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Health care, hated today, to get a boost soon

A CNN poll shows that support for the Patient Protection and Affordable Care Act has fallen to a new low, with just 35 percent of respondents saying they approve of the law.

Look a little deeper, and the poll suggests the public's views will turn around once the coverage starts to take effect this month.

First, 15 percent of respondents oppose the law because it doesn't go far enough. So that leaves 43 percent who think the law is too liberal. But even among that group, there's reason to think some of their opposition is based on not quite understanding how the law will work or who it will affect.

A good example is the widespread concern that people won't be able to keep their current doctors. Thirty-five percent of respondents said they thought they would be cut off from the doctors they now see. That isn't surprising, given recent news stories about exchange plans that will seek to lower costs by providing access to fewer doctors and hospitals than traditional employer-sponsored insurance plans.

But those new networks will cover far fewer than 35 percent of Americans. The Congressional Budget Office estimated that 7 million Americans would be covered by exchange-based plans next year, and as we now know, the actual figure may be much smaller. For most other Americans -#8212; those covered by employer plans, or Medicare, or Medicaid, or Tricare -#8212; there's unlikely to be a similar shift to narrow-network coverage, at least not yet.

The poll also found that 63 percent of respondents think the amount they pay for medical care will increase because of Obamacare. This too makes sense: News about Americans losing their bare-bones coverage, and being forced to buy pricier plans on the exchanges, some with high deductibles, has dominated the debate over the law for months.

Yet here, too, most Americans are assuming, often mistakenly, that the horror stories they've heard will apply to them. For most of the 160 million or so Americans who get insurance through their employers, the biggest change under Obamacare is the end of co-payments for preventive care. The same goes for the roughly 50 million Americans on Medicare and the 55 million or so Americans on Medicaid.

Over the longer term, of course, some people outside the exchanges will see an increase in their medical costs, or they'll find that their current doctor is no longer part of their insurance network. Some of that change is the result of the law, including employers deciding to shift their employees to exchange-based coverage or cut costs in response to the tax on high-cost, or Cadillac, plans. And some of those changes would have happened even if the law had never been passed.

But most of those changes will happen over years. More immediately, at some point early in 2014, two things will happen to boost people's views about Obamacare. First, some people covered by exchange plans will find that the coverage is better than they expected. Second, an even larger group of people will realize that the worst disarray caused by Obamacare doesn't apply to their own coverage.

None of that means Democrats can kick back and stop worrying about what this new year will bring. For the millions of Americans who have lost coverage -#8212; and the hopefully equal or greater number who will gain coverage through the exchanges -#8212; this is going to be the start of a difficult few months.


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