The Affordable Care Act, demystified

In between taxing novel revisions I was toggling over to Facebook the other day, where I stumbled on this eye-opening quiz about the Affordable Care Act (ACA).

To anyone who was paying attention during the healthcare debate, most of the Henry J. Kaiser Foundation quiz should be a snap; the questions are simple and straightforward. 

But after taking the quiz, you get to see the answers - and the percentage of people who got each answer right - and realize just how staggeringly misinformed much of the American public were (and are) about the bill's details.

One of the main arguments made against the Affordable Care Act was that a majority of Americans opposed it. The implication was that voters are rational, informed actors who know best, and that the ACA therefore represented a major overreach of governmental power.

Aside from the obvious problems with the notion that elected officials should govern by public opinion polls, opposition to the Affordable Care Act isn't as overwhelming as it may seem. Roughly half of Americans in a recent CNN poll favored repeal, and this number included people who opposed the bill because it doesn't go far enough.  

Which leaves 40-45% who think the bill goes too far. When one drills down into the Kaiser quiz, it becomes obvious just how much of this opposition is built on a Great Wall of Lies, a translation of surreal right-wing talking points into hardened - and laughably inaccurate - opinions.

Remember the uproar over "death panels?" This referred to a part of the bill that allowed

for advanced care planning, so families wouldn't have to sort through a mess of an

estate while grieving the death of a loved one. When run through Sarah Palin's funhouse mirror, this eminently sensible measure turned into "death panels" (cue:  horrifying Kafkaesque images of faceless BIG GOVERNMENT minions deciding when to pull the plug on granny.) This talking point was so far-fetched that PolitiFact named it their 2009 lie of the year. And yet, because of the constant repetition of this falsehood - and the amount of oxygen it sucked up in the public debate - the Democrats removed the advanced planning plank from the final bill. Even despite this cave-in to crass and reckless stupidity, 55% of Americans in the Kaiser quiz still think the bill has "death panels."

Second, conservative Republicans, who have been trying to eviscerate Medicare ever since it was created, were up in arms about the Medicare cuts they claimed were in the ACA. In fact, the bill only made cuts in payments to providers, and to Medicare plus, a heavily-subsidized, privately-administered optional form of coverage used by a small fraction of Medicare recipients. And yet 60% of people who took the quiz bought this Republican talking point.

Third, the party that has always genuflected before Big Business made a hue and cry about the bill's purportedly crushing burden on ma-and-pa businesses. On the contrary, the ACA is helping small businesses by providing access to exchange pools so they can get more competitive premiums, as big businesses do now. Also, the ACA extends tax credits to companies of 25 or less to help cover their employees, and only applies token fines to businesses with 50 or more employees who fail to offer affordable coverage to their workforce.  75% of people got this wrong.

Fourth, Republicans once again went for the lowest common denominator - racist, anti-immigrant fervor among their palefaced base - by claiming that the ACA would give financial assistance to undocumented immigrants (God forbid!). This claim also false, but 58% of Kaiser quiz-takers got it wrong.

Last, and most importantly, the right-wing repeatedly presented the Affordable Care Act as a "government takeover" of our healthcare system, or "socialized medicine," as they'd done with every healthcare reform measure for six decades. This was the GOP's central talking point, running on an endless, zombie-like loop. The argument was so preposterous that "mild-mannered," generally non-partisan Washington Post columnist Steve Pearlstein referred to Republicans as "political terrorists, willing to say or do anything to prevent the country from reaching a consensus on one of its most serious domestic problems."  More specifically, Pearlstein pointed out: 

"Under any plan likely to emerge from Congress, the vast majority of Americans who are not old or poor will continue to buy health insurance from private companies, continue to get their health care from doctors in private practice and continue to be treated at privately owned hospitals."

Pearlstein wasn't alone. PolitiFact named the "government takeover" meme their 2010 lie of the year. Yet the Kaiser poll shows that 73% of those who took the quiz still believe the ACA represents a "government takeover."

In essence, most of the attacks on the ACA were sound and fury, signifying nothing. 

Add in public ignorance of many of ACA's benefits (allowing kids to be on their parents' plans

until the age of 26, ending annual and lifetime caps and pre-existing condition discrimination, closing the donut hole in prescription drug coverage, creating insurance exchanges - to offer individuals lower-cost plans - and best practices studies to bring future costs down), and it's clear that public opinion on something as complicated as healthcare should be taken with a grain of salt.

Years from now, when healthcare reform has been fully implemented, most Americans - other than the ideologically-ossified few - will have forgotten the forklifts full of bullshit they were fed in the great healthcare debate of 2009-2010. 

For the moment, those with the longview are grateful that Nancy Pelosi pushed President Obama to give people what they needed, rather than leaving them with the horrific status quo (they thought) they wanted.   


p.s. the author is happy to post comments critical of the Affordable Care Act, provided they're policy-oriented and sourced