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Nearly Half The Country Doesn't Know Health Law Exists


I'm Celeste Headlee and this is TELL ME MORE from NPR News. Michel Martin is away. Coming up, we go to Ohio where black business owners are meeting to swap some new ideas. Basketball legend Magic Johnson even got a lead on an investment there. We'll tell you more about that in just a few minutes. But first, House Republicans voted yesterday to repeal President Obama's signature healthcare law - again.

That is the 37th time that they have voted to either repeal or de-fund all or part of that law. The president's also struggling, though, to help the public understand the law. A recent poll from the Kaiser Family Foundation found 42 percent of Americans don't know or aren't sure whether it is still a law. So, just to clarify, it is.

Joining us now to talk about this and some other healthcare issues: NPR's Washington editor Ron Elving and Mary Agnes Carey. She's a senior correspondent at Kaiser Health News. That's a news service that is not affiliated with Kaiser Permanente. So welcome to both of you.


RON ELVING, BYLINE: Thank you, Celeste.

HEADLEE: So, Ron, ding, ding, ding, round 37.


HEADLEE: But this time I think the Republicans have turned it into a social media campaign. Let me read you some of these tweets. They're using the hashtag #obamacareinthreewords and it was actually trending last night. Representative Paul Ryan tweets: Bunch of malarkey. House Majority Leader Eric Cantor wrote: Premiums will double, among other things. He tweeted lots of them.

And then the White House kind of trolled them and tweeted back: It's the law. So does this - I mean, this time, the 37th time take making it into a trending hashtag, does that help the Republicans?

ELVING: It does not help that 42 percent figure that you mentioned a moment ago. You wonder why people are uncertain whether or not this is law. The debate over this law continues as though it were never actually enacted. Which of course it was, back in 2010, and it has been progressively taking effect since. Many parts of the law are already in effect and most people are not complaining about the opportunity to put, for example, their 25, 26-year-old children on their health insurance.

Which, of course, was part of this law. There are a number of other parts of the law that are in effect, but many of the parts have not been. And perhaps the parts that are most important have not been yet felt by the public. So there's still a lot of debate over whether or not there is some way that Congress can keep it from happening.

And if Congress - and when I say Congress I really mean the House here because that's where this is going on - if the House can interfere with the full implementation of the law - stop it cold would be their preference - and this vote yesterday, while the 37th having to do with the law was only the third time that they have outright voted to repeal it. There were a couple of other times they tried to repeal it through the budget resolution.

And then, of course, all the rest of that big number were partial de-fundings and things that they have done. And with some effect, I might add, to cut back on the ability of the government to implement the law. And that's part of what we're talking about today, the effort to keep people from actually getting signed up to be part of the law.

HEADLEE: OK. Before we move on to why people don't understand this law and that it is in effect, the repeal - the reason people don't take this seriously is because, correct me if I'm wrong, there is almost zero chance that a repeal would come out of the House and get passed by the Senate and signed by the president.

ELVING: That is zero.


ELVING: There is no chance of that. That's why I say it's a one chamber exercise where the House certainly has all the power and prerogative to repeal this law as many times as they want; they just don't have the power to change the law by themselves.

HEADLEE: All right. So let's talk again about this Kaiser Family Foundation poll that 42 percent of Americans are not sure the healthcare law is actually a law. And in fact, there are some pharmacies that don't about the fact that the rules have been implemented like better care coverage for birth control. And, again, I want to be clear that Kaiser Health News for which you work, Mary Agnes, is editorial independent of the Kaiser Family Foundation.

But you're familiar with this poll. Why is it that so many - nearly half of Americans don't understand?

CAREY: Well, I think there are two reasons. Number one, to get to your most recent discussion, while Republicans have no chance in this current political climate to overturn the law, perhaps 37 times, 37 votes to try to either de-fund or repeal the law may leave some doubt in the public's mind. Is this a law? Is it not a law? What's happening? What's not happening?

And also, major provisions haven't been in effect yet. To Ron's point, if you have a child who's 24 years old and you want to keep them on your health insurance plan, you understand what the Affordable Care Act does for you. Or if you've gotten more preventive care or more contraception services covered under your policy. But two of the major provisions don't kick in until next January.

Those are the health insurance exchanges and the Medicaid expansion. So I think this summer you'll hear the administration talking a lot about those two provisions, how do you implement them, how do you get people enrolled. And the public's focus will turn to that. Because if you are interested in insurance and the health insurance exchange, you've got to enroll in October. And I think the public information campaign really kicks up.

HEADLEE: Although the majority of Americans will not be on the health insurance exchange.

CAREY: That's right.

HEADLEE: For the majority of Americans, at least the ACA, the Affordable Care Act, only affects the insurance policy they get, most people, from their employer. And those, for the most part, have been implemented, right?

CAREY: Right. Right. And so that's the kind of thing - when I went to the pediatrician and I got my daughters a checkup I realized I didn't have a co-pay or deductible this time for preventive care services. It's when you put it into - when you see it in your own life I think you understand it. But for a lot of people, they know it exists, they currently have coverage.

As you say, they're not going to go in the exchanges or the Medicaid expansion, so they may not really understand how it impacts them.

HEADLEE: Well, Ron, this - first of all, were you surprised by the number of people who thought it probably wasn't the law or weren't sure?

ELVING: Initially, yes. Because it just seemed like a shockingly high number to be misinformed or uninformed on something of this importance. On the other hand, when you stop and think about, among other things, the way the question was framed and the broad scale, the broad cast of the question being asked of people at all different levels of education and information, and so on, it's not terribly surprising, really, that there would be a substantial amount of confusion about this.

There have been, among other things, a lot of campaigns of disinformation. People intentionally telling other people misinformation about the law. And then there's this whole political thing that we've been talking about where there's a constant drumbeat of undercutting of the authority of the law and telling people we're going to get rid of this as fast as we can.

I mean, how many people did you hear in 2012 say that on the very first day that they were in office they were going to repeal Obamacare. It's not hard to imagine that a sizeable number of people who either wanted that to be the case or feared that it might be the case, at polar opposites, got the impression the law was really on the ropes and might be disappearing soon.

HEADLEE: If you're just joining us, we're talking about the Affordable Care Act, President Obama's signature healthcare law. My guests are Kaiser Health News Mary Agnes Carey and NPR Washington editor Ron Elving. And again, to be clear, the Affordable Care Act is the law of the land and over half of Americans are already living under its rules.

Mary Agnes, the White House recently announced - you were talking about the health exchange and they announced a $150 million initiative to try to get uninsured people signed up for coverage. Is that going to maybe shift this 42 percent? As soon as they start getting all these people signed on will that suddenly make people aware that the ACA is the law of the land?

CAREY: It can certainly help. I mean, it's a drop in the bucket. It's money for community health centers to help enroll uninsured people into the exchanges. But they need a much bigger, louder, more powerful information campaign. You've seen the president doing this in the last two weeks. When he's been speaking at - last week they had a Mother's Day event on last Friday where he was trying to explain the healthcare law to people, saying exactly what you said earlier.

For 85 percent of Americans you may not necessarily see it. It's already in effect for you and for the rest of the folks that the major provisions are going to be kicking in. So they need a much bigger, louder campaign. And unfortunately for the healthcare law, only allowed about $1 billion, I think, in implementation money. The secretary of HHS, Kathleen Sebelius, has been out there trying to talk to groups about helping in fundraising and getting more money.

HEADLEE: Private funding?

CAREY: Private funding. Yes. She can't - they've been very clear. They said they have not tried to solicit funds from organizations that they regulate, but she has gone to the Robert Wood Johnson Foundation, to H&R Block to ask them to contribute money, and HHS officials say that she's perfectly allowed to do that under something called the Public Health Service Act.

HEADLEE: Let me ask you, Ron. What she's talking about - Kathleen Sebelius, the health secretary, trying to seek private funding - does that leave credence to the argument that opponents have to this law, that it costs too much and it's not sustainable?

ELVING: Well, these causes do not have to do with really actually administering the law. What they have to do with is getting people to cooperate with it and be aware of it and sign up for the kind of coverage that people currently uninsured can get. And, look, I mean, to be perfectly blunt about it, it's important to get as many people as possible involved in this great insurance pool, if you will, including younger, healthier people who may need to go to the hospital, who may get sick, but who are less likely to than people who are 70 or 80 years old, or people who have preexisting conditions.

So it's important to get everybody in. That's how insurance works. You need the healthy people, as well as the unhealthy people, or it's just not going to work. That's the way insurance has always worked in the private sector. So it's important to get everybody participating, and a certain number of people in that 42 percent we were talking about don't even know if this is necessary, don't know that it applies to them, don't know what it entails for them, don't know what the advantages are for themselves. So it needs an advertising campaign. It needs some kind of outreach. And that is not, strictly speaking, the same thing as administering the law. It's important to getting the law up and running for those individuals who are not yet aware of it, but it is not the law itself.

HEADLEE: OK. We have about a minute left, but let me ask you, Ron: What is the political advantage to people's ignorance about the Affordable Care Act? If there are people that are actually, as you say, having a misinformation campaign, why would they do that?

ELVING: Let's be clear. This law is part of an effort to change the way health care is delivered and insured in the United States over a long phase. There have been proposals for national health care insurance, a single-payer national system similar to Canada's or those in Europe for many years. This goes back to the Truman Administration, back 60 years people have been talking about this. And the most significant stride toward that direction has been made in this Affordable Care Act of 2010, Obamacare. And there are many people who philosophically oppose having our culture, our country, our society - not just our government, but, in every sense, America - move in this direction, more like the way health care is delivered and insured in these other parts of the world. They don't want that. They want the system that we've had, and they don't want it to change.

They were defeated, at least temporarily, in 2010, but they haven't given up the fight. And they feel that if they can resist the implementation of this law and if the law breaks down, it can then eventually be fully repealed.

HEADLEE: Ron Elving, NPR's Washington editor, and Mary Agnes Carey, senior correspondent at Kaiser Health News. That's a nonprofit news service not affiliated with Kaiser Permanente. Both of us here in our Washington, D.C. studios.

Thanks to both of you.

ELVING: Thank you.

CAREY: Thank you. Transcript provided by NPR, Copyright NPR.

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