Implementing the Patient Protection and Affordable Care Act is a — say it with me — massive, complex undertaking involving multiple agencies.
But that's no excuse for the way major changes have been announced lately.
News that the employer mandate was delayed a year (I have a story on that coming out in tomorrow's print edition) was announced via a July 2 post on the Treasury Notes Blog. The author was Mark Mazur, assistant secretary for tax policy at the U.S. Department of the Treasury; I wallow in health care reform stuff almost constantly, and I'd never heard of him. The title was "Continuing to Implement the ACA in a Careful, Thoughtful Manner."
News that the first year of the health insurance marketplaces will rely largely on the honor system in regards to reported income and availability of employer-provided health insurance came via the Federal Register on July 5, in a 606-page final regulation titled "Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment." Also, interestingly, the final page indicates that it came from Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner on May 28 and was approved by Department of Health and Human Services Secretary Kathleen Sebelius on May 31.
Please note that "exchange" was the original term, then the administration inexplicably decided to pull a midstream switch to "marketplace," and yet here we have a final regulation that refers to them as exchanges.
Then, on July 9, I saw an Associated Press story reporting that the smoker's penalty will be delayed at least a year. The story said the Obama administration "quietly notified insurers" and mentions "a June 28 Health and Human Services Department document" that I have been unable to locate.
If you were trying to help a nation understand and navigate a massive, complex undertaking, would you handle important announcements this way?
I certainly wouldn't.
At the very least, I'd make sure that copies of anything that could be classed as a health care reform announcement went up on one central site. Better yet, I'd hire one competent person to write an actual news release on each change that's important enough to merit media attention and include a link to the relevant regulation.
It's not a groundbreaking suggestion: I'm pretty sure you could learn it in, say, any Public Relations 101 class.
Please consider this an urgent suggestion, Obama administration.
On a related note, there was a supporting post on July 2 on the White House Blog by Valerie B. Jarrett, a senior Obama adviser who oversees the Offices of Public Engagement and Intergovernmental Affairs. (It was titled "We're Listening to Businesses about the Health Care Law.")
I mention it because it includes this sentence:
"Starting next year, the law also ensures all Americans will have access to affordable health coverage."
If total Medicaid expansion were a fact, that would be more true. But it has been optional for more than a year now, and a lot of states, including Pennsylvania, haven't said yes. And, backing up a bit, the statement also assumes that plans in the health insurance marketplaces are affordable by definition.
But why, then, the law's list of exclusions that say, essentially, if this — even with all the subsidies — costs more than the income percentage we have deemed affordable, you are exempt from the individual mandate?
It's a nice tagline, but it's demonstrably not true. And it's certainly not helping clear the muddy waters of what America knows about health care reform.
Obamacare doesn't have to be this hard. And it shouldn't be.