Among the promises of ObamaCare made by Democrats and especially the White House, the most evocative may have been the pledge that economic circumstances should not impact choices about care. Why that should be the case is anyone’s guess; economic circumstances impact choices on housing, food, clothing, and everything else in our economy, but somehow ObamaCare would rescue Americans from having to make tough choices when it came to their health. That promise struck deep at our self-conception of equality, and certainly provided plenty of rhetorical ammunition for the class warfare that accompanied the ObamaCare debate.

How has that worked out in practice? According to a new Gallup survey, not so well. In fact, more people are having to make those choices now than ever before:

One in three Americans say they have put off getting medical treatment that they or their family members need because of cost. Although this percentage is in line with the roughly 30% figures seen in recent years, it is among the highest readings in the 14-year history of Gallup asking the question.

Since 2001, Gallup has asked Americans each November if they have put off any sort of medical treatment for themselves or their families in the past 12 months. Last year, many hoped that the opening of the government healthcare exchanges and the resulting increase in the number of Americans with health insurance would enable more people to seek medical treatment. But, despite a drop in the uninsured rate, a slightly higher percentage of Americans than in previous years report having put off medical treatment, suggesting that the Affordable Care Act has not immediately affected this measure.

The theory behind ObamaCare and its insurance mandate was that forcing people into private insurance would allow them to keep from putting off care and treatment. That would mean better diagnoses and more effective treatments, which would then lower costs over the long run. However, the percentage of those who put off care due to cost issues actually rose among those with private insurance — by almost double digits, in fact:

Among Americans with varying types of medical coverage (including no coverage), uninsured Americans are still the most likely to report having put off medical treatment because of cost. More than half of the uninsured (57%) have put off treatment, compared with 34% with private insurance and 22% with Medicare or Medicaid. However, the percentage of Americans with private health insurance who report putting off medical treatment because of cost has increased from 25% in 2013 to 34% in 2014.

Perhaps this is just a dynamic of putting off routine maintenance and diagnostics. That alone would undermine one of the central arguments for ObamaCare, which was to get people to have those routine tests to lower the need for costlier interventions later. It’s not just routine care that’s getting postponed, though, as Gallup finds:

gallup-serious

The level of delay for serious conditions is the highest recorded by Gallup. It even exceeds the percentages seen during the Great Recession, when people had good reason to delay big costs in all areas of their lives. That brings up a rather interesting point, too. If the economy is doing so much better for Americans after five years of supposed recovery, why are more people putting off treatment of serious medical conditions — even with private health insurance?

There are a few possible reasons, with the truth probably in combination of some:

  • The so-called recovery isn’t actually boosting workers the way Democrats claim.
  • Forced carriage of health insurance takes too big of a bite out of workers’ disposable income.
  • The health insurance that consumers get has too large of a deductible for the affordable premiums, or …
  • … it has inadequate coverage for the conditions, while the premiums make it impossible to get treatment on their own.
  • Reimbursement rates and narrowed provider choices make it difficult to get treatment.

Small wonder that Americans have become even less enthusiastic about ObamaCare. Earlier today, Noah noted that HHS Secretary Sylvia Burwell had bragged about the results from the first week of open enrollment, with 462,000 enrollments overall and about half of those new entries. However, almost everyone who enrolled the first time will have to re-enroll now or risk seeing their tax bite dramatically expanded. Over a six-week period of open enrollment before the New Year, when most current policies will expire (the period will remain open through February 15th, primarily for new enrollees), that amounts to less than 3 million enrollees — and about 1.5 million re-enrollments. That’s not exactly a mad rush to re-enlist, is it?