Obamacare? I wasn’t aware…

A takeaway for reporters from the latest Kaiser poll numbers: don't forget who the law is for

When it comes to summarizing the key findings of the latest Kaiser Health Tracking Poll, this Washington Post headline neatly does the job: “Americans don’t know what’s in Obamacare, do know they don’t like it.” The Kaiser poll found that support for the Affordable Care Act among the uninsured, the primary beneficiary of the law, continued to decline. Forty-seven percent of the uninsured viewed the law unfavorably (compared to 24 percent with favorable opinions). In the December poll, 43 percent of the uninsured had an unfavorable view. Nearly half of the people for whom the law was designed to help were unconvinced of its merits.

The poll also showed that

roughly four in ten adults overall, and about half of the uninsured, are not aware that the law provides financial help to low- and moderate-income Americans to help them purchase coverage, gives states the options of expanding their Medicaid programs, and prohibits insurance companies from denying coverage based on pre-existing conditions.

By now we might have expected those numbers to be higher, especially those that measure public knowledge of the law. Lord knows there’s been tons of press coverage in all sorts of media outlets—for a solid month, from the end of October through the end of November, and then picking up again in the weeks before Christmas, the Affordable Care Act was the national political story. So what accounts for the disconnect between the zillions of words written or spoken about the ACA and the poor public knowledge showing in the Kaiser poll? Are reporters doing enough to explain what the law is about, who it affects, and how to buy what is a complicated product (the consumer story)? These are questions I’ve pondered before—they inspired my October post titled “5 Threads Reporters Missed on Obamacare” and my July pieces, “Open Wide” and “Open Wide: The Fine Print,” which discussed the consumer aspects of shopping for a policy.

To explore this further, I checked in with two thinkers on the subject—Yale professor emeritus Theodore Marmor and Drew Altman who heads the Kaiser Family Foundation and knows a thing or two about Kaiser’s polls. Some points of consensus: No, the president hasn’t been a very effective salesman/explainer for the law; Yes, for political reasons, Republicans have demagogued a law that is at its core the GOP prescription for health reform; And, yes, the architects of the law made it super-confusing as they tried to impose some principles of social insurance on a private insurance system—which meant there were always going to be winners and losers. And what of the press? “Media coverage has been vulnerable to death by anecdote from the start,” Altman told me. I’ve written plenty about that, including identifying six questions reporters should ask before using an Obamacare anecdote.

Obamacare, Altman said, “is in large part a program for low income people who are not conversant with the principles of insurance.” When you consider that this group—the uninsured—likely knows little about the interplay of deductibles, coinsurance, copays, and premiums, the Kaiser numbers make some sense. “The social mission of the law is the uninsured,” Altman said. “We have forgotten who the uninsured are.” Reporters included.

Consider how few good stories there have been on Medicaid, particularly stories focused on the poorest Americans left out of the expansion. Until this fine story on the News Hour last Wednesday, I hadn’t seen much discussion of the trouble Latinos are having obtaining coverage in California (though there have been plenty of puff pieces about the sign-up race at Covered California, the state’s shopping exchange.) As I wrote in October, reporters must look “beyond what the politicans and other stakeholders are talking about”—the fixation on last week’s CBO numbers, to take one recent example—remember who the law is for, and not neglect basic, consumer, explainer-style reporting. It bears repeating. This is not like buying an airplane ticket on Travelocity.

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Related content:

Obamacare’s Forgotten Faces

Open wide: the fine print

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman. Tags: , , , , ,