Politics, Perceptions, and the Affordable Care Act
On October14, the Health Policy Institute of Ohio (HPIO) hosted “Politics, Perceptions, and the Affordable Care Act’s (ACA) Impact on Coverage and Access.” The program, held in the Statehouse Atrium, featured Sarah Kliff, senior editor at Vox Media where she oversees health, medicine, and education coverage. Ms. Kliff’s presentation was followed by a “perspective from the frontlines” panel that featured:
- Aly DeAngelo, director, Health Economics and Policy, Ohio Hospital Association
- Patricia Decensi, vice president and general counsel, Medical Mutual of Ohio
- Amy Schultz Clubbs, plan president, Molina Healthcare of Ohio Inc.
- John Corlett, vice president, government relations and community affairs, MetroHealth System
- Randy Runyon, president and CEO, Ohio Association of Community Health Centers.
Ms. Kliff described the ACA as big and sweeping policy that people largely don’t understand and don’t like. She showed the Jimmy Kimmel clip where people were interviewed on the street to ask if they preferred the ACA or Obamacare. Those interviewed had no understanding that they are the same thing. Individual provisions of the ACA are viewed positively but the law as a whole is viewed negatively.
According to Ms. Kliff, the U.S. health system makes up one-sixth of this nation’s economy. In fact, the U.S. health care system is the fifth largest economy in the world.
Ms. Kliff compared the ACA to a three-legged stool – if one of the legs is missing, the stool doesn’t stand. The three legs to the ACA stool are:
- Opening the market to everyone
- Requiring coverage through the individual mandate (getting everyone in)
- Subsidies to make coverage more affordable.
The biggest barrier to access continues to be cost.
ACA implementation has taken place in an environment of great uncertainty. The launch was a disaster but eight million people really, really wanted coverage and battled through all the hurdles to get it.
Much of what was anticipated turned out much differently. Examples include:
- No one anticipated the Supreme Court would rule the way it did
- States deferring responsibility to the feds for developing marketplaces was a surprise
- The number of states refusing to expand Medicaid even though the federal government was picking up 100% of the tab was shocking to most
- Thinking that public opinion about the ACA would improve once the provisions of the law were implemented and people were benefitting from those provisions has not happened.
Ms. Kliff closed with the observation that public opinion and press coverage around Medicare 50 years ago was very similar to what we are seeing today with ACA. So we are left with the question, how will the ACA be viewed in 50 years?
Prior to the event, the HPIO Health Access Committee met privately with Ms. Kliff to discuss ACA access issues. Ohio Academy of Family Physicians Executive Vice President Ann Spicer is a member of the Health Access Committee and attended both the committee meeting and the event.