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March 23, 2017

ACA mythbusters: Breaking down 5 big misconceptions

Daily Briefing

    Thursday marks the Affordable Care Act's seven-year anniversary—and it also marks the day the House is expected to vote on a plan to repeal and replace the law.

    The political debate over the ACA and its potential replacement has been contentious, and as such is prone to hyperbole. Over the years, several ACA myths have been floated and reiterated across both sides of aisle. Daily Briefing breaks down the top five.

    Myth # 1: The Affordable Care Act and Obamacare and are different laws

    Before we go any further, let's clear this myth up: Obamacare is simply another name for the Affordable Care Act. Obamacare was originally cited by critics of the ACA and was soon adopted by the media and even received a seal of approval from former President Barack Obama himself.

    This myth made national headlines in 2013 after an episode of "Jimmy Kimmel Live" highlighted the fact that some people (in this case, people on Hollywood Boulevard) believe the Affordable Care Act and ObamaCare are two different laws. But more than three years later, a Morning Consult poll showed that the confusion lingers: 17 percent of respondents said they believed the ACA and Obamacare were different laws, and another 18 percent said they were unsure.

    Myth # 2: The majority of Americans want to repeal ACA

    This mantra is often touted by Republican lawmakers and ACA opponents to support efforts to repeal and replace the ACA.

    House Speaker Paul Ryan (R-Wis.) as recently as Tuesday reiterated the sentiment during a press conference. "Everybody running for the Congress and the House, everybody running for the Senate, and the president himself, said to the American people, 'You give us this chance, this responsibility, this opportunity, with a Republican president, with a Republican Senate, a Republican House, and we will repeal and replace Obamacare,'" Ryan said.

    However, polls conducted by various organizations since the election have consistently shown that a majority of U.S. residents do not want repeal—instead, they want lawmakers to work to improve the existing law. 

    Even a poll conducted in January by the GS Strategy Group on behalf of the conservative American Action Network found just 21.2 percent of respondents supported a full repeal, while a majority of respondents—68.2 percent would rather see major and minor changes to the law.

    House GOP leaders unveil last-minute changes to ACA repeal plan

    Myth # 3: The quality of health care in the United States has declined under the ACA

    This myth made it into a letter Rep. Kevin Yoder (R-Kan.) sent to a constituent. Yoder wrote, "Quality of care has decreased as doctors have been burdened with increased regulations on their profession."

    But contrary to the claim, a ProPublica analysis point out that "some data shows that health care has improved after the passage of the ACA." For instance, a study published in January shows hospital readmissions within 30 days of discharge have declined since the ACA was enacted.

    The Commonwealth Fund's 2016 Scorecard on State Health System Performance also found that "nearly all state health systems" saw performance gains across a broad array of indicators between 2013 and 2015—an improvement that Commonwealth Fund CEO David Blumenthal said was directly linked to the Affordable Care Act.

    Myth # 4: Congress is exempt from the ACA in a 2013 article addressed questions from several readers about supposed efforts by Congress, particularly Democratic leaders, "to exempt itself from the requirements of the Affordable Care Act." As notes, there is no merit to this myth, which stems from a complicated legal backstory.

    The ACA included a Republican-proposed provision requiring members of Congress and their staff to switch from the Federal Employees Health Benefits Program to the ACA's exchanges—an effort to ensure that lawmakers experienced firsthand the reality of the law's exchanges.  But that opened a legal question: Congressional staff, like other federal employees, had long received a significant "employer contribution" to their monthly health insurance premiums via FEHB. But some stakeholders argued that, once moved to the exchanges, the staff would no longer be eligible to receive that employer contribution—which would lead to a sharp increase in their personal health insurance costs.

    Ultimately, the Office of Personnel Management approved a rule that allowed lawmakers and congressional staffers to maintain their employer contribution and enroll in coverage through Washington, D.C.'s small business exchange.  This ruling gave rise to the "exempt" myth—but in reality, lawmakers were not "exempt" from the law. They simply moved to the exchanges in a way that allowed them to continue to receive the employer contributions that many working Americans receive.

    The OPM rule was challenged in court by Judicial Watch, a conservative public interest law firm, which argued that the ACA denotes small businesses as those with fewer than 50 employees, and that under those rules the House and Senate should not be classified as small businesses. The suit was eventually dismissed by the judge who ruled that the ACA provision that required Congress to receive coverage via the ACA's exchanges was sufficiently vague to allow OPM to issue the rule.

    Myth # 5: You can keep your current health plan (and your doctor, too)

    "If you like the plan you have, you can keep it.  If you like the doctor you have, you can keep your doctor, too.  The only change you'll see are falling costs as our reforms take hold." That quote from Obama's June 6, 2009, weekly address, and reiterated by Democratic leadership, is likely to live in on as one of the Obama administration's biggest health care reform myths. It earned PolitiFact's "Lie of the Year" award in 2013 after White House officials clarified that Obama was referring to a provision in the law that "grandfathered" in certain health plans offered before the ACA became law. Such plans can charge consumers more based on gender or pre-existing conditions, and they are not required to meet all of the ACA's essential benefits requirements.

    Obama in a November 2013 speech to Organizing for Action also tried to clarify that the administration actually had said, "You can keep (your plan) if it hasn't changed since the law passed." That same month, Obama in an interview with NBC News apologized to the millions of U.S. residents with individual health policies who received letters from their insurers that their plans were discontinued under the ACA, and sought to retroactively make good on his word by implementing a fix that allowed individuals to keep health plans that do not meet the law's minimum coverage standards. That fix was later extended allowing people to renew such plans until 2016, with coverage lasting in some cases until September 2017.

    12 things CEOs need to know in 2017

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    The continued growth of the consumer-driven health care market threatens the durability of patient-provider relationships—and, at the same time, the push toward population health management and risk-based payment is greater than ever.

    Hospitals and health systems must adopt a two-pronged strategy to respond to these pressures and serve both public payers and the private sector.

    At the core of that strategy? A formula of accessible, reliable, and affordable care that wins consumer preferences and drives loyalty over time. Below, we share 12 key insights for senior executives working to create a consumer-focused health system.

    Download the research brief

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