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Life Health > Health Insurance > Your Practice

Here Lie Monsters

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I think it will be hard to know exactly where the gaps in our knowledge of the Patient Protection and Affordable Care Act of 2012 (PPACA) lie until all of PPACA that will get up and running is up and running.

The think tanks that hate PPACA are always sending me studies about how PPACA will destroy the U.S. health finance system – as if the system weren’t rapidly destroying itself. The story behind the story in the PPACA hater projections: The health finance system will implode in 2014 or 2015, rather than in 2020. Run for the hills

Meanwhile, over on the calm, naturally lit, hibiscus-tea-fueled moderate left, analysts at the Henry J. Kaiser Family Foundation, Menlo Park, Calif., recently tried to look at the effect of misconceptions about PPACA on consumers’ views about PPACA. Pollsters at looked at poll participants’ views changed when survey workers gave the participants what they analysts viewed as being accurate information about PPACA.

The Kaiser analysts tried to look, for example, at what consumers are thinking about a PPACA provision that calls for some individuals who fail to have a minimum level of health coverage to make payments to the federal government starting with the 2014 tax year.

Congress called the provision a fine, not a tax.

When the U.S. Supreme Court upheld the PPACA individual mandate provision in June, it made a point of calling the provision a tax.

About 66% of the U.S. residents polled this month said they oppose the coverage ownership mandate requirement if it imposes a fine, and 61% said they oppose the mandate if it imposes a tax.

The Kaiser analysts say they think many consumers are hostile toward the uninsurance penalty because they have unrealistic ideas about how many people the penalty will bite. About 20% of consumers think they’ll have to pay the uninsurance penalty, but the real answer appears to be less than 10%, the analysts say.

When the pollsters told survey participants that only 1 in 10 Americans would have to get insurance or else pay a fine, the percentage of participants who said they had a favorable view of the mandate increased to 42%, from 34%.

When the pollsters said most Americans would still get coverage from employers, that increased the percentage of participants with favorable views about the mandate to 58%.

On the one hand: Whether you love PPACA or hate it, Kaiser runs a great health policy website.

On the other hand: Strange things happen. The idea that 20% of U.S. residents could be at risk of having to pay the uninsurance penalty in 2014, or that large numbers of employers could drop their health benefits, is not necessarily all that much stranger than the idea of Chief Justice John Roberts being the justice whose vote was responsible for the PPACA mandate being upheld.

For people in the gray zone — no group health benefits and moderately high incomes — maybe having the threat of the uninsurance penalty hanging over their heads is almost as bad as actually having to pay the penalty.

And what if, instead of asking about “confusion” that makes PPACA look bad, the Kaiser team had asked about “confusion” that makes PPACA look good?

What if Kaiser had told consumers, “There’s a 30% chance that PPACA will make it harder for you to get an appointment with your personal physician on a day when you have a 104 degree fever.”

Maybe the consumers who heard that effort to “clear up confusion about PPACA” would end up liking PPACA less, not more.

On the third hand: We could all go around in circles hyping and trashing PPACA all day, every day, until 2014, or whenever the PPACA insurance provisions die, come to life, or come to life in whatever heavily altered form that policymakers give to them over the next few years.

Chances are that many of the people who have the strongest feelings about the matter today will see what they want to see then, and we’ll have years of survey reports based on the theme, “I told you so,” from people on both sides of the divide.

It will be up to health insurance agents, brokers, company executives and plan administrators to try to help employers and consumers pick out a real path to meeting real health care needs through the fog of rhetoric.


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