THE HILL’s Healthwatchblog recently referred to the July 2 delay in the Affordable Care Act’s employer mandate as “stunning.” I agree. But the delay in the employer mandate, a key linchpin of the law, is only the latest in a long line of gaffesin the law’s history.
Pundits will disagree on how important the employer-mandate delay is in terms of implementing the law. But I’m more interested in the public relations aspect of these missteps and what they say about the law’s future. So here are what I consider the Top Five PR blunders to date in the ACA’s short history.
Blunder No. 5: The one year delay in the implementation of the ACA employer mandate. The law’s supporters play down the importance of the employer mandate. But if you’re trying to achieve near-universal healthcare coverage, this is the place where you can insure the most lives. So you lose public credibility by minimizing your failure to deliver.
Second, the administration announced the delay in a mid-level bureaucrat’s blogshortly before the long Fourth of July holiday. But this only gave the impression that the administration had something to hide.
Third, Democrat supporters of the law played right into the hands of Republicans who chargedthat the delay was intended only to help Democrat incumbents in next year’s mid-term elections avoid questions on the unpopular law’s implementation, which is expected by everyone to be messy. Republicans have complained about the mandate for years. A better play would have been to co-op some of them to at least give the move a veneer of bi-partisanship.
So the focus once again has become the politics of healthcare, rather than the benefits of healthcare. That's not where the law needs to be at this point.
Blunder No. 4: 1099 reporting. The law’s detractors, of which there are many, have claimed that the ACA will require an enormous bureaucracy that will spew out red tape by the mile. So the law’s 1099 reporting requirement just validated that opinion.
The thought of businesses having to file a 1099 for every single, inconsequential transaction over $600 was a bridge too far for even the law’s supporters, let alone the business lobby. A bi-partisan death squad killed it in Congress, but not before the image of the ACA was cast as a huge, overreaaching monster.
Blunder No. 3: The CLASS Act. The ACA was intended to include a program for long-term care, known by its acronym, CLASS. Given the rapidly graying of America this was an important component.
But two problems arose. The first was the fact the bill’s supporters, through creative accounting, claimed that the expense of caring for millions of aging baby boomers would somehow mystically contribute to deficit reduction. The second was that from the beginning budget analysts said CLASS was not financially viable. Congress repealed the CLASS Act last year.
This was a golden opportunity missed by the administration. It should have been able to score points for calling out Congress on a bill that budget analysts said would never work, and for pulling the plug on it. Instead, by sticking too long to phantasmagorical claims of deficit reduction that everyone knew were impossible, they helped foster skepticism of the law as a whole.
Blunder No. 2: ObamaCare for Congress. During the Congressional debate over the ACA, the law’s opponents threw down the gauntlet: If this is such a good idea, then Congressshould give up its own “solid gold” insurance coverage in favor of what at the time was beginning to be called “ObamaCare.” This, by the way, included Congressional staffers. Eventually Democrats accepted a Republican amendment to the bill mandating that Congress and its staffers use ACA-compliant plans. But by dithering over the issue, the bill’s supporters created an indelible impression in the public that health insurance in this country was going to remain an Upstairs-Downstairs affair.
Second, by failing to commit immediately to ACA coverage for their own families and employees, Congress raised doubts in the mind of the public on the value of the product. It would be like seeing the CEO of an American car company, show up at work in a BMW.
Blunder No. 1: Waivers. Perhaps no blunder on the part of the ACA’s supporter was bigger than giving certain organizations passes on key ACA requirements. Let’s just say from the outset that government regulators grant waivers from all sorts of rules all the time. Not just healthcare. Nothing new there.
But in the case of the ACA the velocity of the waivers was breathtaking. The Department of Health and Human Services has approved over 1,200 waivers alone from one requirement: the elimination of annual caps on benefits.
It also hasn’t helped that many of the waivers were granted to organizations like the United Federation of Teachers, which has supported the administration and the ACA. Again, the administration lost an opportunity to demonstrate that by exercising flexibility in administering the law it was being reasonable. Instead, the public was left with the impression that the administration was rewarding its friends for their support of the ACA.
So where does this leave us? Supporters of the ACA look at the law and see the realization of an 80-year old dream: equal access to healthcare for all, lower cost and better quality outcomes.
But because of these gaffes others see a law that will result only in a massive bureaucracy. A law whose supporters haven’t told the whole story. A law whose goals are outlandish and will never be accomplished. A law whose enforcement will be uneven at best and unfair at worst.
But because of these gaffes others see a law that will result only in a massive bureaucracy. A law whose supporters haven’t told the whole story. A law whose goals are outlandish and will never be accomplished. A law whose enforcement will be uneven at best and unfair at worst.
You can’t fault ACA proponents for believing in the cause of healthcare reform. But when your focus changes from writing, passing and administering law to thinking you’re doing the Lord’s work, you run into trouble. The danger is in believing that the value and benefit of what you’re doing is self-evident, and that any rational person should share your belief.
But in a diverse pluralistic society that’s rarely the case. You’ve got to build people’s trust in you and your product—in this case the ACA. That's the value of public relations. Until the bill's supporters understand this, the ACA will remain a political, rather than a healthcare, issue.