rates, which are encouraging a shortage of physicians (estimated at 63,000), a bevy more saying they will retire early and the findings from a Physicians Foundation study in which almost half the 20,000 doctors surveyed gave Obamacare either a D or an F.

For still another, Americans identify ObamaCare with a general decline in the quality of the nation’s health care system. When ObamaCare started, 85% or Americans said they had health insurance and liked it. Now, just 33% say our health care system works properly and 28% regard the system as poor.

In short, King v. Burwell did nothing to make ObamaCare work better. It did nothing to make it more affordable, responsive, or effective. It did nothing to improve its standing with Americans in any meaningful way. In other words, voters may be poised to treat it at the polls in 2016 just as they did in 2014.

Brian McNicoll is an independent writer and editor based in Reston, Va.