Media coverage of the Affordable Care Act reached a new high in 2013, as state and federal officials scrambled to move the final pieces of the law into place and health policy analysts struggled to forecast the triumphs and pitfalls of the overhaul.
As a result, some ACA-related news stories received far more attention than warranted.
In this “Road to Reform,” we recount the three most over-hyped health care reform stories of the year. (Check back with “Road to Reform” in January 2014 for the complement to this piece — a rundown of the most overlooked health care stories of 2013.)
1.) The Unpreparedness of State Exchanges
Earlier this year, myriad news outlets covered a Government Accountability Office analysis finding that states running their own health insurance exchanges were late on 44% of activities slated for completion by the end of March.
In two reports released in June, GAO acknowledged that state and federal officials had made significant progress in developing the regulatory framework and guidance to implement the exchanges. However, GAO said that state and federal officials still had major work to complete before open enrollment began Oct. 1, noting at the time that it was unclear if they would meet the deadline.
The Wall Street Journal was among the first news outlets to examine the reports, but coverage continued throughout early summer under dire headlines, such as “Obamacare Blowing Deadlines,” “Obamacare Exchanges Flail” and “Audit Finds Obamacare Train Wreck Ahead.”
When the October deadline arrived, it became clear that the coverage wasn’t mistaken — just misdirected. It was the federal health exchange website, HealthCare.gov, that proved to be the proverbial train wreck. In October, visitors to HealthCare.gov encountered several issues, including 20-minute wait times, deferral to a waiting page, system shutdowns, and the inability to complete username and password information.
While the federal government scrambled to fix HealthCare.gov, many state exchanges were ably managing their open enrollment periods. According to McClatchy/Sacramento Bee, 75% of U.S. residents who had successfully enrolled in coverage as of the last week of November had done so through a state-based exchange. The analysis pointed out that states like Connecticut, Kentucky, New York and Washington had seen robust enrollment since Oct. 1 and met their projected quotas.
Another sign of state-run exchanges’ success comes in a recent analysis by the Commonwealth Fund. The group found that enrollment through the 14 state-operated health insurance exchanges during the first three weeks of November was nearly double what it was during the first month of open enrollment. In California, November exchange numbers showed significant improvement over October statistics, with 385,556 completed applications through the first three weeks of the month compared with 179,562 applications started but not necessarily finished in all of October.
To be fair, states like Colorado and Oregon have encountered difficulties enrolling residents, but a relatively strong showing from most states proves that harbinger coverage from early in the summer largely missed the mark.
2.) The Mandate ‘Fairness’ Debate
A commotion building since passage of the ACA about the fairness of the individual and employer insurance mandates reached its apex this year, triggered by the Obama administration’s decision to delay the latter rule until 2015.
In a letter sent a week after the announcement, House Republicans questioned the decision: “We agree with you that the burden was overwhelming for employers, but we also believe American families need the same relief.” Health care experts like Chris Conover of the Center for Health Policy and Inequalities Research at Duke University asked the same question. Even Jon Stewart of “The Daily Show” — often an ally of the Democrats — grilled HHS Secretary Kathleen Sebelius about the issue.
However, focusing this debate on “fairness” misses a crucial fact: The delay of the business mandate doesn’t matter. Various think tanks — such as RAND Corporation and the Urban Institute — have said that delaying the employer mandate will barely affect health insurance coverage in that market. (Ninety-five percent of large employers already offer health insurance to workers.) Conversely, an individual mandate delay “would cause 11 million more Americans to remain uninsured in 2014,” Edwin Park of the Center on Budget and Policy Priorities explained, citing Congressional Budget Office data.
Josh Barro, politics editor for Business Insider, wrote that the difference between the two mandates is “necessity.” Barro noted, “If you don’t have an individual mandate, the risk is that only sick people will buy insurance, and then premiums will skyrocket, making it unaffordable for everyone.”
The bottom line is that if you delay the individual mandate after the federal and state insurance exchanges go live, you undo the centerpiece of the law. The notion that the two mandates are on equal footing is unfounded.
3.) Public Opinion Polls
It seems as if there is a new survey of public opinion about the ACA every week, and news outlets seem determined to pounce on all of them. The entire year has been marked by coverage of such polls, creating a No Man’s Land of percentages and fractions that have added up to surprisingly few common themes.
For example, a Gallup poll released during the summer found that 52% of respondents disapprove of the law, while 44% support it. However, the Kaiser Family Foundation’s March 2013 tracking poll found that respondents favored all but one of the law’s major provisions (the individual mandate) and that more than half of those rules garnered support greater than 70%.
Considering young adults, a Reuters/Ipsos poll released in September found that about 50% of U.S. residents ages 18 to 34 support the ACA, with about 33% saying they were very likely or somewhat likely to buy coverage through exchanges. However, a poll released earlier this month by the Harvard Institute of Politics found that support among young adults is low, with just 29% considering purchasing plans through the marketplaces.
These seemingly incongruent findings can sometimes be explained by the methodology of the studies, such as the number or location of respondents. But sometimes, the polls are simply reflections of previous media coverage — the second young adult poll was conducted while headlines about the exchange glitches had reached a “fever pitch” — or worse yet, news reports of other polls.
All the more frustrating is that health policy commentators and lawmakers routinely have cited such polls to support their arguments, when respondents might simply have been parroting opinions already floated through previous talking points by that same commentator or lawmaker.
This is not unrealistic assumption, given that many U.S. residents are not aware of the most important provisions of the law — a finding that also has been revealed through polls — but still have an opinion to share.
If polls are contradictory and confusing, why not get rid of them? Julie Phelan, senior research analyst at Langer Research Associates, told California Healthline in July that some results might not be as “logically inconsistent” as they seem at first glance.
“If you look at the [ACA] provisions that people support overwhelmingly, they’re things … with no cost,” Phelan says, adding, “If you ask, ‘Do you support allowing children to stay on their parent’s insurance plans until they’re 26,’ people will say, ‘Of course — How’s that going to hurt me?'” She added, “That’s why you see the disconnect between what people say about the law overall — they think of the ACA as the individual mandate.”
Meanwhile, Mollyann Brodie — senior vice president for executive operations and director of public opinion and survey research for the Kaiser Family Foundation — told California Healthline that public opinion on the law might become more definitive once U.S. residents start viewing the law through a consumer lens.
When that occurs, we’ll welcome a few more polls, but for the rest of the year — no thanks, we’re satiated.
How-to: Sarah Kliff at the Washington Post‘s “Wonkblog” presents a step-by-step guide for purchasing health coverage through HealthCare.gov.
Who pays?: The Incidental Economist’s Aaron Carroll explains how Obamacare is paid for in a helpful video.
From bad to good: Avik Roy in Forbes‘ “The Apothecary” writes that negative reactions to the ACA could actually make it harder for Republicans to repeal the law because many U.S. residents are being forced to shop for new coverage now and will be less likely to vote for candidates who want to dismantle the law and, thus, require people to switch coverage again.