Published by: Celinda Lake on 6/6/2011 1:35:15 PM
Celinda Lake will be presenting at NAPH's Annual Conference this month in Chicago.
It may be difficult to see from here, but there is little doubt that the Patient Protection and Affordable Care Act will eventually take its rightful place alongside the most cherished social programs such as Social Security and Medicare. Yes, it must first pass judicial review and get fully funded and implemented. And based on the current divisions in the country over the law, it has a ways to go before it achieves this exalted status. But the law’s passage is a tribute to the perseverance, leadership, and courage of those who worked to pass it, especially Speaker Pelosi who found a way to herd enough cats to secure passage.
The PPACA traveled a rocky road just to get where it is today. Prior to the law’s passage, there were some early message battles that were clearly lost. Advocates started out talking about the right values and principles behind the reform effort (keeping your insurance if you like it, ending denials based on pre-existing conditions, etc—all of which have always been immensely popular with the public), but attacks began and were difficult to counter because there was no specific bill to which advocates could point. And there were always deep divisions in attitudes about the law between those with health care insurance and those lacking coverage.
Many of these first wave attacks were false, misleading or even outrageous, including those based on “death panels” (cited by PolitiFact as the 2009 political lie of the year), and the claim that the law would cut Medicare when in fact it strengthens traditional Medicare and saves taxpayers billions through reducing excessive private insurance profits in Medicare Advantage. Seniors were always among the most skeptical demographic groups because they were fearful that any change would impact Medicare, but these lies achieved their desired end of reducing support for reform among older Americans and women. In April of 2010, just 39% of seniors supported the bill, while a majority (56%) opposed it.
Once the House drafted a bill, there was a perilous waiting period between House and Senate action that lasted for months. Having three separate bills also had a negative impact on public support, and served to foster even greater confusion about the substance of health care reform legislation, and made it difficult to push back on attacks made against the reform effort.
Once the PPACA finally passed, advocates could point to what the law would actually do for regular Americans, especially for the 80 percent who already had health insurance coverage. In the past year, the PPACA got a critical boost from several key early implementation milestones, including extending coverage for young adults, eliminating pre-existing conditions for children, the down payment it made on the closing of the Medicare prescription drug donut hole, coverage of preventive health services for seniors, prohibiting arbitrary rescissions, eliminating secret limits on lifetime and annual caps, and enacting small business tax credits. Polling during the latter half of 2010 showed a small but significant bump in support for the law as awareness of these real benefits began to increase. Slowly, more Americans are coming to understand the law’s valuable patient protections, and will oppose having those taken away.
Support for the law was also hurt by insurance company decisions to raise rates when what most people wanted from the law was to reduce costs and premiums. Fortunately, the law’s provisions provide additional powers to states to further regulate insurance company premium increases—an idea firmly supported by public opinion. These provisions have already served as a check against the most egregious rate increases, as insurance companies abandoned some of their plans once they received negative press on the issue. Another recent shot in the arm for the law came with the announcement of $4.3 billion in savings from a crackdown on Medicare fraud and waste, which has become an important populist proof point for advocates in an era of deficits and concerns about government spending.
In the near future, the law still faces significant challenges. The House cast a symbolic vote to repeal the law this year and is threatening its funding through the budget process — despite the fact that 63% oppose cutting off funding for the law, and just 33% support ending its funding. If Republicans take back the Senate and the White House in 2012, they may be able to fully repeal it. Equally pressing, within the next year or so it is widely anticipated that the US Supreme Court will review the law in the wake of the various lower court decisions that have been handed down. In the meantime, some individual states have taken it upon themselves to drag their feet on implementation of the law and have gone so far as to reject federal funds earmarked for that purpose. This flies in the face of the will of the American public, fully half of whom want to expand the law (30%) or keep it as it is (21%), while fewer Americans want to repeal it and replace it with a Republican alternative (19%) or repeal it and not replace it at all (19%).
But if the PPACA survives this gamut, by 2014 it will help tens of millions of Americans in myriad ways. It will eliminate all denials for pre-existing conditions, fully close the Medicare prescription drug donut hole, and use health exchanges to provide affordable coverage to those who currently lack it. Furthermore, the health care system change provisions of the law—though not well understood by the public—also have very significant potential to empower patients while helping the system to deliver higher quality care at lower costs. If given the opportunity, these reforms and protections will eventually make the PPACA politically unassailable.
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This post originally appeared in Kaiser Health News.
Celinda Lake
President
Lake Research Partners