Will Obamacare Ever Be as Popular as Medicare? | Healthcare and Technology news | Scoop.it

With a pen stroke, the president signed into law a health insurance expansion that had previously been deemed "socialized medicine" and had drawn fierce criticism from conservatives.

No, the president wasn't Barack Obama, and the legislation wasn't the Affordable Care Act. Nearly 50 years ago, President Lyndon B. Johnson enacted Medicare and Medicaid amidst passionate opposition to the program that has since become widely ingrained in the fabric of society.

But as liberals celebrate the anniversary of Medicare, it's Obamacare that comes to mind. The hope for liberals: that the shift in perspective on Medicare foreshadows a shift to eventual popularity for Obamacare.

"Before Medicare came into law, one Republican warned that 'one of these days, you and I are going to spend our sunset years telling our children and our children's children what it once was like in America when men were free.' That was Ronald Reagan. And eventually, Ronald Reagan came around to Medicare and thought it was pretty good, and actually helped make it better," Obama said in a 2013 speech in Maryland. "So that's what's going to happen with the Affordable Care Act."

But the differences between the passage and beginning stages of the two laws may be more indicative of Obamacare's future popularity than the similarities, said Jonathan Oberlander, a professor in the Department of Social Medicine at the University of North Carolina at Chapel Hill.

"This is not 1965. American politics are extraordinary polarized by party right now. Congress is more polarized in politics and in ideology than at any point since the 1870s," Oberlander said. "This is a political environment where it's very difficult for a program like the Affordable Care Act that was adopted along partisan lines to gain traction."

Timothy Jost, a Washington and Lee law professor, thinks "there may be some fixes," but believes the law will eventually become entrenched within society.

"I think it already is," he said. "In fact, when people talk about repealing the Affordable Care Act, I think they really don't know what they're talking about."

On that, both agreed: "I think it's past repeal," Oberlander said.

Both the Social Security Amendments—creating Medicare and Medicaid—and the Affordable Care Act created political controversy, and both were passed by large majorities of Democrats in Congress after landslide elections, Jost said. And both took a long time to fully implement—Arizona was the final state to begin its Medicaid program in 1982.

Both were even debated along party lines, although many Republicans ended up voting in favor of the final Medicare bill, viewing it as a lost cause, Oberlander said.

On the other hand, perhaps because they were vastly outnumbered, Republicans never seriously talked about repealing Medicare. The program also had a very identifiable group of beneficiaries, while Obamacare targets diffuse populations, Oberlander said. And there were no significant court cases brought against Medicare, whereas five years after Obamacare's passage it awaits yet another Supreme Court decision on the legality of key aspects of the law.
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Although the gap has narrowed in the past two years, more Americans—43 percent—still viewed Obamacare unfavorably in March than the 41 percent who viewed it favorably, according to a Kaiser Family Foundation poll.

At an event hosted by the Aspen Institute Wednesday to commemorate Medicare and Medicaid's 50th anniversary, several speakers referenced today's partisan gridlock in contrast to the compromises achieved in 1965, although several also brought up the "doc fix" bill—easily passed in the Senate the day before—as a source of hope for increased bipartisanship.

"There are a lot of people who would say this is the most polarized Congress. It doesn't look anything like '64, '65," said former Health and Human Services Secretary Kathleen Sebelius. "I think this is a changed Congress."

Jackie Judd, a special correspondent with the PBS Newshour who served as a moderator at the Aspen Institute event, said the doc fixed served as a reminder that "passions run high around these programs, even today, 50 years later."

But at the end of the day, a bipartisan bill was overwhelmingly passed, a reflection of the way things used to be.

"Medicare and Medicaid were adopted, to some extent, in a bipartisan way, because the parties were much less aligned along the ideological spectrum the way they are now," Jost said.

That meant the programs' flaws could be fixed legislatively. Today, there's little chance of that happening, and solutions instead must come administratively or from the courts, he said.

The question of whether or not subsidies are available on federal exchanges, the largest current threat to the law, "could have easily been fixed by Congress" in 1965, he said.

King v. Burwell, which the Supreme Court is expected to decide this summer, will heavily influence the future of Obamacare. But so will the upcoming presidential election.

"There's a huge difference whether it's Hillary Clinton, Marco Rubio, Scott Walker, or Jeb Bush in the White House," Oberlander said. "The Court case matters greatly here, but I think regardless of what happens in the Court case, the question in 2016 will be: How will the law change?"