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Health care reform demonstration with woman holding
The Affordable Care Act, House Speaker John Boehner aside, is going to go into effect. The rules are being written, and in about half the states work has already begun to set up their side of the program. But there are obstacles beyond just Republican governors dragging their heels.

Here's one of the bigger challenges: how to bring in the millions of people who are completely unaware of the options they will have under the new law.

Part of the problem, experts say, is that people who will be affected don’t realize the urgency because the subsidies won’t begin for another year. But policy decisions are being made now that will affect tens of millions of Americans, and the lack of public awareness could jeopardize a system that depends on having many people involved. Low enrollment could lead to higher premiums, health policy experts say. Hospitals worry that, without widespread participation, they will continue getting stuck with patients’ unpaid medical bills. And advocates say the major purpose of the Affordable Care Act – extending health insurance to more Americans – will go unmet if large numbers of vulnerable people don’t take advantage of it. [...]

Seventy-eight percent of the uninsured Americans who are likely to qualify for subsidies were unfamiliar with the new coverage options in a survey by Democratic polling firm Lake Research Partners. That survey, sponsored by the nonprofit Enroll America, also found that 83 percent of those likely to qualify for the expansion of Medicaid, which is expected to cover 12 million Americans, were unaware of the option.

In separate October polling data from the Kaiser Family Foundation, 41 percent of voters described themselves as “confused” about the health-care law.

Sabotage has been a big part of the Republican fight to make sure that the Affordable Care Act doesn't succeed, their fallback position to doomed repeal efforts. Keeping the public uncertain about the fate of the law and confused on the aspects of the law is definitely part of that effort.

So is Boehner's promise of never-ending "investigations" by the House into the implementation of the law. House Republicans have already started in, specifically targeting the Department of Health and Human Services efforts to publicize the new law.

A number of non-profit organizations have formed a coalition under the umbrella Enroll America, "whose mission is to ensure that all Americans are enrolled in and retain health coverage." It's planning an advertising campaign to inform the public of options under the new law, but confusion in the states where Republican governors are gumming up the works will complicate that effort as well.

The Affordable Care Act will move forward. Now the fight is going to be making it a success.

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Comment Preferences

  •  I wish Senate Dems would start "never ending" (25+ / 0-)

    investigations into tax shelters.

    -1.63/ -1.49 "Speaking truth to power" (with snark of course)!

    by dopper0189 on Fri Nov 23, 2012 at 01:48:28 PM PST

  •  Pity that America lacks billionaires who could (10+ / 0-)

    Drop a million or two on a campaign of public awareness. . . .

    "Let's see what fresh fuckwittery these dolts can contrive to torment themselves with this time." -- Iain Banks, The Hydrogen Sonata

    by Rikon Snow on Fri Nov 23, 2012 at 01:49:10 PM PST

  •  Does the USPS Still Work? (14+ / 0-)

    What's wrong with actually sending every American the information in the mail - say, for instance, with their tax forms? How about buying infomercial time to help educate people?

    I dunno. Seems kind of simple to me.  

  •  Sigh. (0+ / 0-)

    Wish we were eligible for subsidies, because my insurance ends this year since we can't afford it for both.

    •  That sounds like you may well be eligible for (2+ / 0-)
      Recommended by:
      1Nic Ven, MNPundit


      •  I don't think so but maybe. (0+ / 0-)

        She can get it through employer, so unless it's really really crappy we can't get subsidies for her. I'm unemployed and while I can be added to her insurance it's prohibitively expensive to do that for both of us and she had to stay healthy since she's bringing in money so it has to be her.

        So it depends on if I qualify or not. If I count as being able to have insurance through her work then I will just have to go without and pay for my BP out of pocket. At least that's fairly cheap.

        •  According to information I got from a group (0+ / 0-)

          advocating for health care, if the insurance she can get through her employer will cost more than 8% of her family's income she does not have to accept that insurance and can go to the exchange.  I think, that in figuring the cost of the insurance, that cost would include the cost for both her and you, since this information was stated in terms of the family.

  •  Incident during Thanksgiving Dinner a... (9+ / 0-)

    Tea Bagger friend was complaining about the socialist Obama care (it is really about the Black Man in the WHITEhouse).  I asked her if her daughter, age 25 is covered by her employer's health insurance and she said yes.  I asked her why do you use that socialist ACA.  She had nothing to say.  

    She did not know that ACA is really Obama care.

    The good news she did not say another derogatory remark about Obama the rest of the day.  The bad news is she will probably be at the dinner next year.

    Psst!!!......Mittens you are more of a poor loser than I thought.

    by wbishop3 on Fri Nov 23, 2012 at 02:02:25 PM PST

  •  Ezra Klein had a segment on this on Last Word (3+ / 0-)
    Recommended by:
    Eyesbright, 714day, Eric Nelson

    The people eligible for expanded Medicaid needs to be reached out and told they will get these benefits.


    your actual subsidy!

    Try pointing people to this site at least:

    Answer: Your age , how many people in household, household income, marital status and you get a customized report with sentences like this:

    This was for 3 person household, married, 36k income:

    Starting in 2014:
    You will have the option of buying a health plan through your state's exchange with federal assistance. Based on your income, your annual premiums for that plan would be no more than $1,440 to $2,268. Your maximum out-of-pocket costs for deductibles and co-payments would be capped at 15 percent of the total cost.

    Go to the site and do your own. You would think there would be some good sites from the government ... and they might promote the site... but no.

    Give the people a choice between a Republican and a Republican and they will vote for the Republican every time - Harry S Truman

    by mr market on Fri Nov 23, 2012 at 02:08:20 PM PST

    •  you make the rash assumption that everyone (3+ / 0-)
      Recommended by:
      Eikyu Saha, 714day, sebastianguy99

      either has, or has easy access to a computer, they don't.

      Try pointing people to this site at least:
      a web site is only good for those who can access it. for those who can't, it's useless. surprisingly enough, that would be a rather large segment of the population, that segment that the ACA will benefit the most.

      what needs to be done is a combined media public awareness campaign: tv & radio PA's, and mail information, to every household. at some point, someone in those households will pay attention. heck, my son, the 22 year-old college student, even knows he's still on my insurance, because of the ACA. i know this, because i asked him yesterday morning, on the drive to my sister-in-law's, for thanksgiving dinner.

      •  At least we are pointed to it! (2+ / 0-)
        Recommended by:
        mr market, sebastianguy99

        I didn't know about it. And that is exactly the kind of detailed and specific info people want. Tools like that can help me tell people more exactly what they can expect. It can be used by doctors offices. It can be used by media, or people putting toegether information brochures, to give some examples.

        " can’t find any oxygen from outside the aircraft to get in the aircraft, because the windows don’t open. I don’t know why they don’t do that. It’s a real problem." Mitt Romney

        by Catte Nappe on Fri Nov 23, 2012 at 03:57:47 PM PST

        [ Parent ]

    •  Calculator (6+ / 0-)

      Thanks for posting the Washington Post link.  I run my own very small business (three of us) and I had several insurance companies in to quote health insurance.  My best rate was $4000 per year with a $5000 deductible.  No health services were provided with that $4000, not even a physical.  As I am extremely healthy and with the business slowdown of the past few years, I opted not to purchase any health insurance.  The Washington Post calculator indicates that my maximum cost per year would be $3800 and my max deductible and copays would be capped at $1140 per year.  That's a significant savings for me.  And what I understand is that preventative care, such as physicals and certain screenings, would be included in the base $3800.  The ACA is a much better deal for me.  

    •  There ARE some good government sites ... (1+ / 0-)
      Recommended by:

      Ever hear of Google?

      Go to:

      Less than a quarter of America's 27 million small businesses have employees.  An even smaller portion grow beyond 20 employees.  Research from the University of Chicago finds that 75 percent of small-business owners aren't aiming for growth at all, but are simply looking for a steady job as their own boss.    —The Wall Street Journal (2012)

  •  Never could understand (1+ / 0-)
    Recommended by:
    radical simplicity

    why its implementation was so far into the future.  

    If money is speech, then speech must be money.

    by dkmich on Fri Nov 23, 2012 at 02:12:20 PM PST

  •  The Republican brand is miserable and beyond hope (8+ / 0-)

    This voter education message must be hammered home on a national scale. It's also why 2014 needs to be made a "Turnout to Throw Out the GOP" year.

  •  I live in Florida... (6+ / 0-)

    ...which means the entire ACA is a question mark for me. Techncally, I qualify for Medicaid under the new law (at least in my current low-paying job). But with Rick Scott so far refusing to participate, that option will likely not be open for me. The question then becomes, if I qualify for Medicaid but live in a state that's not implementing the Medicaid expansion, am I still eligible for a subsidy to buy insurance on the exchange? And if I'm not eligible for a subsidy, will I be fined if I can't afford insurance?

    Then there's the new regulation which will allow insurers offering "Bronze plans" - which I gather are the only ones which will qualify for subsidies - to exceed the $2,000 deductible cap. A $2,000 deductible will be hard enough for me to meet. Too much above that, and I'm toast.

    I vote we run Rick Scott out of Florida on a high-speed rail.

    by ObamOcala on Fri Nov 23, 2012 at 02:14:22 PM PST

  •  Super Pac (2+ / 0-)
    Recommended by:
    DJDan, fritzi56

    Couldn't a Super Pac run commercials in various markets with basic information on how to enroll?  That's one PAC I'd contribute to.

    •  Go to ... (1+ / 0-)
      Recommended by:

      The exchanges open on October 1, 2013

      "Focusing your life solely on making a buck shows a certain poverty of ambition. It asks too little of yourself. Because it's only when you hitch your wagon to something larger than yourself that you realize your true potential." - Barack Obama

  •  Somebody needs to write a jingle (3+ / 0-)
    Recommended by:
    Catte Nappe, DJDan, mr market

    Seriously.  Set the most important provisions to music and make a commercial out of it.  Forty years later, I can still sing the ingredients for a Big Mac.

    "We *can* go back to the Dark Ages! The crust of learning and good manners and tolerance is so thin!" -- Sinclair Lewis

    by Nespolo on Fri Nov 23, 2012 at 02:37:30 PM PST

  •  Healthcare info .... (3+ / 0-)
    Recommended by:
    eps62, Eric Nelson, DSPS owl
    Most people are expected to shop for health insurance plans on the exchange's website, (set up by each state) where they will enter personal information such as age, family size, income and ZIP code to determine what plans they can buy.  The health insurance plans available on the exchanges will vary from state to state. The federally run exchanges and some states will opt to allow any licensed insurer to sell as many products as it wants, giving consumers a large number of choices. Other states will take a different approach by demanding lower premiums from participating insurers and limiting the number of products sold to ensure consumers don't have to navigate too many similar plans.  All the health insurance plans sold on the exchanges will be subject to new federal consumer protections, including the prohibition against turning away people with pre-existing conditions, and will have to meet the health care law's minimum benefit standards, such as coverage of maternity care and prescription drugs.  Much info is currently on the web, but make sure you get your info from an authentic Obama website or government website.  

    Go to the website:

    We organize governments to provide benefits and to prevent abuse.

  •  Guvmint git yer hands off my Obamacare! (1+ / 0-)
    Recommended by:

    You heard it here first.

    "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

    by kovie on Fri Nov 23, 2012 at 02:41:38 PM PST

  •  Here are some Obama benefits (9+ / 0-)
    ^ACA makes hospitals pay 1% of total costs if their patients are re-emitted; then that money will go to hospitals that exceed benchmarks
    ^obamacares 10% rate increases justification reg saved consumers 1bn in 2011
    ^provides grants to communities that adopt policies that make people healthier
    ^provides funding to teach people about healthier living styles
    ^increased funding for school health programs
    ^requires drug, device or medical supply companies to report annually certain payments or things of value that they've given physicians and teaching hospitals
    ^. Employers must provide "a place, other than a bathroom, that is shielded from view and free from intrusion from co-workers and the public, which may be used by an employee to express breast milk."
    ^funding support for early childhood home visitation for people which reduces drug use by 2.5%, marriages time by 3 years, 2% higher intelligence, saved govt almost 1,000 dollars
    ^mandates health planes be simple to understand
    ^increased high value medical fraud criminal sentences by 20-50%
    ^expanded doj ability to press charges for different kinds of medical fraud.
    ^increased Medicare bidding process to save 28billion in 10 years
    ^allowed 10,000 seniors to get home care
    ^requires insurance companies to justify rate hikes 10% or above
    ^obamcare dedicated over 400million to help poor neighborhood shops sell healthy food
    ^obamacare ended dentist monopolies allowing for more completion, jobs and lower costs. Estimates show this potentially reducing teeth cleaning costs by $63 an hour and providing poorer people with 1.5billion in increased wages
    ^7million young adults now have health care through their parents’ health insurance plans due to obamacare
    ^Obamacares medical loss ratio regulation has resulted in 1.3billion in rebates to private consumers in 2011 equaling around 130 per family per year
    ^ACA’s CMS competitive bidding program for durable medical equipment and supplies has saved over 200million in its first year. In 2013 the program will be extended and is estimated to save 45billion between 2013-2022
    ^ACA expansion of value-based medicine estimated to save 60,000 lives and 35 billion dollars in its first 3 years.
    ^New ACA regulations expanding electric funds transfers save around 200million dollars a year
    ^New ACA regulation simplifying of eligibility rules and claim transactions to save a net of 1.2billion dollars a year by reducing bureaucracy/paper work
    ^repeal the individual mandate would result in
    1)    15million more uninsured Americans
    2)    Premiums being 20% higher
    ^Medicare’s bundled payment system that pays based on health outcomes costs 5% less than fee-for-service; and has resulted in doctors getting higher salaries, and better service. This payment system is mandated to expand to non-Medicare related payments
    ^the cbo estimates that this system will increase the quality of care by 13%
    ^Some effects of ACA 2 years after passing.
    1)    54million Americans now have access to preventative medicine.
    2)    2.5million children now have health care via their parents
    3)    51million seniors now have lower prescription drug costs
    ^RomneyCare in Mass, is making people healthier and has increased health outcomes, of which Obamacare has more health enhancing policies.
    ^The ACA provide subsidies for employers, and other programs to boost wellness program participation of which wellness programs have a 6-1 benefit cost ratio
    ^New CBO report finds that health reform cuts deficit by 50billion more than the original estimates
    ^Repealing the health care mandate would increase health premiums by 25%
    ^Calorie and health labeling on restaurants resulted in 15% of people using the information to eat healthier and reduce caloric intake by 106 calories per meal.
    ^The result of every American eating 20 fewer calories a day would be 2.4 million less cases of diabetes, 1.7 million less cases of cardiovascular disease and 16 million more quality life years.
    ^ (diabetes Medical cost (leaving out indirect costs) is around 4,400 per person per year).
    ^ (Heart disease costs (leaving out indirect costs is around) 4,500 per person
    ^So everyone reducing caloric intake by 20 calories per day would save around 20 billion dollars a year in direct medical costs.
    ^requiring companies to put nutritional values on menus reduces calories in food goods by 7%, after 18 months (in sit down settings)
    ^80 things the ACA does
    Required health insurance companies to all form a standardized breakdown of benefits to be sent to patients.
    ^The ACA has cut premiums for Pre-existing condition insurance plans by 40% so far
    ^Facts on ACA waivers
    1)    The DHHS has clearly laid out criteria for granting waivers, which they list along with the entities who’ve gotten them at their website.
    2)    The waivers don’t exempt then entitles form the law but rather allow them more time to adjust to a key provision that outlaws health insurance that doesn’t provide reasonable benefits.
    3)    The reason a lot of waivers are in Pelosi’s district is because a third-party company in that district with no connections to politics applied for them en masse.
    4)    The reason many Unions are given waivers is because they are locked in current collective bargaining agreements and that restricts them from making sudden changes.
    5)    94% of waiver applicants are granted, ranging from big business to small local ones of all colors.
    ^The ACA regulations for some part of health care such as ACO's will move our current payment system to one were doctors/hospitals are paid on how well your health becomes instead of how much they do to you.
    ^Republicans vote to remove ACA implementation funding would increase government spending by almost 10 billion dollars.
    ^ways ACA reduces costs
    IMBD board
    Invests in community health centers
    Invests in computerized health care records, and other new technology.
    Reduces drug patents by 2 years.
    Requires health insurance companies to spend more money on benefits and less on profits and administration fees.
    Invests in comparative effectiveness research.
    Creates a completive insurance market for those without employer based health care.
    Switches to a payment system that is bundled, and based on the quality of care received instead of the amount of care.
    Puts a Pigovian tax on tanning booths
    Puts a Pigovian tax on high-cost high-administration health plans
    Requires food companies to put accurate and seeable food labels.
    Administration simplification such as electronic funds transfers, and eligibility simplification
    Expanding value-based payment structures
    Lowers emergency room visits.
    Makes people healthier
    Lowers job lock.
    Increases peoples health resulting in higher productivity
    Tort reform (that doesn’t consist of letting bad doctors free and screwing consumers)
    ^only 6.1% of the cost of Cadillac health plans can be attributed to better/more benefits

    Aca allows those effected by environmental disasters to enroll in Medicare

    The ACA provides grants/funding to allow states to implement tort reforms that foster better communication between medical professions and patients and other measures to reduce tort costs, and to reduce tort fillings
    ^Cutler/Davis estimates that the ACA will reduce the deficit by 250billion more than the CBO for a total of 400 billion.
    ^The new health reform law (ACA) is estimated to create 250,000 jobs a year when it is fully implemented.
    ^repeal of health care reform would take away health coverage for around 35 million people.
    ^repeal of ACA would expand deficit by 230 billion dollars over the period of 2012-2021.
    ^Premiums would increase, and healthcare plans benefits would decrease.
    ^The new health care law according to a Harvard Medical study will save around 35,000 people’s lives each year.
    ^Health care reform (ACA) reduces total national health care spending by .1% a year while at the same time expanding coverage to 35 million people.
    ^Analysis concludes that health reform will expand health insurance for 35million people while simultaneously reducing overall health spending by around 2% (or .2% yearly)
    This analysis does not include savings, from reduced job lock, less ER visits, and increased productivity/lifetime earnings.
    ^Health care reform will reduce health care premiums and expenditures made by families making 37,000 or less by 70%, and families making 72,000-85,000 by 25%
    ^ACA effects prior to 2014
    1) Small business offered tax credits up to 35% of premium cost.
    2) Seniors receive a $250 yearly rebate for prescription drug costs
    3) Provides free coverage for preventive medical care
    4) Bans discrimination against children.
    5) Bans health insurance from dropping your coverage
    6) Bans limits on annual/life time benefits
    7) Requires 80-85% of premium dollars to go directly to health care benefits.
    8) Creates a high-risk pool for the uninsured
    9) Youth can now stay on parent’s health insurance up to their 26th birthday
    10) Provides funding for more primary care doctors, and community health centers.
    11) Reduces deficit.
    ^Community centers investments in ACA will save private consumers around 18 billion dollars a year (180 billion over ten years) so the benefit cost ratio for ten years is 17-1.
    ^2009/10 Health reform drug patent changes would save private consumers up to 108 billion over ten years. The changes are making patients last 2 years shorter going from 12 years to 10 years.
    -Evidence from Mass shows that costs will drop by 55%, though Mass has less cost controls and reductions then the ACA. Cost to drop 50% in non-group market. In the next 4 years.
    ^Obmacare will further reduce premiums by 2,000 a year by 2019
    ^New HHS report shows that in 2014 alone health care reform will cause health premiums to drop by at least 14-20%
    ^Food labeling on meat and other products to save a net of 80million dollars a year.

    We only think nothing goes without saying.

    by Hamtree on Fri Nov 23, 2012 at 02:49:44 PM PST

  •  I turned someone onto high risk pool today .. (3+ / 0-)

    A comment on a local newspaper's forums about a man whose premiums had been raised to $800 a month (I don't know how, she didn't say.)  I turned her on to Ohio's new high risk insurance pool.  $347 a month.

    Her tune changed.

  •  It will help that draft regs are coming out (1+ / 0-)
    Recommended by:
    Eric Nelson

    People want details. They want to know how it will affect them specifically. It also helps that some states are making decent progress on how their exchanges will work and what they will do. It does not help that some of us are in states where the leadership is going la-la-la-la-la and refusing to set up exchanges. It will help if the feds can pretty quckly tell us what exchanges will look like in our states, too.

    " can’t find any oxygen from outside the aircraft to get in the aircraft, because the windows don’t open. I don’t know why they don’t do that. It’s a real problem." Mitt Romney

    by Catte Nappe on Fri Nov 23, 2012 at 03:53:38 PM PST

  •  Sadly, I heard a WH rep discussing ACA on (1+ / 0-)
    Recommended by:
    mr market

    NPR in the summer and she stated she didn't think it was their job to explain the benefits of the new law, that they would become obvious in time.
    I couldn't believe this nonsense! The population has been bombarded by disinformation from the instant the ACA was in the clockworks and that was prior to passage.
    If one third the effort to illustrate what the benefits actually are as opposed to the mountain of crap that has been peddled, there would be rousing support from most of the country. Some serious pushback is still required on death panel, pull the plug on granny propaganda.
    I'd rather see Medicare for all, but that's another story.

  •  another area where RW radio will do very well (0+ / 0-)

    - adding to years of already established unchallenged misinformation

    This is a list of 76 universities for Rush Limbaugh that endorse global warming denial, racism, sexism, and partisan lying by broadcasting sports on Limbaugh radio stations.

    by certainot on Fri Nov 23, 2012 at 04:11:06 PM PST

  •  we are so lucky to have to buy insurance policies (0+ / 0-)


    without the ants the rainforest dies

    by aliasalias on Sat Nov 24, 2012 at 12:04:48 AM PST

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