Posted with permission of the author:
Karl W. Albrecht, CEBS, President - Action Benefits
For the most part, Michigan finally dislodged itself from the on-again/off-again battle with winter in May. Spring reminds us of all the promises of the summer to come, and those unfinished to-dos we abandoned in the fall. Each May brings fleeting glimpses of beautiful ghosts from times and places long since gone. Scattered in massive clutches along country roads, flowering lilacs mark the corners where a home or farm once stood.
This spring, America is waking up and paying attention to things many had ignored. The specific details and impact of the 2010 health reform legislation will soon be felt by Joe Average, and the rhetoric of what the law will or will not do is becoming progressively irrelevant. People are nervous. Nervous people make nervous voters, and nervous voters make for nervous (and very testy) politicians. Reform is taking shape all around us and what actually occurs, not what was promised, is how America will judge the Affordable Care Act (ACA).
In a perfect world, rearranging 20 percent of the U.S. economy would be a massive and daunting task—incredible challenges, inevitable surprises, and political difficulties would be a given—yet, with the solid popular support of the people and thoughtful bipartisan cooperation, America could handle a challenge of such magnitude with a minimum of pain. We have none of that with the ACA.
The ACA is Supreme Court tested and, as the law of the land, it's moving forward at the fastest speed it can muster. Do not lose sight of this fact. As would be expected with any legislation this large, the sailing is anything but smooth. One key area where the law will progressively struggle is on the financial side. Any financial miscalculations or errors (something of a given with federal budgets) run straight into a purse tightly held by a cynical and fairly sour-minded Congress. The ACA was sold to America with firm assurances as to its total cost, and Congress clearly intends to hold Washington to its word.
In 1996, 53-year-old Michigan native Lou Kasischke set out to climb Mount Everest. Prior to his climb, Lou spoke to a large group of Blue Cross agents about the challenges he was training for. His training turned out to be a critical factor in the battle he would face for his life on Mount Everest. On that terrible day in May of 1996, eight climbers from his group perished on Everest. Lou shared the post-climb story of the tragedy with a second group of agents two years later, and it is a gripping one. This story was also told in great detail by Lou’s climbing companion, Jon Krakauer, in his famous book “Into Thin Air.”
Both climbers spoke of the incredible dangers and challenges they faced every moment on the mountain. When a sudden storm trapped them near the summit, Krakauer ended up lost in pitch blackness as night fell and temperatures plunged. Fearful he would freeze to death, he attempted to make his way to base camp by inching along the ice in total darkness. Part way down, he reflexively came to a sudden stop. Even though he could not see anything, he could “feel” a massive void in front of him and he didn't dare move. He survived the bitter night, and dawn confirmed that his instincts had saved his life. He was perched at the edge of an immense drop-off down the side of Everest, and certain death. The void he could only feel was, in fact, very real.
We all know that perception can be reality, but eventually reality will exert its rightful place. A CNN poll from May corroborates a long line of previous polls showing a lack of popular support for the ACA, with 54 percent of respondents opposing it. Politically speaking, this doesn’t generate soaring optimism. When it comes to the ACA, Americans are feeling a void, and time will soon tell whether this fear is justified or not.
The Messaging Onslaught
ACA proponents strongly contend that a lack of understanding is driving the poor public support. Funding to promote the law was not included in the legislation, and requests to Congress for additional monies for this purpose didn’t get far. This financial challenge has led the Department of Health and Human Services (HHS) to find private entities to promote the law, and to raise money for them.
HHS Secretary Kathleen Sebelius is both a cheerleader and fundraiser for Enroll America, whose purpose is to educate and sell Americans on the details of the ACA. Enroll America is a private organization launched by Families USA Executive Director Ron Pollack, and was approved as a nonpartisan 501(C)3 organization by the IRS in late 2011. (No, I don’t know if they received enhanced IRS scrutiny.) In early 2013, Anne Filipic left the White House Office of Public Engagement and replaced Pollack as its president. Enroll America’s Managing Director, Chris Wyant, directed the President’s 2012 election efforts, as head of eastern Ohio field operations. Impeccably connected politically, they also have a broad-based Board of Directors and an Advisory Board, which includes the National Association of Health Underwriters (NAHU).
A government official coordinating donations to a private entity, while concurrently quarterbacking that private entity's focus, is not a violation of any law. However, should donations be culled from those directly regulated by the same governmental entity, then there’s an issue. Discussing the “opportunity” to donate to a regulated organization creates the perception of a shakedown. Some are suggesting this is precisely what is happening now, and Congress is probing.
Raising money to fill gaps not addressed in the law is not a sign of strength. Efforts like this are likely to grow as more gaps are exposed, and Congress is not likely to suddenly warm to the idea of writing large checks beyond what the law requires.
Selling Reform to a Wary, and Frequently Weary, Public
The Democratic Steering and Policy Committee has developed an extensive guide for members to bone up on ACA talking points. Timelines, key information, sound bites and other analysis are all organized to give political leaders what they need to drive support and defend the ACA, but will politicians running for office actively support it? As more leaders of the reform effort speak up and call it a “train wreck,” or “beyond comprehension” (and then proceed to retire), legislators left behind are becoming progressively more worried. How will they react should large numbers of constituents speak out against the impact of the ACA?
Washington’s Credibility and Trust
Whether the issues with the IRS remain as low-level distractions or bloom into a full-blown scandal, it hurts the overall message. The public’s perception and trust in government institutions, like the IRS, is critical. The intimate role government plays handling confidential personal information and the sensitive functions they perform with the ACA, demand a high level of trust. Should the IRS appear to be less the impartial revenue collector and more a political operative, the challenges will grow enormously!
Will the messaging convince America that the ACA is a good thing? Not on its own. The rhetoric is becoming less effective, and actual consumer experiences will take center stage very soon. A smooth, surprise-free implementation is the only cure for the remarkably steady and negative polling numbers since the passage of the ACA. Provided that overall participation, functionality and “user experience” on the new marketplaces go well, and the rates are competitive, America will embrace the ACA. The spin from both sides about Armageddon or Rapture will be settled over the next few months!
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