Obamacare misunderstood, burdened in politics


Pop quiz: What is the Affordable Care Act? If you answered: “a violent assault on not just the Constitution, but on liberty itself, and a sign of the abject evil that inhabits the Obama administration,” you’re probably a Republican. If you answered: “The signal achievement of President Barack Obama and a historic expansion of healthcare access that will literally save lives,” I’m guessing you’re a Democrat. However you answered, I’ll bet you can’t explain, in any detail, what’s actually in the ACA. That’s partly the result of a basic failure to communicate on the part of the administration and congressional Democrats.

The technocrats in the Obama White House ceded the crafting of the bill to the slow-walkers of the Senate Finance Committee and then presumed that anyone with a brain can figure out what’s in the law. Meanwhile, Democrats in Congress finally forced the bill through, and then ran for the hills, refusing to campaign on the law in 2010.

After the disastrous election that followed, they were still left holding a rather unpopular bag.

And that’s partly the result of a dogged, unyielding campaign by the refuseniks in the Republican Party, whose current message is that they are willing to shut down the government in order to somehow force the president to sign a bill defunding or killing his own plan. Republicans don’t have an idea that would replace Obamacare, other than to recommend that the uninsured keep going to the E.R. But they don’t need a plan, I suppose — they have conviction.

If the GOP can be credited with anything — and given the state of their brand and the paralyzed mess they’ve made of Congress, they can’t be credited with much — it is persistence. Republicans made a decision in the summer of 2009 to wage all-out war on the notion of universal healthcare, with one guiding principle: If it has been touched by Barack Obama, it is bad. That includes the individual mandate that was originally their idea.

From that visionary thinking sprung the moniker Obamacare, designed to elicit horror in the listener, but based on the faulty premise that the “real” majority of Americans hate Obama as much as the hardened right-wing core does. That presumption proved to be wrong in 2012, when Obama won a decisive reelection victory. But the GOP did succeed in one measure: Most Americans have no idea, really, what the healthcare law entails, but they are pretty sure they don’t like it.

To bear that out, a new NBC/Wall Street Journal poll finds that Americans see the law as a bad idea versus a good idea at a ratio of 44 percent to 31 percent, leaving 25 percent somewhere in the “beats the hell out of me” zone.

In the same poll, 34 percent of respondents said they don’t understand the law, and 35 percent have only some understanding, and 30 percent said they understand it “pretty well” or “very well.”

And did I mention, the law that will not be understood, kicks in Oct. 1?

Perhaps another issue is that with some three-fourths of Americans telling pollsters they’re satisfied with the healthcare they have, many Americans don’t feel a pressing need to know. Of course, a nasty health surprise could change that for any of us at any time.

The administration is belatedly mounting a public information campaign to get people in the know. And the states that are running their own versions of Obamacare stand to be the strongest communicators of their own plans. For the rest, here’s a quick primer on what Obamacare actually is:

• An end to pre-existing conditions as a bar to getting coverage.

• A requirement that individuals carry health insurance or pay a tax fine.

• Free screenings, such as mammograms, for preventive care.

• A provision allowing young people to remain on their parents’ policy up to age 26.

• A requirement that your insurance company spend 85 percent of its money on healthcare, not ads and such, or give you a rebate.

• A guarantee of your right to appeal payment denials by insurers.

• A prohibition against insurance companies arbitrarily dropping people from coverage.

• Plus, hefty federal subsidies for the uninsured to buy health insurance, through a state or federally run marketplace called an “exchange.”

Or an abrogation of your very freedom to exist, depending on your politics.

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