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Fluctuating Opinions Amidst Constant Truths

By Dr. Ram Krishnamoorthi
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Even as the dominant item in the news continues to be the GOP presidential race, the topic of health reform doesn’t exactly take a back seat; in fact, unlike the frontrunner candidate, which seems to change on almost a weekly basis, the Affordable Care Acts holds a rather steady position in the GOP debates: the reliable punching bag.  The call to repeal “Obamacare” is an easy “go-to” for a candidate when he is up against the ropes, always garnering loud applause and cheers from the audience and restoring unity to the otherwise contentious exchange.

The general public’s opinion about the ACA has fluctuated a little bit more than that of its staunch opponents in the one political party—but only recently. The Kaiser Family Foundation’s monthly Health Tracking Poll for December 2011 reported that support for the ACA is back up to the level it saw for most of 2011, after having a rather rocky fall season. For most of the year, about 40% of Americans favored the law and about 40-45% had an unfavorable view, a relatively even split according to Kaiser’s public opinion research team. But in October, those who had an unfavorable view of the ACA were 51% and only 34% found it favorable, the lowest proportion since its passage. This was largely due to many Democratic voters backing down in their support. Beginning in November, the numbers started to come back but not all the way, with 37% favorable and 44% unfavorable, demonstrating that there was a real change in thinking.

Why would there be this dip at all? To be sure, it looks now to be a minor, temporary blip. But the Law certainly hasn’t changed, and in fact, the provisions of the ACA that have already gone into effect are among the most popular, such as allowing parents’ children to stay on their health insurance until age 26 and requiring insurance companies to provide easy-to-understand explanations of benefits.

The answer seems to be in the details of the poll, which reveal that well over 18 months after it was passed, a large portion of Americans still feel they know little about the law or its potential impact on them.  In December, about 55% said they knew a “fair amount” but 42% said they   did not know enough to estimate its impact. These numbers are almost identical to the numbers in April 2010. Perhaps most unfortunate is that even those Americans who stand the most to benefit have a poor sense of how the ACA will help them. Of the uninsured, 40% say they know little about what the law will do, and nearly 50% of the low‐income also are uncertain.

As the poll results are broken down further, the fluctuations of public opinion become more understandable: When the Kaiser poll would inform respondents about individual reforms and then ask them to comment on their favorability, even the most popular reforms were unknown. For example, over 85% of respondents favored the requirement that health plans provide straightforward summaries of benefits for customers, but only 42% of them knew it existed. Similarly, around 60% of people were unaware of the requirement for insurance companies to spend 80% of their premium collections on health services (the medical-loss ratio), but 60% found this to be a favorable rule. Other “pleasant surprises:” nearly 80% support the Health Exchanges and subsidies to small businesses to buy insurance, and even 69% support the expansion of Medicaid, another much-maligned piece of the law.

The most telling finding is that the message matters: the individual mandate is the least popular at 33% favorability. But, when respondents were informed that for most Americans, their employer-provided coverage would qualify for the mandate’s requirement, the favorability jumps to 61%, completely flipping the ratio. However, when they are told that the Supreme Court is going to rule on whether the mandate is constitutional or not, 74% disapprove of it.

Myth about the law still prevails: Nearly 70% either think or do not know if the law includes a new government-run insurance plan. And a third (35%) believe a government panel will make decisions about end-of-life care for Medicare recipients, the infamous and mythical “death panel”       

The ACA’s supporters, the politicians who passed it as well as the advocacy groups who fought for it, have made a smaller impact on informing the public than its detractors have. Using the ignominious name “ObamaCare,” opponents have not only called for its repeal, they have falsified its contents, labeled it as socialist and worse, and have successfully scared the public into fearing it, especially the most vulnerable, our senior citizens. The Kaiser poll points out that Americans get their information about the ACA from a variety of sources, most popularly from the cable news networks (both supporters and detractors).  Among those who get their information solely by word-of-mouth, the information is mostly negative, demonstrating the poor understanding of the complex law and ability to explain it to one another.

This is why DFA has launched the One Million Campaign, to help serve as a corrective to the current climate of myth and propaganda and to aid those in understanding this complex but important law. The campaign will aim to reach its target of educating Americans, other physicians and the general public, on the facts, the benefits, and the still-to-be determined elements of the ACA. Please join us in this effort, to help take back control of the health reform debate. 

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