Friday, August 20, 2010

Health Reform Brouhaha

I was on one of a long series of conference calls on health reform organized by Families USA yesterday. These calls have been going on for a long time. For those of us who are not based in DC, these calls have kept us up to date, educated us about various reform proposals, and helped us figure out how to explain the truth about reform in effective ways. Yesterday's call was about this last subject, messaging. With the six month anniversary of reform coming in September and a handful of changes taking effect then (or at the beginning of the next plan year after that date), the premise of the call is that we need to explain reform, educate the public, try to dispell some of the fears that are based entirely on misinformation and even lies, and fend off the calls to repeal the law. The presentation yesterday was by the Herndon Alliance, a public relations firm that focuses on messaging around health care and health reform.

All of the Families USA calls are closed to the media. However, there was no big secret in yesterday's call. The Herndon Alliance's most recent research is right on their website. So there was no conspiratorial attempt at pulling the wool over the eyes of the public, no secret compact to hatch a bunch of new lies about reform.

Most importantly, there was nothing new in substance. In other words, it was not the case that everybody decided that we need to change strategy to "sell" reform. The strategy since way before the law was passed has been to educate, educate, educate. But HOW you say things, HOW you educate -- the Herndon Alliance has done the focus groups and polling to help those of us who are not professional communications experts to stress the right things, to approach people the right way, so that our message about how the law is going to work really gets across.

Apparently, immediately after yesterday's call, somebody leaked the Herndon Alliance's presentation to Politico, which immediately published an inflammatory article stating that Democrats -- led by Families USA -- are retreating from the arguments we've made all along and taking up a new strategy. THIS IS FALSE. There was some discussion of how effective it is to stress the cost savings to families, employers, and the federal government, for example. The Herndon Alliance's research tells us that this isn't the most effective message point; people don't believe it, and it's too wonky. Instead, the Herndon Alliance suggested that we stress people's stories -- that we paint a picture of how people's lives will be changed by reform. That doesn't mean we don't believe that, in the long run, there will be cost savings. I was on the call, and nobody even implied that the cost savings and deficit reduction are any less true than we previously thought. It was about choosing the best message, not telling lies.

Politico spun the story in a very unfair way. First of all, there was not one single suggestion that anybody hide any facts, distort any facts -- this was not about telling lies, as Politico implied (and the comments to the Politico post are both wrong and absolutely brutal). Just as companies consult with advertising agencies, who conduct focus groups and opinion polls all the time, so, too, do political parties, and the various organizations that take positions on public policy. Does anybody think Politico has never conducted any kind of focus group or polling about how best to present its messages? Certainly, the Republican party, the insurance industry, and anti-health reform groups all talk about how best to craft the anti-reform message. Do you think someone casually came up with the idea to call it "Obamacare?" That was a concerted, deliberate strategy. So yes, those of us who are in favor of reform because we HONESTLY believe that it will improve the lives of many Americans also talk about how best to get the message across to the American people. There's nothing sinister about this. It's not about telling lies. It's about how best to tell the truth.

For example, I can tell you that, effective September 23, 2010 (or the first plan year after that date), children under age 19 cannot be excluded from insurance due to a pre-existing condition (with the exception being grandfathered plans, explained below). Or I can tell you about the phone call I got from a mom in Missouri who's trying to find insurance for her 14 year old little boy with ulcerative colitis and asthma who's been calling and calling insurance companies and they're telling her to not even bother applying because they won't take him with a pre-existing condition. I can tell you that, when she makes those same phone calls after September 23, 2010, she is far more likely to find answers. I can tell you that these insurance companies are hiding that fact from her now, but they won't be able to hide it after September 23, 2010. Isn't it more effective if I tell you that story than if I just tell you what the law says?

And that's all the call yesterday was about -- how to communicate the truth. It was not about bending the truth or pulling the wool over anybody's eyes. It was about how to talk about what are some fairly technical changes.

If you want technical, I can give it to you. Grandfathered plans are plans that existed in substantially the same form when the law was signed on March 23, 2010. As you will recall, President Obama kept saying that if you're happy with your insurance, you can keep your insurance. Nobody believed him then, but here it is -- grandfathering. If a plan existed on March 23, 2010 and it does not change copays, deductible, out-of-pocket limits, coinsurance, annual limits on benefits, or eliminate all the benefits to diagnose and treat a particular condition, then it is exempt from many of the changes. If you are happy with that plan, you can keep it exactly as it is. However, if the plan changes in one of these important ways, then it loses its grandfathered status and no longer is exempt from the health reform changes.

Now that you're asleep, perhaps you will appreciate it if I tell you that the woman in Missouri will be able to take advantage of the elimination of pre-existing conditions for children under age 19 after September 23, 2010 because she will be buying a whole new individual plan. As a new plan, it can't be subject to grandfathering. And perhaps more importantly, the way the insurers tried to hide this from her -- indeed, she expressly asked them, didn't this change under the new law? And they didn't tell her anything about September 23 -- that will stop the more we implement the consumer protections in health reform.

Is health reform perfect? Far from it -- and saying that is nothing new, either. But for those of us who are out here in the trenches, who can't afford focus groups and polling, and who want to be as effective as possible when we educate the public about the changes that will be taking place, organizations like Families USA and the Herdon Alliance help us to do our jobs at no cost to us. Sometimes wonky lawyers like me need to be reminded -- tell stories, don't just rattle off facts. That was the key message of yesterday's call. It was not about lying. It was not about changing strategy. It was just about how best to get out point across.

Shame on you, Politico, for distorting that. Jennifer

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