On Tuesday, the Affordable Care Act made its official debut, adding another patch to America’s patchwork quilt of health insurance. This fix retains the system of private health insurance and private delivery of care, but aims to brings another 24 or 25 million people under the insurance cover. They are people who, for the most part, did not have insurance before because they had no employer providing it, were too poor to buy it on their own, or were so sick insurance companies didn’t want them. Given that retaining private insurance was the only solution this political system would tolerate, the ACA’s debut should be cause for cautious celebration.
But it isn’t, judging by the public pulse. In mid-September, a Kaiser Family Foundation poll found 43 percent of Americans have an unfavorable opinion of the law, while 39 percent view it favorably—roughly the same split that has existed since the law passed in 2010. About half the public and two-thirds of the uninsured continue to say they don’t have enough information about the law to know how it will affect their families.
Why is that? There was tons of coverage of the ACA before and after it passed. Zillons of words have been written. Harold Pollack, a health policy wonk from the University of Chicago, called it the best-covered news story ever. But the words that told “the best covered story ever” have apparently not quite connected with the average man and woman on the street. This summer, a Kentucky woman told Politico, “Oh, I’ve heard of Obamacare, yes, but I didn’t know all that was involved. Everybody that I have ever talked to is totally against it. They’re afraid all the doctors are going to pull out, and you’re going to have to be like Canada and have to be on a waiting list.”
Is the press at fault for Americans’ misconceptions about international healthcare systems and, more important, for the lack of understanding of their own system and the ways Obamacare does or does not change it? There have been all-too-familiar shortcomings in coverage: too much following the leader, recording and reporting what others say, succumbing to spin every which way. During the debate on the Affordable Care Act in the years between its passage and now at implementation, reporters too often followed the lead of the president, members of Congress, and, in the last several months, Republican politicians who, fueled by well-funded conservative groups, have shut down the government. As recently as last week, reporters passed along selective facts from the Secretary of Health and Human Services.
But beyond some of these too-common press shortcomings, I’ve identified five points that the press, for the most part, failed to adequately cover. These are threads that would have helped people understand what the law is all about, as well as comprehend the ongoing backlash.
1. The press did not make clear enough to the public what the law would do. “There was no sustained media commentary, no coherent discussion about what the law was and what would happen to whom,” says Theodore Marmor, Yale professor emeritus and a long-time of observer of healthcare politics. There continues to be a great deal of confusion about who is eligible for coverage in this market—people on Medicare want to know if they can buy a policy, people in the employer market aren’t clear that they can’t shop in the exchanges. This confusion would not be as widespread and persistent had reporters explained from the beginning, this is not wholesale reform, but instead one more patch in the patchwork, this is bringing in (a relatively small number of) people who couldn’t shop in the individual market or were uninsured.
2. Reporters did not adequately explain how Obamacare was financed, and why—why the modest wealth redistribution the ACA calls for is necessary to bring health insurance to more Americans. There was little coverage of what Marmor says is the “distribution of benefits and burdens.” After all, the Affordable Care Act does call for wealth redistribution with its benefits distributed to the neediest. Those with the lowest incomes get the biggest subsidies. A few years back, Drew Altman, who heads the Kaiser Family Foundation, got to the nub of American healthcare. “It’s a problem of reallocating wealth in America and we don’t do that very well,” Altman said.