Obamacare: Losing the Battles of Communication & Facts

There's a brief post up at Economist's Democracy in America blog commenting on a speaking appearance by Valerie Jarrett, Senior Adviser to the President. When asked what the administration's biggest mistake has been so far, Ms. Jarrett reportedly said it was a failure to communicate the benefits of the administration's policies. "If people voted their self-interest, they would vote for [President Obama]."

The author of the post calls this sort of response "arrogant," and in full said:

I think, goes to the heart of one of the Obama administration's weaknesses, one that certainly cost him the 2010 mid-terms and might cost him the presidency itself in two month's time. It is the idea that if only people were in full command of the facts, they would immediately see that the president was wise and right. It is arrogant, and, when you think about it, fundamentally anti-democratic. And it leads you to push policies that voters don't actually like.

 I have to disagree with the author that this sort of response is arrogant. I think ACA (Obamacare) is a great example of this. When people are polled on the individual elements of the legislation they support many of the pieces, but the administration has lost the battle of communicating the law in totality. Now part of losing that battle is the willful cognitive dissonance of the conservative attack on the legislation, perhaps tippified by this absurdly false and misleading advertisement from the 60 Plus Association, which perpetuates Vice Presidential candidate Paul Ryan's shameful and repeated attack that the Obamacare cuts $716 billion from Medicare (when it's actually future savings, not diverted funds) when Ryan himself would have included the same cuts in his Medicare plan.

The broader point being, healthcare reform as enacted by Obamacare is incredibly complex. The individual parts, healthcare for dependents up to age 26, no exclusion for pre-existing conditions, insurance plans required to cover birth control, poll incredibly well. The parts that don't poll well, like wringing $716 billion in savings over ten years from Medicare, which helps perpetuate the Medicare program aren't as easy to understand immediately. The point being, it's easier to point at these things, call them flaws, and harp on them at the cost of not telling the whole story.

That's where the administration is suffering. On certain elements they have been drowned out by misleading half-truths on policies that aren't simple to understand. This is all by way of saying that facts aren't what they used to be and if you lose the communication battle it can obscure the positive effects that the facts would seem to indicate, because everybody is getting skewed facts. I don't think it's "arrogant" on the part of Ms. Jarrett to says that's a mistake. I think it reflect the reality of a conservative movement that has systematically created a world of parallel facts designed to discredit ideas not aligned with their ideology.

I'm not sure how we fix it, but it is frightening that beyond trying to get an electorate engaged, we will now constantly debate who's facts to believe.

The Obamacare Direct Mail Campaign

The Affordable Care Act, often labeled (derisively) as Obamacare, has never been an incredibly popular piece of legislation at least not when pollsters ask about the overall legislation. Individual elements do poll quite favorably. ACA has become the domestic achievement for this White House for good or for ill and I think a recent letter I received could help to change the perception of the ACA and make the title "Obamacare" a positive descriptor.

About two weeks back I had a curious voice mail from my health insurance company about an issue I should really call them back about.  I didn't because typically when my health insurance company needs to talk to me about something, it's not a good something.  Not this time.  A few days later I received a letter in the mail. There were two sheets and on the second sheet in large, plain type it read: "A rebate will be paid to your employer due to new requirements outlined in the Federal Healthcare Reform regulation." A rebate you say?  On the other page was more of fine print:

The Affordable Care Act requires [my employer's provider] to rebate part of the premiums it received if it does not spend at least 80 percent of the premiums [my employer's provider] receives on healthcare services...No more than 20 percent of premiums may be spent on administrative costs...This is referred to as the "Medical Loss Ratio" standard or the 80/20 rule. The 80/20 rule in the Affordable Care Act is intended to ensure that consumers get value for their health care dollars.

So let me get this straight, my employer will receive a check from our insurance provider because our insurance provider didn't meet the 80/20 rule, and the letter goes on to describe how my employer can distribute the rebate, provided it's a non-Federal governmental plan.

1. "Reducing premiums for the upcoming year; or"
2. "Providing a cash rebate to employees or subscribers that were covered by the health insurance on which the rebate is based."

My employer's insurance provider is a large one, covering over 3 million people. While the 80/20 rule is determined state to state--basically my provider didn't meet the standard in DC, but might have in Virginia--there are potentially a couple million people just from my provider that are primed to see a tangible benefit from the 80/20 rule and they all got a letter telling them they would get a tangible benefit.  You can't buy this kind of positive publicity for legislation.

Now, I'm not here to debate the wisdom of this rule.  I'm simply suggesting a piece of legislation that has elements a majority of people clearly favor just picked up what will likely prove to be a net positive in an election year.  Obviously Romney has been reluctant to come out too strong against Obamacare because, well Obama aped Romneycare, but potentially there are independents who weren't too excited about Obamacare that have now seen as many as three direct benefits from legislation that doesn't even take full effect until 2014. They've seen insurance companies can't deny them coverage, they've seen their children receive continued coverage until age 26, and they've seen a letter about a rebate.

Now perhaps I'm overestimating the impact and I haven't seen other pundits talk about this much, but this seems like a piece of good news for Obamacare and by transitory properties, a good piece of news for the president.


UPDATE: I've been informed by a friend at Doctors for America that I got one of the policy points wrong. Insurance companies can still deny coverage to people over 18 due to pre-existing conditions. This protection isn't set up to take place for a bit longer. Right now only those 18 and under cannot be denied coverage due to a pre-existing condition. If someone over 18 is denied coverage due to a pre-existing condition and can't get coverage for 6 months, they are eligible for a high-risk buying pool through the federal government. Full details available at www.healthcare.gov.