For ACA’s 2nd anniversary, go beyond talking points; look at delivery systems, innovations

About Joanne Kenen

Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.

With so much focus on the coming Supreme Court case, it’s easy to forget that next week (March 23)  marks the second anniversary of the health care law.

Don’t expect too much hoopla from the White House, which is reluctant to look as though it’s trying to influence the Supreme Court. You probably will  get the usual onslaught of emails (“Hey, have you heard the one about young adults staying on their parents’ health plan until age 26?”) from HHS and the advocacy groups will step up their game in building support for a law that remains quite unpopular. House Democratic whip Steny Hoyer got a jump start with the first “health reform is working” anniversary release, so that gives you a taste of what you will find in your inbox.

As of this writing, neither Speaker John Boehner nor Senate Republican leader Mitch McConnell have updated their websites with an anniversary missive, but both are likely to, and both sites have ample background on why they oppose the law. The House will probably vote on a measure to repeal  the Medicare Independent Payment Advisory Board (IPAB) around the time of the anniversary, and that will let them showcase their arguments about government takeovers, rationing, harming Medicare etc. Groups like your local chapter of the National Federation of Independent Business (which is a party to the lawsuit against the law) may be good anti-ACA sources.

The federal site, HealthCare.gov will give you an overview of what’s in the law, what’s gone into effect and what’s ahead.

Both the Kaiser Family Foundation and the Commonwealth Fund have good timelines. They overlap, of course, but they aren’t identical.

There are many, many polls on health care and although they differ in details, the gist is: The health law is unpopular and opinions largely split along party lines. And there is, as we’ve noted here many times in the past, a truly striking disconnect because even while the law is unpopular, people really like the individual provisions (except the individual mandate which even many Democrats oppose.)

As you all know, people are really, really confused about what’s in the law and what’s not. And in one of my favorite recent tidbits (h/t Sarah Kliff) 14 percent of those surveyed in a recent Kaiser poll thought it had already been overturned by the Supreme Court and is no longer law. Another 28 percent weren’t sure.

One element often overlooked is the shorthand reporters and pollsters often use. We talk about “the individual mandate” or the “requirement that people by insurance.” What would happen if we wrote “the individual mandate – which is accompanied by subsides on a sliding scale for low-income and middle-class people up to 400 percent of the federal poverty level.” (And 400 percent of FPL is currently around $92,000 for a family of four.)

To get past the warring talking points, many of the resources we assembled last year for the first anniversary remain relevant and helpful.

One of the stories that might be intriguing to tackle is whether people who are experiencing some of the benefits or being affected by some of the new programs understand that they are in fact part of the health care law, not just some sort of benefit manna descending from health care heaven (wherever that is).

Another would be to look at some of the delivery system reforms or pilot programs that have gone into effect. They don’t get enough attention. Some may fail. Others may turn out to improve quality without saving money. And some may fulfill the promise for improving quality while saving money. Be careful of drawing conclusions too soon – for many of these it’s just too soon to know.

One place to find some innovators – the CMS Partnership for Patients Initiative and the Care Transitions program – both of which have attracted a great deal of hospital and health plan interest.

Another is the CMS Innovation Advisors – several dozen clinicians and policy experts tasked with testing good ideas and then spreading those that work.

Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.

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