Monday, September 30, 2013

Marketing the Affordable Care Act


Infographic for Affordable Care Act

Countdown for the Affordable Care Act and Covered California

In my travels and daily life this week I have been surveying most people I meet. These are ordinary citizens, single Moms, minimum wage workers. My cohort has been fast food employees,  real estate agents, truck drivers, taxi drivers,  and the type of people we run across every day (In California).  This is not a scientific study.

Few if any of them have reliable and/or affordable health insurance, and I doubt if the figure of 8 million uninsured in California is correct.   I really don’t think statistics are that important except to number crunchers who seem to manipulate numbers to prove their point or determine what it will cost to implement the Affordable Care Act.  You are either insured, or not insured.  Many who have ‘Medi-Cal have it only in name…high shares of cost sometimes as much as 2,000/month and unable to access health coverage due to pre-existing conditions.  The devil is in the details and it is all supposed to be revealed with a wave of a wand and flashing of a magicians’ handkerchief.

Out of the first ten people I met not one of them  new what Obamacare planned to accomplish. The had never heard the term “Affordable Care Act”.  They had no idea what a Health Benefit Exchange is and also did not know when each step occurred for it’s implementation.

The Amazon Shopping Cart Model

The survey was accomplished in Riverside California a city which is fairly metropolitan and is ‘internet enabled” as much as any other city.  If they received Medi-cal  they were entirely passive about receiving the benefit, did not know much about share of cost or how it would change as income rose or as their children left home.

Despite all the television and newspaper reporting about Obamacare most did not “get it”.  The message has not been visible and there are no advertisement in newspapers, magazines or gathering areas such as shopping malls, theaters, or sport’s venues.

On the eve of Obamacare’s launch, the White House is lowering expectations for it, downplaying their assumptions for signups and emphasizing this won’t be a launch so much as the start of a conversation with the American people, and so on and so forth. The truth, of course, is they’re downplaying things because the exchanges, implementation, and promotional efforts for Obamacare are so far behind and have had such little impact on the very people the approach is intended to reach.

How little impact?

A new poll finds a majority of the public -- especially those lacking health coverage -- is unaware that new insurance marketplaces created by the health law are slated to open ... The poll also found deep skepticism of media coverage of the law, with more than half the public saying they don’t trust any media source to provide credible information. Two-thirds of the public were not aware when the new online marketplaces open to allow people without employer coverage to shop and purchase their own health policies, according to the poll by the Kaiser Family Foundation. These exchanges open Tuesday. Despite outreach efforts by the Obama administration and supporters of the law, the poll found the number of uninsured unaware of the opening date is even greater than the public at large, with three out of every four not knowing the marketplaces are supposed to open in October.

The rollout has not gone as expected, or as supporters had hoped. Even hours before open enrollment is set to begin, confusion reigns in states where navigators haven’t even gotten a chance to use the systems they’re supposed to guide people through. These IT problems are significant, but they will come and go in the context of these political battles. Some will seize on them as signs Obamacare will crash and burn. This isn’t the case, though – it’s not the glitches that will undermine Obamacare, it’s the effect it has on the people who already have insurance.

I don’t know whether to laugh or cry. My health insurer, Kaiser Permanente, has finally calculated what our family’s new health insurance rates will be under the grotesquely misnamed Affordable Care Act (a.k.a. Obamacare.) The upshot: my premiums are about to rise by 114.6%. My wife’s rates? Up 109%. Our kids? Don’t ask.

Yes, it’s time to say goodbye to my current plan, with its $232-a-month premium. That plan is being discontinued, I’m told, because it “does not meet the requirements of the ACA.” It was a nice plan, with low premiums, free physical exams, a high deductible and eligibility for a Health Savings account. We got access to Kaiser’s lower in-plan rates for minor medical care, and we had the peace of mind of substantial coverage if anything catastrophic ever happened. But that plan is going the way of Lake Superior sturgeon or the Hetch Hetchy meadows. It’s vanishing in favor of what someone else has decided would be progress. So now I’m being offered what’s dubbed the KP CA Bronze HSA 4500/40%. My new premium will $519.25 a month -- more than double my old rates.

I wish there was some way of regarding this new “bronze” plan as an improvement over what we had before. But that’s really not possible. The new deductible will be higher ($4,500 instead of $4,000.) My primary care benefit is worse (I’m now being told to pay 40% of billed charges, instead of a cap of $40.) My inpatient hospital coverage is worse (I’m to pay 40% instead of 30%.) Terms on emergency-room visits and prescriptions drugs are inferior, too. There’s probably a “silver” or “gold” plan that would match or even top my old coverage. But then I wouldn’t be looking at a mere 114.6% increase in my premium. I’d have to pay even more.

There’s little wonder that Obamacare remains unpopular, even if you don’t call it that. On the eve of its launch, CNN found 38 percent of Americans favor it and 57 percent oppose it – even when described in neutral terms. That measure of success or failure will have more to do with Obamacare’s survival as a long-term policy reality than any of the early glitches – and that’s something the American people themselves will determine according to their own measures.

-- Benjamin Domenech

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