By: Shannon Manning, Director of Communications Programs
Let’s start by stating the obvious: the Affordable Care Act’s implementation has been rough. The news is flooded with stories and speculation: 4 million voters saw their individual policies cancelled; the website rollout was a disaster; the Obama Administration has delayed implementation of some aspects of the law, which could prove beneficial or harmful; it’s unclear. According to recent CBO projections, 2 million fewer people will enroll than originally estimated for 2014.
The latest blow: the CBO estimates the ACA will shrink the full-time workforce by 2 million people as workers who remain eligible for health insurance without full-time jobs voluntarily reduce their hours or opt out of the workforce entirely. The Administration argues these are the choices the ACA was meant to give voters; Republican opponents say it incentivizes people to live off taxpayer-funded benefits.
Politically, health care will shape the midterm elections and beyond. In his State of the Union address, President Obama again invited Republicans to propose alternatives. Just a day earlier, Senators Tom Coburn, Richard Burr, and Orrin Hatch put forth the Patient CARE Act; a good comparison between their proposal and the ACA can be found here. While efforts to repeal the ACA seem to be dying, the process of “fixing” the law has only begun.
From an advocacy perspective, what this means for stakeholder audiences, writ large, is uncertainty:
- The impacts for the business community are well-covered territory. The most recent focus of congressional scrutiny is how the ACA defines full-time employment: 30 hours per week rather than 40. For businesses, especially in sectors that predominantly employ workers on an hourly basis, that could impact business expansion, job creation, the stability of benefits, and labor relations. The employer mandate has been delayed, and much could change before implementation.
- For the medical community, the Supreme Court decision allowing Medicare cuts to go forward without a corresponding expansion of Medicaid in some states means hospitals may see reimbursement levels drop precipitously. Doctors are struggling with similar reimbursement challenges, as well as increased reporting requirements. While doctors were opting out of Medicare and Medicaid prior to the ACA, the new law does seem to be accelerating the rate of opt-out. However, there are also those in the medical community who point to the positive impacts. It’s too early to tell how the ACA is going to change the medical landscape long-term.
- Patients and families—A Kaiser Family Foundation poll found that a majority of Americans believe Congress should fix problems in the law rather than repealing it. There are abundant anecdotal stories both pro and con about the impacts on individuals, and the only thing voters seem to know for certain is that they don’t know what health care will look like in a year or two.
What does this mean for advocacy? If you engage stakeholders in health care reform, you should take a solutions-oriented tack rather than an opposition-oriented one.
Voters are demoralized by a sense of having less control than before over their health care choices. Help your stakeholders navigate the issues simply and give them something to fight for—meaningful, incremental changes that will give them back a sense of empowerment. “Uncertain” may remain the biggest descriptor of health care reform for some time. Alleviating that uncertainty can help build trust and loyalty with your advocates and turn them into champions for the solutions you support.