“Sometimes, writing about the health reform law means reading Friday afternoon press releases and combing through Health Affairs studies.
But sometimes …
Death panels! Secret slush funds! Open warfare on the Catholic church!
… coverage of ObamaCare reads like a bad Hollywood thriller.
It’s been three years since President Obama launched the campaign that would ultimately become the Affordable Care Act.
And there’s been no shortage of myth-making — and myth-busting — ever since.
Once-unassailable truths — like the ACA’s constitutionality — may turn out to be fictions after all. And the jury’s still out on several heavily debated points, such as whether the law will come in relative to its budget estimates.
There’s one absolute fact, though: ObamaCare is destined to play a major role in this year’s debt talks and elections. Here are several common myths that we’re still hearing, from both ACA champions and critics, and why we find them misleading.
Myth 1: Obama Messed Up the Message
Many supporters of the ACA continue to blame its popularity problems on the ultimate preventable health care error: a failure to communicate.
“Barack Obama repeatedly botched, bungled and bobbled the health reform message,” patient safety advocate Michael Millenson concludes in the Huffington Post. A tone-deaf White House allowed itself to be caricatured by its conservative opponents, he adds, and “never once tried to mobilize ordinary Americans to demand a basic right available in all other industrialized nations.”
Millenson’s right in one respect; the White House never settled on a powerful, simple story.
Yet as Duke University professor Don Taylor notes, it’s harder to play defense than offense — and the ACA remains an especially difficult law to defend.
Its ambitious attempts to revamp health care provider payment and expand health insurance coverage can’t be boiled down to a simple sound bite. Critics have developed attack lines for provisions nestled throughout the legislation, from Title III’s so-called “death panels” (the Independent Payment Advisory Board) to abortion-related rules in Title I.
“It’s also hard to know what the administration could have done differently” to better sell the ACA to the American people, political scientist Brendan Nyhan recently told California Healthline.
After all, the White House deployed surrogates on cable TV and in newspaper columns, held multiple health reform-related summits and rallied supporters in every state. And as Ezra Klein has written, there’s little evidence that great presidential speeches are ultimately persuasive. Obama spoke, spoke and spoke some more — 54 speeches on health reform alone between March 5, 2009, and March 19, 2010 — even as support for his legislation faded.
Myth 2: The ACA is Unabashedly Liberal — but Conservatives’ Resistance Was Unprecedented
By seeking to reinforce the nation’s employer-based health care system, ObamaCare openly draws on conservative principles. It generally resembles Republican Mitt Romney’s Massachusetts health care overhaul, combined with the GOP’s alternative to President Clinton’s failed 1994 health reforms.
It was “a plan that ought to attract 70 or more votes in the Senate,” the American Enterprise Institute’s Norm Ornstein concluded in February 2010.
It got 60 votes. Famously, none were Republican.
“Before Obama was inaugurated, Republican congressional leaders made a strategic calculation,” Thomas Mann of the Brookings Institution also noted in 2010, “that the best route to reclaim the majority in Congress was to unify in opposition to all of Obama’s major initiatives.”
Of course, Republicans were just lifting from Democrats’ own playbook. When President George W. Bush attempted to privatize Social Security, congressional Democrats refused to deal, seeing the fight as a political opportunity. There was similar resistance to Bush’s Medicare Part D proposal in 2003, although several Democrats, including Sen. Max Baucus (D-Mont.), did defect to support its passage.
There were signals that a few GOP lawmakers would break from the pack and vote for the ACA, and Democrats ultimately lost months courting them.
For instance, Sen. Chuck Grassley, R-Iowa, Baucus’ longtime collaborator on the Senate Finance Committee, had indicated through the spring of 2009 that he’d be willing to compromise on the ACA — until raucous town halls that summer changed his mind. By the end of August 2009, Grassley was warning that Democrats’ health reforms would lead to “pulling the plug on Grandma.”
“The simple truth is that I am and always have been opposed to the Obama administration’s plans to nationalize health care,” Grassley later wrote in a fundraising letter. “Period.”
Myth 3: Democrats’ Drive for Health Reform Hurt the Economic Recovery
When the White House first took up health reform in March 2009, Congress had just passed Bush’s Troubled Asset Relief Program and the Obama administration’s stimulus package. Another bailout, of the automotive industry, was weeks away.
Some critics suggest that the White House should have continued to foster shovel-ready projects in 2009 and ramped up stimulus programs to boost job-creation.
But after billions in requisitions, Congress had little appetite for more federal spending. Just getting the stimulus package to nearly $800 billion was perceived as a possible overreach by the president.
Meanwhile, many Democratic lawmakers were convinced that health reform’s time had come. And the new head of the White House’s Office of Management and Budget, Peter Orszag, believed that reining in health costs would help reduce financial pressures on American businesses. Orszag was Obama’s chief economist — and his counsel proved crucial in spurring the president to prioritize health reform as a strategy to boost the flagging U.S. economy.
Health reform may not have been a second stimulus, but it certainly hasn’t been the job-killing law that its fiercest critics warned. And health costs do continue to slow, in the wake of the ACA’s passage.
Alternately, some observers argue that Obama took his eye off the ball by adding health reform to his agenda — that it took up too much time and distracted him from other initiatives. But Washington legislators aren’t single tracked.
Writing in Slate last year, John Dickerson noted a typical day in the life of the president: Obama visited a middle school and gave a speech on education policy, met with Denmark’s prime minister, attended a Democratic Party fundraiser, agreed with Republicans on a stopgap measure to keep the federal government running — oh, and chaired a meeting on the top-secret plan to kill Osama Bin Laden, too.
Myth 4: The White House’s Lawyer Muddled the Message, Too
OK — Donald Verrilli didn’t have his best day in court on March 27. Even Verrilli’s cheerleaders admit that the U.S. solicitor general coughed and stumbled his way through the most-scrutinized Supreme Court oral argument in years.
And although the high court won’t issue its ruling for weeks, bloggers and news analysts delivered their verdict within minutes.
“Trainwreck for the Obama administration.” — Jeffrey Toobin
“The word ‘choke’ is being bandied about, a bit.” — Rachel Maddow
“One of the most spectacular flameouts in the history of the court.” — Adam Serwer
However, a countervailing school of thought has emerged. “The small band of lawyers who argue frequently before the Supreme Court say 1/8Verrilli’s 3/8 performance was solid,” writes the New York Times Supreme Court correspondent Adam Liptak.
According to these elite litigators, “much of the criticism misunderstood the nature of oral argument and the role of the solicitor general.” Verrilli’s points were well-argued, they say, and the Obama administration’s legal briefs carry far more weight.
Even Chief Justice John Roberts has dismissed the importance of oral argument.”Quite often the judges are debating among themselves and just using the lawyers as a backboard,” Roberts has previously said. “One of the real challenges for lawyers is to get involved in that debate.”
Around the Nation
Given the law’s size and delayed implementation, health reform will continue to spawn fears, both real and overblown, until it’s ultimately enacted or overturned.
Which means ObamaCare will continue to loom, like a budget-busting phantom, in the minds of many lawmakers and voters this election cycle — and we’ll keep an eye out for the most misleading claims. Here’s what else is happening around the nation.
HHS Secretary Kathleen Sebelius last week unveiled the first recipients of the Health Care Innovation Challenge awards that will support projects to cut costs, improve care and boost the health workforce (Zigmond, Modern Healthcare, 5/8). The award recipients include collaborations of hospitals, technology innovators and community organizations (Mosquera, Government Health IT, 5/8). CMS awarded a total of $122.6 million to 26 projects, which are projected to cut health spending by $254 million over three years (Monegain, Healthcare IT News, 5/8).
Last week, HHS announced that it will provide $75 million in new grants for building and renovation projects of school-based health clinics. The funds are part of $200 million in grants allocated for the clinics under the federal health reform law. HHS officials say the money would support a nearly 50% increase in the number of students who will gain access to school-based health care (Baker, “Healthwatch,” The Hill, 5/9).
Inside the Industry
A coalition of children’s health advocacy groups in a recent letter to federal health officials expressed concern that low-income families could miss out on health coverage through health insurance exchanges — created by the federal health reform law — because of complex enrollment procedures. In March, HHS released a final rule governing the state-based exchanges. The coalition wrote that “many provisions” in the rule “would potentially undermine the 1/8overhaul’s 3/8 clear intent to establish a simple, unified pathway to health coverage for consumers” (Norman, CQ HealthBeat, 5/14).
In the States
Last week, New Jersey Gov. Chris Christie (R) vetoed a bill (A 2171) that would have created a health insurance exchange in the state, calling the legislation “premature” ahead of the pending U.S. Supreme Court decision on the federal health reform law. Christie also said he had other concerns about the legislation, including that the exchange’s board of directors each would receive a $50,000 salary (Alonso-Zaldivar, AP/U-T San Diego, 5/10). Christie issued an “unconditional” veto, which consumer advocates say leaves no room for the Legislature to reintroduce the bill after the court’s decision (Millman, Politico, 5/10).
On the Hill
Some House and Senate Republicans are suggesting that party leaders refrain from proposing a comprehensive health reform plan to replace the federal health reform law if the U.S. Supreme Court strikes down the law. The GOP lawmakers argue that voters might oppose another effort to quickly push through a large-scale overhaul plan. Instead, some GOP lawmakers want the party to take a piecemeal approach that focuses on individual health care policies (Baker, “Healthwatch,” The Hill, 5/9).
In a letter to HHS Secretary Kathleen Sebelius last week, five House and Senate Republicans asked for in-depth information on the process through which the department has awarded loans through the Consumer Operated and Oriented Plan. The lawmakers questioned HHS’ claim that the plans will create more competition and the financial risk of the loans HHS is providing (Bunis, CQ HealthBeat, 5/10).
Studying Its Effects
A report published last week in the journal Health Affairs recommends that states follow Massachusetts’ example and limit the number of health plans consumers can choose from in state health insurance exchanges required under the federal health reform law. Authors of the report say that consumers prefer to choose among a few carefully vetted and clearly explained health plan options (Baker, “Healthwatch,” The Hill, 5/8).”