The upshot? The public had a vague sense that it was wrong for insurance companies to deny coverage to sick people, but explanations of why the law was necessary to stop that practice flew over a lot of heads, if they few at all. To many, the idea of a mandate—with penalties for failing to buy insurance—made no sense. In another CJR Town Hall, a worker at a Pennsylvania Walmart told me, “If you can’t afford healthcare, how are you going to afford the penalties? Why punish them?” The president—and therefore the press—failed to address the “why” in terms people could understand.
Meanwhile, a third factor is at work: Our health insurance system is changing under our feet, and those changes make it more difficult for proponents to explain the Act, and they make it easier for its enemies to blame Obamacare for marketplace shifts, even though most of the Act has yet to take effect.
When he did try to explain his health reform law, the president’s language and what ordinary people were experiencing were not in synch. For example: Several times Americans heard Obama tell them if they liked the coverage they had, they could keep it. But today’s reality is that they can’t keep what they had, and they know it.
The health insurance market was changing in 2009 and 2010 even as the president pitched his plan. Employers had started giving their workers insurance coverage with sky-high deductibles and high coinsurance, in an effort to make them pay more for the cost of their care. In Omaha, a young woman explained to me that to keep the premiums low, her employer had increased the amount of the family deductible from $5,000 to $10,000. That means she has to pay $10,000 toward medical expenses before the insurer pays a dime. “Obamacare is making an impact on insurance policies,” she said. “He’s driving the price up.”
Meanwhile others—like Robert Smale, an assistant professor of Latin American history at the University of Missouri, whom I spoke with back in the summer of 2010—know they are losing the good coverage they have. Smale’s university had informed employees that the level of their insurance benefits was too high. “Our coverage is too good, according to health reform,” he said. The Affordable Care Act indeed discourages so-called Cadillac plans that offer high-cost, comprehensive benefits, as a cost-control measure. The theory is that if insurance covers less, people will use fewer medical services, and the price of care will drop.
There are exceptions, but there has been little reporting on these continuing big shifts in the health insurance market. The public knows they don’t have the same coverage they had a few years ago, and that reality may show up in their responses to pollsters.
In March, as the Affordable Care Act approached its second birthday, the administration began a new sales job for the law, touting its more popular provisions. Still, there was no discussion on why the mandate was necessary.
The Hill reported that while the president was not mentioning healthcare in his public appearances, administration officials were busy making the case for Obamacare by releasing “a deluge of positive reports, press releases and blog posts.” One example was a report timed to coincide with National Nurses Week that highlighted what the law is doing to help cure nursing shortages. The National Journal reported in mid-March that the “HHS Health Message of the Day” reminded voters that drug coverage in the Act had saved some 5 million seniors and disabled people $3.2 billion, by filling the “donut hole” omission in coverage that was part of an earlier prescription drug law. The press picked up on some of this PR and offered up stories, especially ones about young adults continuing coverage under their parents’ insurance.
Positive response from the public could arrive in 2014, when the uninsured will start getting government help paying for their coverage—the heart of the law.That assumes, of course, the mandate survives.
Even so, how much the subsidies would be, and who actually would get them, is not clear—given a not-so-secret assault on the funding mechanisms in the law from employers, insurers, and manufacturers of medical devices. They are waging fierce campaigns in Congress to rid themselves of taxes imposed by the Affordable Care Act to help pay for those subsidies. If Congress repeals the taxes, what will that do to the subsidies they were to help finance? If there is less money for subsidies, will Congress scale back who will be eligible for them? And how much will those still eligible get? Those are important questions overlooked by a press still waiting for its cues from the president.