When Congress was considering the Patient Protection and Affordable Care Act (PPACA) in the spring of 2010, then House Speaker Nancy Pelosi (D-CA) made this now-famous statement: "But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy."[1]
Although many poked fun at Pelosi's gaffe at the time, the reality is that she was right. We are still finding out what is in PPACA, even 18 months after its passage. Above all, the on-going regulatory process has perpetuated this journey.
A key challenge facing the White House and U.S. Department of Health and Human Services (HHS) is that many people who would potentially benefit from PPACA's future entitlements do not understand the details of the legislation or the emerging overlay of regulatory guidance. This confusion is documented in a recent August 2011 poll released by the Henry J. Kaiser Family Foundation. The researchers note:
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Despite the fact that (PPACA) is expected to expand coverage to 32 million of the uninsured, only half of those currently without coverage report being aware of the key components of the law designed to achieve this goal: the expansion of the Medicaid program and subsidies for low and middle income Americans without insurance. Perhaps tied to this lack of awareness, almost half of the uninsured expect the (PPACA) will have little impact on them personally, and just three in ten believe the new law will help them get health care. Among Americans as a whole, views on the (PPACA) remain roughly divided, as they have for most of the past year.
At first blush, these findings are surprising given the amount of press this issue has generated since Obama first ran for President and announced that health care reform was a major element of his election platform.
One primary driver of the public's lack of understanding is the massive complexity of PPACA. For example, PPACA is directly or indirectly impacting about 17% of the U.S. economy. It also impacts many, many business and provider systems, which literally are dealing with life and death issues every waking hour with significant financial repercussions. Further, tens of thousands of pages of regulations are being drafted by HHS and other federal agencies to implement PPACA. It is simply overwhelming.
Behind-the-scenes deal making and negotiations on Capitol Hill prior to passage also added layers of detail and complexity to PPACA. For example, several waiver programs were embedded in the legislation to keep the peace and garner key political votes. Additionally, the Obama Administration's attention has been diverted by the performance of the economy and the concurrent levels of unemployment. Another key factor is that many of the most comprehensive provisions of PPACA will not take effect until 2014 — so many details still need to be worked out.
With all the ambiguity surrounding PPACA, many Americans support its repeal as documented by a number of polls since the law was first signed by the President. Some consumer advocates also have voiced concerns that some individuals are anticipating certain benefits or financial subsidies that might not crystallize.
The dynamic nature of PPACA precludes the use of simple sound bites by its supporters who need to generate a higher level of acceptance than the current polls reflect. No matter what happens in the coming months and years, re-evaluating the key elements of the new law and setting the right expectations for the different stakeholder groups and individuals will continue to be a priority to ensure an optimal outcome – not matter how much PPACA is modified or enhanced.
BenefitMall will continue to keep you apprised of the latest developments as health care reform continues to evolve. For blog posts, legislative alerts, pools, surveys and other resources, visit www.HealthcareExchange.com or www.BenefitMall.com.
[1] From Speaker Pelosi's remarks at the 2010 Legislative Conference for National Association of Counties. See http://www.usnews.com/opinion/blogs/peter-roff/2010/03/09/pelosi-pass-health-reform-so-you-can-find-out-whats-in-it
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