For those of us who support the Affordable Care Act and health care as a right, we need to bolster messaging for politicians and mainstream media in the face of unprecedented lies and misinformation.
I get why you may think Congressional Budget Office scores are enough. As the defense lawyer for the ACA, you’d look the jury in the eye and say, “Swampcare is of the Swamp, for the Swamp and decidedly written by the Swamp. Swampcare will cause 22 million people to lose coverage, the death of tens of thousands and a doubling of personal bankruptcies across the nation. The defense rests.”
But we live in a world where these plain truths may not be enough.
My Argument
Good old-fashioned greed propped up by the old standbuys—lower taxes and free markets that will reduce premiums, increase choice and spur growth—may still win the day.
Solid reporting on these fallacies is abundant, from the Kaiser Foundation to the Washington Post to AlterNet. But on mainstream and cable news, it's a different story, where protocols permit unchallenged lies and favor the repetition of simple talking points, true or not.
While admittedly not a marketing maven, I’m going to take a shot at framing some of the critical elements in the ACA that are not receiving the attention they deserve. OK, repeat after me:
Freedom is coverage.
Say it louder!
Freedom is coverage.
You too, Perez, Ellison, Schumer, Sanders and Warren.
Freedom is coverage.
Yes, repetition matters. A lot. Ask Larry Bird.
Freedom is coverage.
Because you don’t choose to get sick, you just do.
Why is it important? Because we can’t cede a concept as basic as freedom to the opposition—and we have.
Because the 10 Essential Benefits truly are essential.
What Does the Swampcare team Say?
Freedom and choice, freedom and choice, freedom and choice, is their mantra.
Tom Price, as Secretary of Health and Human Service is the message lead and champion of health care “freedom,” helping citizens “to select the kind of coverage that’s right for them and their families, not that Washington forces them to buy.” Tom Price wants to turn back the “tide of all the rules and regulations that decrease choices that increase costs.”
Libertarian wingman Senator Rand Paul says, "perhaps we should try freedom."
From their perspective, the mandate reduces freedom, the 10 Essential Health Benefits limit freedom, the caps restrict freedom and yes, even the pre-existing conditions requirements interferes with free markets, choice and personal freedom.
They want citizens to have freedom of choice and to save money. And for the states to decide on their plans. Who doesn’t like choice? And freedom?
What’s not to like?
What Happens in Real Life?
In real life, people really hate paying a premium every freaking month for 10 years and then when they need the insurance, discovering there was a loophole, disclaimer or exclusion for an “act of god.”
You have a car accident, and want the policy to cover the cost of repair with a modest deductible. A tree falls on your house, and you expect the homeowner’s policy to cover the cost of repair with a modest deductible. If your business has errors and omissions, you expect it to cover the legal costs when you or your company make an error or omission.
When it comes to insurance, what people hate is no coverage.
In real life, 69 percent of U.S. adults have less than $1,000 in savings.
Most Americans are living close to the edge, paying bills month to month and watching every penny. They would easily fall prey to cheaper plans that did not cover essential benefits. It's human nature. They need to feed their kids, pay the rent or fix the car to get to work.
They will roll the dice, and pray.
When it comes to insurance, what people really want is coverage.
In real life, no one knows when they are going to get sick, or have a Steve Scalise moment.
According to the CDC in 2014, the “number of medically attended injury and poisoning episodes in the population: 39.5 million. Episodes per 1,000 population: 126.3. Number of emergency department visits for unintentional injuries: 28.1 million.”
Translation—your chances of a medically attended injury each year is over one in 10.
And sadly, Steve Scalise is not alone; in 2016, according to the Gun Violence Archive, there were 30,616 gun-related injuries. I doubt any of them were planned for.
You won’t need more than a million dollars in coverage this year and would rather save $200? Bam. Bankruptcy.
When it comes to insurance, what people really need is coverage.
In real life, most businesses and families want to lock into monthly fixed costs.
A CFO will tell you it is better for planning to have monthly costs to avoid fluctuations in expenses whenever possible. If you are a family with the income and luxury to budget, you pay for the security of insurance. And if you are at the lower rung, even a modest expense can throw your life into a panic.
It is the conservative, prudent and more business-like approach. Which one would expect Republicans to embrace. Instead, we have conservatives, Republicans and libertarians ignoring common sense and suggesting the American public play Russian roulette with their health to save a short-term buck.
When it comes to insurance, what people really expect is coverage.
What Should Dems Say?
Drop the qualifier. Democrats—please stop leading with “we know it could be better” and “we are ready to work with Republicans.” You think it makes us sound less partisan, but it makes us sound weak, like we don’t even believe in the bill we fought for.
Try this…
The ACA is the greatest piece of legislation in this generation.
Nine out of 10 Americans live with the freedom afforded by full coverage, the freedom to change jobs, the freedom to live without bankruptcy, the freedom to choose plans in an open market.
Talk About the 10 Essential Benefits a Lot More
Isn’t it telling that male Republicans use maternity leave as an example of a benefit that is not “essential?" They don’t want to pay for it, ladies.
So what else is new?
Let’s do 10 Days for 10 Essential Benefits
Dems, Berniacs, Indivisible groups, everyone on point for 10 days, asking the same question: Why shouldn’t every plan provide coverage for_______?
Day One is ambulatory, Day Two is emergency services. Etc. By the time we get to hospitalization, Republicans will look ridiculous. Let’s ask them to list the coverage they will skip in their family plans.
As a reminder, the 10 Essential Benefits are:
- Ambulatory patient services (Outpatient care)
- Emergency Services (Trips to the emergency room)
- Hospitalization (Treatment in the hospital for inpatient care)
- Maternity and newborn care
- Mental health services and addiction treatment
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services, including chronic disease management
- Pediatric services
Propose Amendments to Make Points About Coverage and the ACA
When Republicans talk about freedom and choice, they repeat two points about Obamacare—the insurers are leaving rural counties (46 without plans) and Obama didn’t let you keep your doctor, reducing choice.
The Senate and House bills only offer the “free market” as a solution.
Both problems are driven by insurance profits. Insurers leave rural counties because they can’t make as much money—so “skinny” plans will be the cure. As anyone who has ever wrestled with the “in-network” search tools on a health care site knows, it is the insurers who pick your doctors—even in employer plans.
When Republicans talk about “freedom,” it's freedom for insurers and doctors they are mostly talking about. So here are some amendments to solve the rural and doctor problem that insurers and doctors will hate, but will stir the freedom and choice discussion.
Patient Freedom of Choice Act
Insurance companies offering insurance in a state must offer insurance in all counties in the state. Doctors who accept insurance in a state must accept insurance from all providers in the state.
Want to talk about real patient freedom? Rural problem is solved. Throw away those thick “in-network” books forever—if you have insurance, just go to the doctor.
Congresspersons Health Savings Amendment
Government employees, including congresspersons and the executive branch, will purchase the least costly health plan offered in the state in which they permanently reside.
Republicans would never offer their constituents a plan that was unsafe that they would not take themselves—would they? Do unto others...what is good for the goose is good for gander. And so on.
I am certain good Republicans throughout the government, devoted to saving their fellow taxpayers money wherever they can, will embrace the cheapest plan being offered in their home states, along with fellow constituents.
The Bottom Line
Freedom is coverage. And lots of protections in the Affordable Care Act are worth fighting for.