HCR -- Ignorance Is Reaching Pandemic Levels

Seven percent of Americans think SCOTUS overturned Obamacare; 12 percent say Congress repealed it. wapo.st/11UxdMx
— Sarah Kliff (@sarahkliff) April 30, 2013

Poll: 42 percent of Americans unsure if Obamacare is still law

This headline illustrates how successful opponents of PPACA have been with their relentless negative propaganda. 

If you want to know what a challenge the Obama administration faces in implementing its signature health-care law, this statistic might help: Fewer than six in 10 Americans know that the Obamacare law is still on the books. Seven percent think the Supreme Court struck it down; 12 percent say Congress repealed Obamacare.

This comes from the Kaiser Family Foundation, which is out with a poll Tuesday morning looking at how much Americans know about the health-care overhaul—before a deluge of public outreach, set to begin this summer, kicks off. 

The short answer is: They do not know a lot. Most Americans likely to access new health care programs under the Affordable Care Act—either through subsidized private insurance or the Medicaid expansion—say they don’t have enough information to understand “how it [the health law] will impact you and your family.”

This poll does, however, show greater awareness than separate research conducted last winter by Enroll America, a new non-profit that’s leading much of the outreach effort. It found that 78 percent of Americans likely to gain access to health coverage had no idea that such programs would roll out in 2014. 

The challenge that the Obama administration faces is more complex than just increasing awareness and improving public awareness. It has a lot to do with improving knowledge at the exact right time—not when benefits are way out in the distance, but also not when the public has passed them by.

I have no idea why the administration and others trying to advance healthcare reform have failed to even explain the basics of the legislation. Lord knows, it's not easy. I suspect it has something to do with Congressional shit-tossing. As long as the Tea Party House caucus keeps up the "repeal it all" charade and the Senate refuses to confirm presidential appointees, anything Obama does is politically DOA. Those are not good reasons to ignore the challenge but it's also not smart to waste political capital. 

My suspicion is that the major players -- providers and insurance companies -- are waiting until the last minute for two reasons. 

First, the timeline is still unfolding. Until changes actually become official, early planning may confuse people which would make matters even worse. An unrelated example regards the Congressional passage of "Real ID," Congress passed the REAL ID Act of 2005 in that year and it has been slowly but surely making progress ever since. 

When my wife and I recently went to get our drivers licenses renewed we faced Georgia's new requirements to be in compliance with REAL ID. Each of us had to furnish (in addition to surrendering our expired licenses)

• Two items proving residence (mail to our address, business statement or employer document with our address. 
• Social Security card (or something from the SS Administration with the number)
• Birth certificate (or certified copy) or unexpired Passport. 

The Bureau of Drivers Services was very polite but it was clear that they were charged with following the rules whether or not the public liked it. And the public, from what I saw, was patiently, if grudgingly, in compliance. Discussing our experience with others I know there is a vague awareness that as of this year Georgia is gonna be doing something different with drivers licenses, but the details are of no interest until each person has to deal with it personally. 

Second, it is difficult to predict how many people will respond when the provisions are officially enacted.  Providers very likely fear that they will be overwhelmed as millions of newly-insured people (many with long-neglected medical issues) present for attention. And the insurance industry, salivating for new business from tax-subsidized new customers, will keep their cards close to their vests until the last minute, watching the market and their competition before advertising something not yet ready for prime time.  

It is not surprising that ACA is grinding along so slowly. The majority of Americans have some kind of health care, either from the Veterans Administration, Tri-care (which covers military dependents), employer group plans or private insurance. The working poor live without professional health care, enduring both chronic and acute problems until they rise to the emergency level, and when they present at a hospital ER they are stabilized and dismissed in accordance with EMTALA. And finally, those who qualify for Medicaid receive a range of medical attention according to where they live. (There is a wide range of quality from state to state as well as urban to rural locations.) And fortunately most people are not sick, so until they are confronted with an injury or illness (like people whose drivers licenses are not about to expire) there is no compelling reason to pay attention. 

Meantime, those who care to look can check out this excellent timeline from the Kaiser people. 

Also, most people are already insured. But those who are not may want to check out this chart.