Oct 23, 2017

Keeping the Alexander-Murray health care bill in context

As the debate unfolds about the bipartisan bill by Senators Lamar Alexander and Patty Murray to repair the Affordable Care Act marketplaces, the public could be just as confused as they have been about the ACA's marketplaces. That's why it's important to debate it in the right context: It's aimed at an urgent problem affecting a relatively small sliver of the health insurance system, not all of the ACA and not the entire health system.

The bottom line: It's a limited measure that will never give conservatives or liberals everything they want.

Expand chart
Data: Kaiser Family Foundation Health Tracking Poll conducted Oct. 5-10, 2017; Chart: Chris Canipe / Axios

Reality check: Many people will think it affects their insurance when, in actuality, it will have no impact on the vast majority of Americans who get their coverage outside of the relatively small ACA marketplaces.

The chart based on our new Kaiser Tracking Poll shows the confusion. Just 23% of the American people know that rising premiums in the ACA marketplaces affect only people who buy their own insurance. More than seven out of 10 wrongly believe rising premiums in the marketplaces affect everyone or people who get coverage through their employer.

The public will be susceptible to spin and misrepresentation of the limited goals of Alexander-Murray: a bipartisan effort to stabilize the marketplaces by funding the cost-sharing reduction subsidies, providing more resources for open enrollment outreach, and expediting state waivers.

President Trump has added to the confusion. He recently pronounced the ACA "dead", adding, "there is no such thing as Obamacare anymore." Possibly that's because he wishes it was dead. More likely, he was referring to the problems in the ACA marketplaces, which he has exaggerated.

Like thinking your whole house is falling down when just a part of the foundation needs shoring up, both he and the American people have an inaccurate picture of where the marketplaces fit in the ACA and where the ACA fits in the health system.

A few facts:

  • There are just 10 million people enrolled in the ACA marketplaces.
  • The law's larger Medicaid expansion and consumer protections are popular and working well.
  • The far larger Medicare and Medicaid programs and employer based health system combined cover more than 250 million people, and are largely unaffected by developments in the ACA marketplaces.
  • Premiums for the 155 million people who get coverage through their employers rose a very modest 3% in 2017.

Some conservatives in Congress will hold out for repeal, and they'll resist any legislation that they view as propping up Obamacare. But for everyone else, it's important to understand the problem and get the facts.

Go deeper

The polarized pandemic election

A Trump supporter protests Pennsylvania's stay-at-home order, during a May 15 rally outside the Capitol in Harrisburg. Photo: Mark Makela/Getty Images

President Trump is going all-in on pushing for a rapid, robust return to normal life, creating a visual, visceral contrast with Joe Biden and other Democrats who are more reticent to rip the masks off.

The state of play: Business friends have been urging Trump from the beginning to keep the lockdowns short. He's listening more and more.

Tech's long hot summer of antitrust

Illustration: Aïda Amer/Axios

Google, Facebook and other tech giants face a summer of regulatory grilling as long-running investigations into potential anticompetitive practices likely come to a head.

The big picture: Probes into the power of Big Tech launched by federal and state authorities are turning a year old, and observers expect action in the form of formal lawsuits and potentially damning reports — even as the companies have become a lifeline for Americans during the pandemic lockdown.

Palantir CEO hits Silicon Valley "monoculture," may leave California

Palantir is "getting close" to a decision on whether to move the company out of California, CEO Alex Karp said in an interview for "Axios on HBO."

The state of play: "We haven't picked a place yet, but it's going to be closer to the East Coast than the West Coast. ... If I had to guess, I would guess something like Colorado."