BY: JEFF TIEMAN
The Patient Protection and Affordable Care Act — the most important and substantial social policy to be made in decades — is not wildly popular. Although many of its benefits have already helped millions of people, it is no better liked by the public at large than it was following the controversial months leading to its passage. In fact — although there is a silver lining — the law it is now viewed more unfavorably than ever.
Public opinion research continually validates the law's unpopularity. Since the law was enacted, the Kaiser Family Foundation has been tracking public perception on a monthly basis. In its most recent survey, Kaiser found that just 34 percent of Americans say they view the law favorably; 51 percent view it unfavorably. For advocates and supporters of universal health care, this is not a happy set of statistics.
The silver lining, however, is the finding that the opposition can be overcome with education. Those who have delved a bit deeper into the questions typically asked in a survey on the Affordable Care Act have found that support can be built — that even those people who are at first unsupportive or even outright hostile to the law can be educated about its provisions to a positive effect.
In other words, the lack of information — and especially complete, honest information — is the greatest obstacle to acceptance and support of the law.
"Every single deliverable since the passage of ACA has the potential to increase the popularity of the law if more people were aware of them," said Celinda Lake, a pollster with Lake Research Partners, in a recent presentation on health reform.
According to a corollary survey by Kaiser, 72 percent of respondents view the law more favorably once they learn that it prohibits denial of coverage to children. Similar increases in support occur when people become aware of tax credits for small businesses, medical screenings and preventive care with no out-of-pocket costs and gradual closing of the Medicare prescription drug "doughnut hole."
A few groups are doing excellent work to extol these benefits and help explain the law in an effort to garner broader support. One such group is the Herndon Alliance, a coalition of minority, faith and health care provider organizations educating the public on the Affordable Care Act and related topics. Research commissioned by Herndon and conducted by Celinda Lake identified women as a key group for expanding knowledge and support of the law.
Independent female voters, for instance, move from supporting the law by a single point in one survey to supporting it by 33 points once they have learned details of how it works and how it is already helping women and families.
Lake's research identifies a couple of central themes, or "frames," that are the most effective when communicating reasons for and benefits of the law:
- Consumer frame: New protections in the law (e.g., standard premium pricing for men and women and no pre-existing condition exclusions) invoke the values of security, wellness and fairness
- Prevention: Simply naming the preventive benefits available under the law is a powerful message that resonates with women and men alike. The prevention provisions also tap into cost concerns, helping people understand that the law ultimately saves them money by requiring coverage for health care services that keep them healthy.
These themes also resonate with CHA's Our Vision for U.S. Health Care, which spells out the principles our ministry said should be reflected in health reform legislation, including fair financing, coverage and access for all, health and prevention and patient-centered care. As we have learned from anecdotal reports and experience, framing health reform around these principles is an extremely effective way to move people from the "Obamacare" frame (which is largely negative and highly political) to a values-based, consumer-oriented frame that makes the law and its intentions more clear and palatable.
As I've written in this column before, the "Obamacare" moniker and the themes of government takeover it invokes have been quite harmful. In a presentation I gave recently in St. Louis, I explained that even when the ACA is fully in effect, the vast majority of people will still get their health coverage from a private insurance company as they do now, even those who obtain that coverage through one of the forthcoming state insurance exchanges.
Following my presentation, one of the audience members approached me to say that he had assumed the information he heard was correct — that "Obamacare" represented a government takeover not only of insurance but also hospitals and physicians. In a moment that validates Lake's research, he told me that my presentation changed his mind. He walked away convinced that the law is not a government takeover of any kind but instead an effort to expand coverage and make the system more fair and accessible.
While Americans express support for most of the Affordable Care Act's provisions — even when they say they don't like the law overall — opposition to the individual mandate has been steady and strong. Some theorize that the concept of requiring all people to purchase health insurance goes against the American ethos of independence and personal freedom.
ACA proponents have suggested rebranding the mandate as the "individual responsibility" provision, which does seem to help attract more support for it. Regardless of what we call it, a CNN opinion survey conducted in November shows that the public can be brought around on this issue too: according to the CNN poll, 52 percent support the mandate and 47 percent oppose it. That's a sea change from earlier surveys that showed more than three-fourths of Americans opposing the mandate.
The bottom line here is that while the ACA is still not popular, according to polls, most people begin to come around once they hear the facts. And certainly the millions of people who have already benefited from the law — children, seniors and small businesses among them — view it favorably.
If you can convince even one person who thinks he or she doesn't like "Obamacare" to support the notion of fair, affordable, accessible health care for everyone, you've helped reframe the issue. CHA and other groups have many resources to help communicate effectively about the law. Check our web site — and then get the word out.
JEFF TIEMAN is senior director, health reform initiatives, Catholic Health Association, Washington, D.C.
Copyright © 2012 by the Catholic Health Association of the United States
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