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Obamacare: Hope, Fear and Misinformation

Recently I spoke about Obamacare to two different community groups. My expectations of each group were different given their locale – one was in well-to-do neighborhood that trends quite red at the voting booth (I was braced for anything up to and including a death panel discussion) and the other was in central Denver which I guessed would be more progressive in tenor. It turns out that the conversations were nearly identical and characterized by a striking polarity in which nearly everyone simultaneously viewed Obamacare with hope and fear. Lack of any real understanding of the details was the other common denominator. From the questions and comments of nearly 75 people, I identified only one person who actually seemed well versed in the Affordable Care Act (ACA) legislation.

Most everyone started with a personal story about the difficulty and expense families had with getting, keeping and affording insurance. They seemed to either have experienced problems with pre-existing conditions and unaffordable coverage or ascribed those problems to the situation of family members. I couldn’t help but marvel at why more people weren’t in support of Obamacare, if only for eliminating pre-existing condition restrictions, removing lifetime caps on payments and gaining affordable coverage.

At the first meeting, I took the comments to mean I’d found kindred spirits who shared my aspiration for affordable and available coverage. I then started expounding on the virtues of the 32 million new enrollees that Obamacare was designed to bring into coverage. I had misread my audience. Their hope quickly turned into fear that 32 million newly insured combined with too few doctors to see the influx of new patients would mean their families would get squeezed out. Little comfort was taken when I talked about 25% of waste in the system that can be removed with thoughtful, coordinated delivery system approaches and how systems and providers can adapt to take on additional covered lives.

They weren’t convinced by a long shot. The sense was that we shouldn’t plunge into expanding coverage nearly so quickly. The ACA strategy won’t be an easy sell.

The other common denominator I noted was a near total lack of understanding on what Obamacare is designed to do or will provide. While the audiences knew that pre-existing conditions might be covered, there was no understanding of health insurance exchanges, coverage subsidies or the benefits of being able to get more affordable coverage. By a show of hands, 75% of the attendees believed that all 32 million new enrollees were going to be covered by government insurance. There was no concept that Obamacare is the largest-ever expansion of private health insurance.

Many believed that the cost of insurance would sky-rocket and cripple small businesses. More than a handful focused on the “panel of government bureaucrats” cutting benefits and withdrawing care for the elderly. My assurances and ACA facts may have made a slight dent but the “terror hooks” of those opposed to Obamacare have been driven in deep and it will take quite a while to change that dynamic.

From these recent experiences I stand firm in my belief that those of us who are knowledgeable and passionate about universal coverage and transforming health care can’t be so timid about what is very good about Obamacare. Papa John’s CEO John Schnatter recently received a lot of media coverage over his fear about what Obamacare will do to his business model – the estimate is that ACA mandated coverage will add $0.11-0.14 to each pizza. I say, bring it on because I know that any of us with insurance are already getting hit with that much and more through the cost shift of the uninsured.

Another CEO right here in Denver brought up the cost to Colorado of the Medicaid expansion, particularly after the feds quit their 100% subsidy in a few years. He said it will raise taxes in Colorado. He may be right but ignores the costs we are already paying for those without insurance. We need to bring these hidden costs into the open and counter fears with information. We have a lot of work to do.

About the Author: Phil Kalin is CIVHC's President and CEO. Contact him at pkalin@civhc.org.

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Comments

Julian Carpender
Prior to 11/6/2012, audiences were "on guard" when talking about the Affordable Health Care Act, so the use of the moniker "ObamaCare" has negative and positive connotations. I would suggest that in the future it be termed what it was first called, "Romney Care", or "Massachusetts Care" or most appropriately, it should be called "Patient Protection and Affordable Health Care Act of the 111th Congress", and not attributing it to any one individual as it took at least 262 people to get it passed.
2/5/2013 10:52:15 AM

JG
Phil:

Forgive me if I do not share your reverence and adoration for the ACA or "Obamacare" as its affectionately referred to. I don't find it at all surprising that only one in 75 attendees had a grasp of this legislation and all it entails. It's convoluted, ill-conceived, and hardly makes healthcare more affordable in its current form. In fact, as time marches on, I would posit it will prove to be a massive fiscal entitlement boondoggle whose largess will far exceed any projected CBO scoring or projections. In my view, the ultimate goal of this administration and this legislation was to pave the way for a single payor system. This "largest expansion of private health insurance" was simply the vehicle (e.g. trojan horse) needed to make it possible.

As for the misinformation, I suspect there's plenty to go around on both sides of this issue. But rather engage in demagougery, let's take-up some basic tenets of "insurance" that most people (including the proponents and legislators who voted strictly along party lines for this bill) don't fully understand, or worse completely ignored:

Insurance in its simplest from is "the law of large numbers" and involves the "spreading risk." When you crash the car, and then bind coverage the following day, yet receive full payment, this is no longer insurance--it's a subsidy. In other words, you weren't paying-in or contributing to the pool, yet you were still indemnified against your loss.

By removing the preexisting condition exclusions and plan caps, extending coverage to dependent children through age 26, mandating birth control, while adding untold millions of previously ineligible, or uninusrables to the pool, the cost for delivering this care does not go down. And this is no longer "insurance." Hence why every healthcare carrier has increased its rates whereever possible in the run-up to 2014. Efficiencies, not massive governmental regulation drive cost-savings. You can't expand the pool, remove the carriers ability to underwrite, mandate enhanced coverage parameters and have costs go "down." Simple economic principles defy this notion.

When we raid Social Security by $700+ billion and begin taxing for the coverage 4 years in advance of the effective date (before you cover one uninsured) foist one tax after the other in completely unrelated bills which contain provisions to indirectly funnel funds to the ACA, and inject countless millions of uninsureds into an already inefficient healthcare system without adequately staffing-up for this massive influx, how are we better served? How can one extol the virtues of this "plan" unless wearing rose-colored glasses, or standing to profit or gain from it?

If this program is so transcendant please tell me why so many corporations have applied for and have been granted 'waivers'? Mind you, many of these organizations were ardent supporters of this administration and this piece of legislation.

Perhaps it's the "Do as we say, not as we do" mentality and the "Law of unintended consequences" that your audience understood all too well-- but you didn't "hear" because of your superior knowledge of, and passion for this canard called universal coverage.

I also question the veracity of the numbers of total uninsureds. During this past election, whenever the topic of unemployment would arise, the media and the left immediately seized on "23 million under or unemployed" figure-- endlessly parsing it to arrive at a more palatable number (one which was more favorable to their candidate).

What's good for the goose is good for the gander. The 32 million you cite as "uninsured". How was that number arrived at? HHS? Whom might it include? Are we talking total persons or those legally entitled to coverage by virtue of citizenship? What about the young adults and the "one percenters" who elected not participate? (and will now have a tax levied upon them by the IRS) Yeah, that's progressive legislation.

You can dismiss the concerns of taxpayers and business owners and continue to extol the virtues of this very flawed and deceptive legislation. But you cannot empirically support the argument that the savings gained by expanding coverage will outweigh the crippling effects of taxation and waste inherent in this new entitlement program. It's quasi-private sector at best, and thus, ultimately it will be prone to abuse and fraud. The manner in which this legislation was pushed through Congress and the public's disdain for it tells you all you need to know.

Informed dissenters will continue to monitor what's being served-up in the little Dixie cups in the days, months, and years to come--and with good reason.
1/4/2013 3:50:52 PM

Maricrys
Under the Health Care Act, insurance companies must cover children with pre-existing conditions. I read today that some of these insurance companies have committed a despicable act but putting their profits way ahead of childrens care. They had refused to cover seriously ill children before but they have gone beyond the pale by by cutting off childrens policies completely.I dont think Obama and those who wrote the bill expected that to happen. They negotiated with the insurance executives several times in good faith and caved in to Republicans not to have a public option with the guarantees the insurance coinepmas would cover kids with medical conditions.I understand that United, Cigna, Aetna are refusing to write policies. Dont blame Pres. Obama. He tried to force insurance companies to cover sick children.It is just terrible. If I had insurance with those companies I would cancel it.If you already have children covered by Blue Cross they probably wont drop them but you cannot get a new policy if the kids have pre-existing conditions. Blue Cross is Anthem.Parents wont let their seriously ill kids go without insurance because they can get sick at any time and there are waiting periods for care so no parent would take that kind of risk.
12/23/2012 8:54:44 PM

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