As lawmakers grapple with the fate of the Affordable Care Act, healthcare communicators are anxiously waiting on the sidelines, observing each rhetorical back-and-forth about the future of the law.
With the legislative debate about how to repeal and replace the law, commonly known as Obamacare, in its opening stages, healthcare communicators say the debate will happen at a much faster pace than actual changes. Most do not expect immediate changes, despite the fact that the Republicans control both the presidency and both houses of Congress and repealing and replacing the law was one of the cornerstones of President Donald Trump’s campaign.
"Change will be slow," says Eileen Sheil, executive director of corporate communications at Cleveland Clinic. "The law has been in place nearly seven years; it’ll be hard to unwind that quickly."
Last week, the House of Representatives began the repeal process with the approval of a budget resolution that sets the stage to kill much of the law. Nearly all Republicans agree on the repeal, but the replacement effort is causing more turmoil among the party.
"It’s not going to be as easy as people thought it was going to be [to replace the law]," agrees Richard Sorian, head of FleishmanHillard's Washington D.C. healthcare team.
"There is complexity when political reality meets rhetoric," adds Kathleen Harrington, government relations chair at Mayo Clinic. "Some of the details are definitely to be determined, but there is a shared objective, in medical terms, to do no harm."
In the meantime, healthcare organizations such as the Cleveland Clinic are being "measured" and "simple" in their communications about the law, notes Sheil. She has regular talks with Cleveland Clinic CEO Toby Cosgrove, who speaks often about how the law has changed the healthcare system for the better, discussing how to talk about the complex issue with patients.
"We hope that if there is a repeal, there is a really good replacement," she adds. "Everyone is very anxious to see what the replacement is. The idea of just repealing it without a real, adequate replacement has us sitting on the edge of our chairs."
To glean clues about what form a replacement law could take, healthcare marcomms professionals are hanging on every word from politicians involved in the debate. In particular, many are paying close attention to the debate between "access" to healthcare versus making it a requirement.
"The fundamental piece is this issue between the Republican positions and the Democratic positions, access to coverage versus requirement of coverage," says Bill Pierce, senior director at APCO Worldwide. "There is a fundamental difference in what Republicans and Democrats are talking about and it is like ships passing in the night. Frankly, the industry is caught in the middle."
The messaging fight
Republicans are continuing to blast what they see as the failings of the Affordable Care Act, such as penalties for not signing up or the rising costs of insurance. Democrats, meanwhile, are playing up the millions of people who could lose coverage if the law is repealed.
Sorian believes the Republicans are "losing the messaging war."
"They’ve been using ‘repeal and replace’ pretty effectively for a number of years," he explains. "Now that they have the power, the public and media expect them to be more definitive about what it means. They don't have an answer."
Meanwhile, the Democrats are faring better with stressing the potential fallout that would result from repealing the law without replacing it, Sorian contends. For the first time in years, more Americans have a positive view of the Affordable Care Act than a negative opinion. According to a CNN/ORC poll released this week, 49% of Americans favor the law, compared to 47% who do not.
"The Democrats have effectively managed the message, which is 20 million people are going to lose health insurance," he says. "If you look at all the news coverage, ‘20 million losing health coverage’ is in almost every story. That's a number that the public won't stand for."
However, healthcare organizations say they are less interested in politics and more interested in ensuring their patients will have affordable coverage—and the debate has moved in their direction.
"We know there will be a flurry of ideas and approaches in the weeks ahead, but there seems to be broad consensus that we must continue working towards 100% access and affordability for all Americans," said Nick Ragone, chief marketing and communications officer at Ascension.