Tumultuous year ahead for the healthcare law

With a new year and a new Congress, what are the implications for the Affordable Care Act?

With a new year and a new Congress, what are the implications for the Affordable Care Act? Just in the month of January, the House of Representatives voted to repeal the law, and a judge in Florida overturned it in a landmark decision. Yet despite these events, insurers and state governments are moving forward with implementation. The year ahead promises many more twists and turns on the road to reform.

Despite Republican calls for repeal of the law, neither party thinks this is likely. While the Republican-led House passed a repeal measure, the vote was largely seen as symbolic. On February 2, the Senate, led by a Democratic majority, voted against repeal. Even if repeal had passed in the Senate it would most certainly be vetoed by President Obama.

While Congress is not likely to repeal the law, efforts are underway by Republicans to “starve” the law of funding. A House resolution passed on February 15 is laden with amendments to block funding of the law, a move likely to be blocked by the Senate and not favored by the public in recent polls.

No Repeal, But Some Tweaking

In response to Republican leaders promising repeal of healthcare, a number of companies including Cigna and UnitedHealth have come out in support of the law and the mandate. The health industry spent two hard years negotiating with the administration to shape reform and they don't want to go back to the drawing board. Many elements of reform are favorable to the industry, particularly the mandate. Insurers stand to gain 32 million new customers when the mandate is enacted in 2014. The worst scenario, particularly for insurance companies, is losing this expanded market, but still bearing the burden of accepting people with pre-existing conditions and other regulations.

Public Opinion Shifting

Public support for the law is growing, though new polls show divided support for key provisions.  Well over 70% of the public support provisions on pre-existing conditions and eliminating caps on insurance coverage; however, the mandate, which is the funding mechanism for these provisions, is only supported by about one-third of the public. Despite these concerns, a Kaiser Family Foundation survey conducted in early January found that 62% of respondents were opposed to de-funding the law.  

In response to Republican plans for a multi-year assault on the law, proponents of reform have mobilized for a sustained campaign to win public support.  Families USA and other groups that led efforts to pass the law have formed a coalition, independent of the White House, to promote the benefits of the healthcare law. 

Communications Key in Year Ahead

While support is growing, there is still rampant confusion with more than half of the public saying they don't understand the law and how it will affect them. The disconnect on the mandate and other provisions of the law are clear evidence that the public does not understand how the law works. A survey just conducted by the Employee Benefit Research Institute and Society for Human Resource Management found that both employers and workers are not clear about details of the law. Among workers, 37% said they did not know enough about the law, and 18% said they did not know anything; 52% of employers reported not feeling comfortable in their understanding of the law.

There is a great need for communications on the law overall, and on how specific elements impact individuals and businesses. For communications professionals, this is an unparalleled opportunity to provide leadership as their organizations navigate the turbulent waters of reform.  Issues management will be front and center for all industry sectors as companies struggle to implement new elements of the law. 

There are also great opportunities for reputation building. Already major insurers are burnishing their leadership credentials by launching high-visibility campaigns to educate their members about the new law. Similarly, hospitals are staking out leadership positions as they morph into accountable care organizations (ACOs), a centerpiece of reform. Pharmaceutical companies will soon be touting a closing of the “doughnut hole” for seniors' drug coverage. Reputations can be enhanced, or diminished, as reform plays out in the coming years.

The healthcare law was dominant in every 2010 news cycle, and this will continue in 2011.    With actions in the courts and Congress and major provisions of the law unfolding this year, the Affordable Care Act will stay front and center of the news agenda for some time. And communications professionals will be at the fulcrum of this change, guiding their organizations in the post-reform world.

Nancy Hicks is a SVP at Ketchum's Washington, D.C., office, and serves as associate director of Ketchum's North America Healthcare Practice.

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