Early Retiree Program to Employers: Bye

Officials at the Centers for Medicare and Medicaid Services (CMS) were right back in April when they predicted they would probably use up Early Retiree Reinsurance Program (ERRP) funding early.

CMS stopped taking ERRP applications in May because of concerns about lack of availability of funds, and now officials say in a new notice that ERRP probably will stop helping with claims incurred by the employers already using the program at the end of the year.

The drafters of the Patient Protection and Affordable Care Act  of 2010 (PPACA) created ERRP and provided $5 billion in ERRP funding in an effort to help the dwindling number of employers that still provide health coverage for retirees ages 50 to 64.

ERRP, which began taking applications in June 2010, has been reimbursing participating employers for 80% of the amount of claims costing between $15,000 and $90,000 for early retirees and early retirees’ spouses, surviving spouses and dependents.

The ERRP creators supporters were hoping ERRP would help keep coverage in place for early retirees until 2014. Early retirees cannot get Medicare coverage unless they qualify for Social Security Disability Insurance benefits, and, in states that allow medical underwriting, early retirees with health problems may have trouble qualifying for conventional commercial health coverage.

If PPACA provisions take effect as written and work as backers hope, carriers will still be able to charge older consumers more than they charge younger consumers in 2014, but they will not be able to use an individual’s health status when deciding whether to issue coverage or when setting rates.

Unless Congress provides additional funding, ERRP likely will end 2 years earlier than hoped, because the program already has spent $4.5 billion of its funding, CMS officials say.

Plan sponsors must not mix claims incurred after Dec. 31, 2011, with 2011 claims in ERRP reimbursement requests, officials say.

If circumstances change, and more funding surfaces, CMS may announce that it can help with some 2012 claims, officials say.

“If a claim is incurred on or before December 31, 2011, but paid after December 31, 2011, the sponsor may submit the claim, but not until it has been paid,” officials say.


Physicians Are Pessimistic About Health Reform

Only 27 of doctors expect the Patient Protection and Affordable Care Act (PPACA) to reduce healthcare costs by increasing efficiency and only 33% expect it decrease disparities in healthcare access. In fact, half expect access to decrease because of hospital closures that result from the law, according to a study by the Deloitte Center for Health Solutions. Seventy-three percent of doctors are not excited about the future of medicine. Sixty-nine percent say that many of the best and brightest who might have considered a career in medicine will think otherwise.

Paul Keckley, Ph.D. of Deloitte said, “Physicians are resistant to reform and are frustrated with the direction of the profession. Understanding the view of the physician is fundamental to any attempt to change the health care model; this is the person prescribing the medicine, ordering the test and performing the surgery.” The negativity is driven in part by concern over the pressure primary doctors will face from millions of newly insured consumers seeking care and how it could affect the larger system. Doctors also fear that reform will mean a loss of autonomy and more costs and administrative burdens.

The study also reveals the following about doctors’ opinions:

  • Nearly three-quarters say that emergency rooms could get overwhelmed if primary care physician appointments are full as a result of the Patient Protection and Affordable Care Act.
  • More than 80% say that wait times for primary care appointments are likely to increase because of a lack of providers.  More than half say that other medical professionals (physician assistants, nurse practitioners) will deliver primary care both independently and in addition to physician services.
  • 57% of surgical specialists support repealing the health reform law compared to 38% of primary-care providers and 34% of non-surgical specialists.
  • 59% of physicians 50 to 59 years old say that PPACA is a step in the wrong direction compared to only 36% of those ages 25 to 39 share this sentiment. Younger physicians (ages 25 to 39) are also more likely than older doctors (ages 40 to 59) to think the transition to evidence-based medicine will improve care.

GAO: States Were Quick to Implement PCIP

This article should be read by anyone applying for individual health insurance coverage, with a pre-existing condition sever enough to cause a decline or high rating by an insurance company.In California anyone can obtain health insurance coverage, the only question is the premium. – John Barrett

By Allison Bell – December 13, 2011

The painful birth of the federal Pre-Existing Condition Insurance Plan (PCIP) program — a health insurance program for people with health problems — may be due more to restrictions imposed by Congress than major problems with implementation.

John Dicken, a director at the U.S. Government Accountability Office (GAO), gives that assessment in a PCIP review requested by Senate Democrats. The senators asked the GAO to compare the early progress of the PCIP program to the early progress of the Children’s Health Insurance Plan (CHIP) program.

Dicken notes that Congress tried to keep PCIP risk pool coverage from crowding out existing public and private sources of coverage for people with health problems by requiring that PCIP applicants be uninsured for at least 6 months.

The 1997 law creating CHIP does not include any specific methods for excluding children who already have other health coverage, Dicken writes.

The 6-month no-coverage requirement for PCIP applicants is “the most common factor explaining lower than expected enrollment cited by the state PCIP officials we interviewed,” Dicken says.

Because of the requirements spelled out in the law that created the PCIP program, PCIP coverage costs an average of about $400 per month for a 50-year-old applicant, and the cost of the coverage is another reason for slow early enrollment growth, Dicken says.

“In contrast, many states did not charge any CHIP premiums, and among those states that did, premiums were significantly lower compared to PCIP,” Dicken says.

Congress added the law that created the PCIP program to the Patient Protection and Affordable Care Act of 2010 (PPACA) in an effort to provide immediate relief for people who have a hard time buying health coverage because they have conditions such as obesity, high blood pressure, cancer or hemophilia.

If PPACA takes effect on schedule and works as drafters expect, it will require insurers to start selling subsidized coverage on a guaranteed issue, mostly community-rated basis in 2014.

PPACA calls for PCIP to provide comprehensive health coverage for people with health problems for a price similar to the price healthy individuals pay for ordinary commercial health coverage.

Eligibility is not based on income, and the risk pools cannot charge higher rates for people with more severe health problems.

Congress let states choose between running PCIP risk pools themselves or letting the U.S. Department of Health and Human Services (HHS) provide PCIP risk pool services for their residents.

Program critics originally predicted that millions of uninsured Americans with health problems would rush to enroll in the program and quickly use up federal PCIP funding.

Analysts at the Congressional Budget Office (CBO) predicted the $5 billion in funding allocated for the program could accommodate about 200,000 people.

At the end of August, only about 34,000 people were enrolled in the program.

When the CHIP law was passed, CBO analysts estimated that the program would provide coverage for about 2.3 million children after 1999. After CHIP was in effect for about a year, the program had 705,000 enrollees.

States took about 3 years to implement CHIP and just 7 months to implement PCIP, Dicken says.

States with their own high-risk pool programs started their PCIPs faster than states without existing risk pool programs, but PCIP enrollment in the states with state risk pools was just 3.7 enrollees per 10,000 uninsured lives, compared with 5.5 enrollees per 10,000 uninsured lives in states that started with no state risk pools, Dicken says.



Choking on Obamacare

By George F. Will, Published: December 2

In 1941, Carl Karcher was a 24-year-old truck driver for a bakery. Impressed by the large numbers of buns he was delivering, he scrounged up $326 to buy a hot dog cart across from a Goodyear plant. And the war came.

so did millions of defense industry workers and their cars. And, soon, Southern California’s contribution to American cuisine — fast food. Including, eventually, hundreds of Carl’s Jr. restaurants. Karcher died in 2008, but his legacy, CKE Restaurants, survives. It would thrive, says CEO Andy Puzder, but for government’s comprehensive campaign against job creation.

CKE, with more than 3,200 restaurants (Carl’s Jr. and Hardee’s), has created 70,000 jobs, 21,000 directly and 49,000 with franchisees. The growth of those numbers will be inhibited by — among many government measures — Obama­care.

When CKE’s health-care advisers, citing Obamacare’s complexities, opacities and uncertainties, said that it would add between $7.3 million and $35.1 million to the company’s $12 million health-care costs in 2010, Puzder said: I need a number I can plan with. They guessed $18 million — twice what CKE spent last year building new restaurants. Obamacare must mean fewer restaurants.

And therefore fewer jobs. Each restaurant creates, on average, 25 jobs — and as much as 3.5 times that number of jobs in the community. (CKE spends about $1 billion a year on food and paper products, $175 million on advertising, $33 million on maintenance, etc.)

Puzder laughs about the liberal theory that businesses are not investing because they want to “punish Obama.” Rising health-care costs are, he says, just one uncertainty inhibiting expansion. Others are government policies raising fuel costs, which infect everything from air conditioning to the cost (including deliveries) of supplies, and the threat that the National Labor Relations Board will use regulations to impose something like “card check” in place of secret-ballot unionization elections.

CKE has about 720 California restaurants, in which 84 percent of the managers are minorities and 67 percent are women. CKE has, however, all but stopped building restaurants in this state because approvals and permits for establishing them can take up to two years, compared to as little as six weeks in Texas, and the cost to build one is $100,000 more than in Texas, where CKE is planning to open 300 new restaurants this decade.

CKE restaurants have 95 percent employee turnover in a year — not bad in this industry — and the health-care benefits under CKE’s current “mini-med” plans are capped in a way that makes them illegal under Obamacare. So CKE will have to convert many full-time employees to part-timers to limit the growth of its burdens under Obamacare.

In an economic climate of increasing uncertainties, Puzder says, one certainty is that many businesses now marginally profitable will disappear when Obamacare causes that margin to disappear. A second certainty is that “employers everywhere will be looking to reduce labor content in their business models as Obamacare makes employees unambiguously more expensive.”

According to the U.S. Small Business Administration, by 2008 the cost of federal regulations had reached $1.75 trillion. That was 14 percent of national income unavailable for job-creating investments. And that was more than 11,000 regulations ago.

Seventy years ago, the local health department complained that Karcher’s hot dog cart had no restroom facilities. He got help from a nearby gas station. A state agency made him pay $15 for workers’ compensation insurance. Another agency said that he owed more than the $326 cost of the cart in back sales taxes. For $100, a lawyer successfully argued that Karcher did not because his customers ate their hot dogs off the premises.

Time was, American businesses could surmount such regulatory officiousness. But government’s metabolic urge to boss people around has grown exponentially and today CKE’s California restaurants are governed by 57 categories of regulations. One compels employees and even managers to take breaks during the busiest hours, lest one of California’s 200,000 lawyers comes trolling for business at the expense of business.

Barack Obama has written that during his very brief sojourn in the private sector he felt like “a spy behind enemy lines.” Puzder knows what it feels like when gargantuan government is composed of multitudes of regulators who regard business as the enemy. And 22.9 million Americans who are unemployed, underemployed or too discouraged to look for employment know what it feels like to be collateral damage in the regulatory state’s war on business.


California Officials Measure PCIP Progress

The California Pre-Existing Condition Insurance Plan (PCIP) is growing rapidly, but the number of enrollees is still much lower than expected, and the average amount of claims per enrollee is much higher than expected.

The state’s Managed Risk Medical Insurance Board has reported on PCIP program performance in documents posted in connection with a recent board meeting.

If the Patient Protection and Affordable Care Act of 2010 (PPACA) takes effect on schedule and works as drafters expect, it will require insurers to start selling subsidized coverage on a guaranteed issue, mostly community-rated basis in 2014.

Congress added the PCIP program to PPACA in an effort to provide immediate relief for uninsured people with health problems.

PCIP is supposed to provide comprehensive health coverage for people with health problems for a price similar to the price of ordinary individual commercial health coverage.

Eligibility is not based on income, and the risk pools cannot charge higher rates for people with more severe health problems.

Congress let states choose between running PCIP risk pools themselves or letting HHS provide PCIP risk pool services for their residents.

To avoid crowding out existing commercial health coverage and government-provided coverage, including existing state-funded risk pools, PPACA drafters required that PCIP enrollees have gone without any form of health coverage, including state risk pool coverage, for at least 6 months.

Program critics originally predicted that millions of uninsured Americans with health problems would rush to enroll in the program and quickly use up federal PCIP funding. At the end of August, only about 34,000 people were enrolled in the program.

California was expecting to have about 23,000 residents in its PCIP program by February 2011, and it was expecting those enrollees’ claim costs to average about $1,100 per member per month.

As of the end of October 2011, the program had received about 8,500 applications and enrolled about 6,000 people. The program ended the month with 5,300 enrollees, up from 513 enrollees a year earlier. The enrollees have been averaging claim costs of $3,100 per member per month, officials say.

The high cost means that, unless more funding surfaces, the program can afford to serve only about 6,800 enrollees at a time, not 23,000, officials say.

The state has found that 19% of the enrollees are ages 29 or under; 41% are ages 30 to 49, and 39% are ages 50 to 64. Only 25% of the applicants have had help with filing their applications, and 96% of the subscribers speak English.

About 50 insurance agents and brokers have earned PCIP continuing education credits, and 120 people with the Certified Application Assistant designation have become PCIP certified.

Officials found that program vendors seem to be doing a good job of running the program. The plan administrator is processing 91.5% of clean claims within 10 business days, compared with a goal of 90%, and the administrator has resolved all disputed claims within 30 days, compared with a goal of 95%, officials say.


IRS warned healthcare law could leave millions without insurance

By Julian Pecquet – 11/17/11 03:38 PM ET

President Obama’s healthcare law will leave millions of families without affordable coverage unless tax officials rewrite the rules on who gets subsidies, advocates warned Thursday.

A dozen consumer advocacy groups urged the Internal Revenue Service to allow workers’ spouses and dependents to qualify for tax credits if employer-sponsored family plans are unaffordable. The Treasury Department in August released proposed regulations that grant subsidies to workers and their families in cases when employer coverage costs too much for the employee only, but not when family coverage is out of reach.

The issue risks blowing up in Democrats’ face in 2014, when the subsidies for coverage in state-based insurance exchanges become available. House Republicans have already used the glitch, which The Hill first reported in July, as ammunition to hammer the law for allegedly discriminating against marriage.

Advocates shared their concerns in person with the IRS during a hearing on the tax credits after deluging the agency with comments about its proposed regulation last month. The proposed rule would not penalize families that can’t afford insurance, but advocates say that’s not enough.

“It’s not sufficient not to penalize families — what we want to do is make insurance affordable and get them into coverage,” said Lynn Quincy, senior policy analyst with Consumers Union.

IRS officials listened silently for two and a half hours and asked no questions. The Treasury Department has said its hands are tied because of the way the law was written.

Advocates weren’t having it.

Criticism of the proposed rule, said SEIU healthcare policy coordinator Dania Palanker, “occurred because (it) is in contradiction with the intent of the law.”

Advocates said repeatedly that the Treasury Department has the authority to change the law, as outlined in comments from the liberal Center on Budget and Policy Priorities.

And they downplayed the cost of fixing the problem, citing a new UC-Berkeley micro-simulation study that concludes it would cost much less than the $50 billion a year suggested in an earlier, less thorough study.

“The legal analysis should be enough to make the case,” CBPP Vice President for Health Policy Judith Solomon told The Hill, “but there’s that looming cost issue.”

Advocates also urged the IRS to strengthen the definition of the minimum value requirement for employer-sponsored healthcare plans. The law requires employers to offer plans that cover at least 60 percent of the cost of the benefit or face a penalty.

The SEIU’s Palanker said the law however doesn’t define what those benefits should be, creating a “huge backdoor” for employers to continue offering sub-par coverage that the law seeks to eliminate. She called for employer benefits to be indexed to the government-regulated plans that will be offered on the state insurance exchanges.


Since Obamacare’s Passage, Millions Have Lost Employer-Sponsored Health Insurance

Nov 11, 2011 • By JEFFREY H. ANDERSON

Throughout the Obamacare debate, President Obama repeatedly promised, “If you like your health care plan, you can keep your health care plan.” Now, Gallup reports that from the first quarter of 2010 (when Obama signed Obamacare into law) to the third quarter of this year, 2 percent of American adults lost their employer sponsored health insurance. In other words, about 4.5 million Americans lost their employer-sponsored insurance over a span of just 18 months.

This is not what the Congressional Budget Office (CBO) had predicted would happen. Rather, the CBO had predicted that Obamacare would increase the number of people with employer-sponsored insurance by now.  It had predicted that, under Obamacare, 6 million more Americans would have employer-sponsored insurance in 2011 than in 2010. The CBO’s projected increase of 3 million under (pre-Obamacare) current law and an additional 3 million under Obamacare). So the CBO’s rosy projections for Obamacare (and even these paint a frightening picture) are already proving false.

Whether the decline in employer-sponsored insurance over the past 18 months is a product of Obamacare or of the Obama economy — and whether Obamacare is the principal cause of the anemic performance of the Obama economy — can be debated. But what’s clear is that, more than 25 months before Obamacare would really go into effect — if it’s not repealed first — employers are already dropping employees from their insurance rolls.

Take Walmart, for example — a prominent Obamacare supporter. Gallup writes,

“The nation’s largest private employer, Wal-Mart, announced in October that new part-time employees who work less than an average of 24 hours a week would no longer be able to get their health insurance from the company. Wal-Mart laid out several other cuts to its health insurance offerings, including some workers’ ability get coverage for their spouses. Other companies have already made and will likely continue to make similar changes to their health insurance benefits….

“If Wal-Mart’s decision is a precursor of how employers intend to manage their healthcare costs, the downward trend in employer-based healthcare will likely continue.”

So in addition to costing about $2.5 trillion over its real first decade (2014 to 2023), looting nearly $1 trillion from Medicare over that time (according to the CBO), forcing Americans to buy government-approved health insurance under penalty of law, and amassing unprecedented power and money in Washington at the expense of Americans’ liberty — if Obamacare stays on the books, you may like your health care plan, but that doesn’t necessarily mean you can keep your health care plan.


ObamaCare Is A Flop With Small Businesses

From Investors Business Daily 11/10/2011

Health Reform: To the long and growing list of failed ObamaCare promises, you can now add this one: The tax credit that was supposed to cut insurance costs for millions of small businesses has proved to be a complete bust.

Shortly after President Obama signed his signature health reform law, he boasted that it would help the economy, pointing specifically to the small-business tax credit. Under the law, businesses that employ fewer than 25 full-time workers can get a credit of up to 35% of the premiums, climbing to 50% in 2014.

“This health care tax credit is pro-jobs, it’s pro-business, and it starts this year,” Obama said. The administration has since repeated this refrain many times.

Deputy chief of staff Nancy-Ann DeParle claimed that the tax credit is “one of the largest tax cuts for health care in history.” Small Business Administration head Karen Mills said it “will provide about $40 billion in tax relief over the next 10 years,” adding that it is “one of the most significant aspects of health care reform for small businesses.”

And to make sure everyone knew about this great new benefit, the IRS sent postcards to roughly 4 million eligible businesses, did extensive press outreach, organized more than 1,000 events and created a new Web page.

Yet despite it all, a mere 228,000 small businesses — just 5% of those eligible — have signed up for the credit, according to a Treasury Department Inspector General report released this week.

Why were the administration’s forecasts so wildly off the mark?

According to the IG report, one big reason is that the rules were way too complicated for most small businesses, noting that many complained the credit “is not worth the time and effort to claim it.” Among other things, applicants have to wade through seven worksheets.

This is, by the way, precisely what the National Federation of Independent Business — a stalwart ObamaCare critic — said would happen. “Far fewer than 4 million are eligible for the credit as a practical matter and still fewer will be able to avail themselves of the full credit,” it said. “Others who are eligible will find the credit so small and complex that it is not worth the cost of calculation.”

If this were the only way ObamaCare failed to lived up to its promises, it would be bad enough. But this is just the latest in a string of troubling flops. Among them:

• The $2,500 cut in insurance costs Obama promised his reforms would produce has instead turned into a premium hike of $2,400 since he took office.

• ObamaCare was supposed to provide affordable access to hundreds of thousands denied coverage because of pre-existing conditions. But instead, the “high risk” pools have attracted a meager 30,000.

• The initial insurance market reforms, which raised annual payment caps, unexpectedly threatened to push more than 3.4 million into the ranks of the uninsured, forcing the administration to quickly issue more than 1,500 waivers.

• Obama was also forced to abandon the long-term care insurance part of the reform after realizing it was hopelessly flawed.

• And the advertised price tag has already been busted, with the Congressional Budget Office upping the cost by more than 10% to cover unanticipated administrative costs.

Remember: These are all the quick and easy reforms contained in ObamaCare. Given that none of them has worked as promised, imagine the nightmares ahead when ObamaCare’s massive changes kick in after 2013.

We can only hope that a Republican president kills the entire misbegotten law before then, so we’ll never have to find out.


States worried they’ll bear the brunt of anger over health law’s shortcomings

By Julian Pecquet – 11/06/11 02:39 PM ET  THE HILL.COM

State officials are pushing back hard against what they view as shortcomings in the healthcare reform law for fear they’ll be barraged with complaints when people have trouble affording insurance.

Federal regulators are writing the rules governing key aspects of the law, including the guidelines to determine who’s eligible for subsidies to buy private insurance.

Those benefits will be delivered through state-based exchanges, however, leaving state officials on the receiving end of angry phone calls if glitches in the law aren’t ironed out by 2014.

One key shortcoming is found in the law’s subsidies for people who don’t have access to affordable coverage through their employer. As The Hill first reported in July, the law links the subsidies to the cost of coverage for a single employee. If that coverage is found to be affordable, the individual does not qualify for subsidies in the state health exchanges.

But the determination is based on the single-employee rate regardless of whether the individual has a spouse and/or children, meaning that someone could end up disqualified from the federal assistance, yet unable to afford the family coverage that an employer offers.

“Such an outcome would undermine Maryland’s goal of reducing the number of uninsured residents,” Maryland Health Benefit Exchange officials wrote in comments to the Department of Health and Human Services that were due Monday.

“It could also engender significant frustration with the Exchange among affected families.”

Some states are worried about a particularly powerful constituency: state workers.

North Carolina, for example, fully subsidizes healthcare coverage for its employees, but doesn’t pay a cent of their dependents’ health insurance costs. The average cost of basic family coverage is $516 per month, which is out of reach for many state workers.

“Because employee-only coverage for this plan is provided at no cost to the employee, based on the proposed regulations all family members would be prohibited from accessing subsidies through the Exchange,” North Carolina Commissioner of Insurance Wayne Goodwin wrote to HHS. “This rule puts state employees at a disadvantage as compared to other workers in the state.”

Michigan, which is a party to the 26-state lawsuit seeking to overturn the healthcare law, told HHS that federal officials — not states — should be responsible for hearing appeals from people who are denied subsidies.

And Tennessee points out that states without an individual income tax have no data source to determine who’s eligible for the income-based subsidies in the first place.

The deluge of comments over the past week wasn’t the only sign of increased attention by the states.

The new president of the National Association of Insurance Commissioners (NAIC), Florida Republican Kevin McCarty, vowed Friday to defend state powers threatened by federal intrusion.

“Whether it is Dodd-Frank or the Affordable Care Act, the federal government has become increasingly involved in the insurance arena,” McCarty said. “As your president, I intend to vigorously defend the role of state-based regulation, highlight our accomplishments, and continue to work for regulatory modernization and national uniformity to create an insurance framework that benefits both consumers and the insurance industry.”

NAIC consumer advocate Tim Jost this past week urged the group to take a “leadership role” in pressing states to address potential gaps in the healthcare law’s consumer protections.

Self-insured plans are exempt from most of the law’s regulations, Jost pointed out, and policies offered by large employers also don’t have to meet certain requirements.

Jost also said small businesses are shifting toward self-insurance, so employees will be stuck without benefits Congress intended to provide.


Healthcare law’s popularity hits new low

By Julian Pecquet – 10/28/11 08:50 AM ET

Support for Democrats’ healthcare reform has hit its lowest point since the law passed in March 2010, says a new monthly poll from the Kaiser Family Foundation.

After months of split support for the law, 51 percent of respondents to the latest poll had an unfavorable view while only 34 percent had a favorable impression.

The key reason for the change, the poll found, was Democrats’ waning support: Even though they remain more favorable to the law than Republicans and Independents, the proportion of Democrats with favorable views has decreased from about two-thirds to just 52 percent in October.

The poor polling numbers all but ensure that the law will be a handicap for many Democrats — and the president himself — going into the 2012 election. They also suggest that Republicans’ constant hammering at the law has been effective: Only 18 percent of respondents now expect that they and their families will be better off thanks to the law, down from 27 percent just last month.

The poll caps several weeks of bad news relating to the law.

Late last month, Kaiser released its annual report on healthcare premiums showing a 9 percent hike in family premiums this year. Rather than driving premiums down by $2,500, as President Obama promised during the 2008 campaign, the healthcare law is responsible for about one sixth of that increase, according to Kaiser.

And earlier this month, the administration announced that the law’s long-term-care CLASS program was unsustainable and that it was dropping it. The move has infuriated many of the law’s supporters, who feel the Department of Health and Human Services hasn’t been honest about its intentions.

The poll also could carry some good news for GOP presidential candidate Mitt Romney. Even as his primary opponents are trying to link his Massachusetts healthcare reform plan to the federal law, nearly seven in 10 likely Republican voters say they don’t know enough about the Massachusetts law to have either a favorable or unfavorable opinion of it. And 71 percent couldn’t say whether the law was similar to the national healthcare reform law.