Many Americans still don't know what's in new health law

[Temujin]

Not surprising given its size, complexity, the three ring circus that was the process of passing it, and all the lies and bullshit that keep coming from the Conservatives.

Many Americans still don't know what's in new health law
Over half mistakenly believe overhaul will raise taxes for most this year

By RICARDO ALONSO-ZALDIVAR, TREVOR TOMPSON
updated 9/21/2010 5:23:56 PM ET

WASHINGTON — Six months after President Barack Obama signed the landmark health care law, the nation still doesn't really know what's in it.

More than half of Americans mistakenly believe the overhaul will raise taxes for most people this year, an Associated Press poll finds. But that would be true only if most people were devoted to indoor tanning, which got hit with a sales tax.

Confusion remains over 'death panels'
Many who wanted the health care system to be overhauled don't realize that some provisions they cared about actually did make it in. And about a quarter of supporters don't understand that something hardly anyone wanted didn't make it: They mistakenly say the law will set up panels of bureaucrats to make decisions about people's care — what critics labeled "death panels."

The uncertainty and confusion amount to a dismal verdict for the Obama administration's campaign to win over public opinion. Before the final votes in Congress, Obama personally assured wavering Democrats he'd take the case to the American people after the law passed. But it hasn't worked. And in the final stretch before the midterm elections Republicans are united by their call for repeal.

"I'm insecure about a document that was as big as the health care bill and wonder if anybody understands exactly what's in it," said Diann Kelley, 61, a retiree from Marietta, Ga., who says she's "somewhat opposed" to the law. The AP poll was conducted by Stanford University with the Robert Wood Johnson Foundation.

"The main fear is the cost," explained Kelley. "I'm not sure that we can afford to take on something quite as massive as the health care reform with the economy the way it is."

It's not that Kelley has a negative opinion about everything in the law. The prohibition on health insurance companies denying coverage to people because of pre-existing medical conditions "is really a fine idea," she said.

The poll's questions included a true-or-false quiz on 19 items, some of which are in the law and others not. People were also asked how confident they were about their answers.

For the most part, majorities picked the right answers. But a sizable number also got things wrong. And right or wrong, people were unsure of their answers. Two-thirds or more were uncertain about their responses on eight of nine core provisions of the legislation.

Analysis of the findings indicated a split as far as the impact of accurate knowledge, between Democrats and independents on one side and Republicans on the other.

Accurate knowledge of the law made no difference in overwhelming opposition from Republicans.

Michael Cagnina, 33, a web developer from Powhatan, Va., summed it up: "It just doesn't make me feel comfortable that the government is going to give people free health care but ultimately the government's money is my money."

However, for Democrats and independents, the more accurate knowledge people had of the bill, the more they liked it.

"Among Democrats and independents, the lack of knowledge is suppressing public approval of the bill," said Stanford political science professor Jon Krosnick, who directed the university's participation. "Although the president and others have done a great deal to educate people about what is in this bill, the process has not been particularly successful."

Marking the six-month anniversary
The White House is staging an event Wednesday to mark the six-month anniversary of Obama signing the bill. The president and top administration officials will be joined by people from around the country who are already benefiting from such popular provisions as allowing adult children to remain on their parents' insurance until they reach 26.

Will it make a difference?

The poll shows Obama has yet to find the right wavelength for communicating even information that's relatively straightforward. One question stood out as an example:

People were asked whether the Congressional Budget Office had ruled that the legislation would probably increase the government's debt, or whether the nonpartisan budget analysts found that the health law would reduce red ink. (Correct answer: CBO found it would reduce the federal deficit over time.)

But 81 percent in the survey got the wrong answer, including a majorities of both supporters and opponents - even though Obama seldom misses a chance to remind audiences of CBO's favorable report.

Overall, three out of ten in the poll said they favored the law, while four in ten said they were opposed. Another 30 percent were neutral. The findings on support and opposition differ from another recent AP poll, but the two surveys cannot be compared because they were drawn up and carried out differently.

The other survey, an AP-GfK political poll, found 41 percent supporting the bill and 46 percent opposing it, with only 12 percent neutral.

The new survey was conducted Aug. 31 to Sept. 7, and involved interviews with 1,251 randomly chosen adults nationwide. It has a margin of sampling error of plus or minus 3.9 percentage points.

The survey was conducted by Knowledge Networks, which first chose people for the study using randomly generated telephone numbers and home addresses. Once people were selected to participate, they were interviewed online. Participants without Internet access were provided it for free.

Stanford University's participation in the project was made possible by a grant from the Robert Wood Johnson Foundation.

[Kanastrous]

*shrug* didn't the bill's leading senior proponent herself say during its passage process that We have to pass it in order to find out what's in it?

[TithonusSyndrome]

I remember in the 1995 Quebec referendum, over a quarter of Quebecois voters were revealed as not understanding what the phrasing of the actual question on the referendum ballot meant exactly, and thus accusations were directed at separatists that they had made the question intentionally confusing so as to draw more voters to their cause. The Republicans' first intention when debating the bill was to water it down and stall it, undoubtedly, but if as a byproduct of it's congestion has the additional side effect of confusing voters into rejecting it, then that's just that much more incentive for them to politic bills they dislike to death.

[Broomstick]

Just in case anyone is wondering - CNN has a summary of what the most recent changes (effective September 23) will be by the end of the week (with a few comments by me)

NEW YORK (CNNMoney.com) -- September 23 marks the six-month anniversary of health reform. It's also the date when several key insurance changes come into effect.

Here's what you need to know about how your insurance is affected.

If you get insurance through your boss: Many people who are insured through work won't notice immediate changes to their health plans until their health plans renew, which is tied to companies' open enrollment periods. Health plans offered through large employers usually get renewed on Jan. 1.

Remember - MOST Americans get their health insurance through their employer. So most won't see any change until January 1, 2011 at the earliest.

But the mandates could kick in sooner for health plans sold to new entities or individuals after Sept. 23.

Here are some key changes coming into effect:

* Coverage expansion for adult dependents until age 26. Employers will have to provide coverage for dependents of workers who don't have access to other employer-based health care coverage 'till age 26. Some states already mandate this coverage until age 28 or 29.

This new provision could also push companies to look for ways to restrict the number of new people added to their health plans. [Employers get tough on insuring 'family' ]

Getting tough on insuring family means asking for proof they actually ARE family. So, for example, married couples might be asked to produce a marriage certificate. No big deal, you think? Well, if my experience at Public Aid is anything to go by a lot of people don't have copies of their marriage certificate, or lost them. Also, there is the common law marriage custom which is more complex than most people realize, as it varies from state to state and does have differences from common law marriage in other countries. Common law marriage was recognized as valid by the Supreme Court back in 1877, but produces no marriage certificate and proving one has a common law marriage may be a bit difficult in the modern world (one reason my Other Half and I went for a civil marriage with official license/certificate). Even in a state such as Illinois, where common law marriages were abolished in 1905, people STILL say they have common law marriages, hold themselves out in public as married, and carry on as if it was still a legally recognized custom. It's what, 105 years later? Obviously there are some communication issues at work. But a common law couple in Illinois will find that their health insurance company does not need to recognize their marriage. Unless they moved to Illinois from a state where it IS legal, due to the "full faith and credit" clause, but it will be up to the coupe to PROVE their married status and there will be definite push-back from the insurance industry. I can't wait until some same-sex couples legally married in one state run into this in another state, the fireworks will be impressive.

Likewise, I don't doubt stepchildren will become an issue as well - unless there was a formal adoption procedure I can see health insurance companies fighting tooth and nail to drop stepkids off coverage. It will be tough, as traditional stepkids have been covered as long as the marriage endures but I'm sure there be an attempt to claim these kids are somehow not family.

In other words, this could be uglier than it first appears. Also note that such adult children could ONLY be covered if there was no other option - meaning if the kid has a suck minimum wage job that has suck health benefits the kid is NOT eligible to be on the parents' insurance anymore. If the suck job has no benefits, no problem, but the shittiest health insurance will bump the kid off the parents insurance.

* Children no longer denied coverage for pre-existing conditions: Insurance plans can't deny coverage due to a pre-existing condition to children under age 19. For adults, the same provision goes into effect in 2014.

Notice this gotcha - children can't be denied due to pre-existing conditions up to 19 - but once the kid is 19 tough shit. Unless the kid is already on a policy when they turn 19 they are shit out of luck - meaning a pre-existing condition can negate the mandated coverage until 26 provision. Since it's kids with pre-existing conditions who are most likely to need medical care and also most likely to be un- or underemployed this can leave kids over 19 who are dependent on their parents entirely without insurance coverage. Sucks to be them, I guess, was the attitude of those who wrote this section.

* Prohibit insurers from rescinding coverage: It's illegal for insurers to drop a customer when they become sick or search for an error on a customer's insurance application and then deny payment for service when the person gets sick.

I'm sure the insurance companies HATE this. Seems pretty straightforward.

* Free Preventive Care: All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. If individuals keep their existing plans or if a group plan doesn't make major changes, the provisions won't kick in until the plans get changed. [Health reform: What you're not getting]

Which means a substantial number of people won't see this until 2012 or 2014 or beyond - the "self insured" companies being most likely to fall under this.

Now, if you're a HUGE corporation, like General Motors used to be, this form of health insurance might be workable (disclaimer - I have NO idea if GM was ever self-insured or not, I'm just using them as an example of a big corporation). GM has a HUGE pool of employees over which to spread the risk. However, self-insurance is actually probably more common among mid size to small employers - and that's not good because they have much smaller risk pools. One bad illness or injury, one very premature baby, or other medical catastrophe can easily bankrupt a small size self-insurance fund, even with stop-loss insurance. You also wind up with perverse incentives. For example, the last time I was under such a plan (a small, not-for-profit clinic) while pregnancy complications and something like and emergency Cesarean would be covered in full NO routine prenatal care or normal labor and delivery were covered at all! Now, at the time, normal pregnancy, labor, and delivery could easily run $10,000 - far more than most families of staff at the clinic could afford to pay, as it was easily a third to half of one's yearly wages. Surprise, surprise - every time someone there got pregnant complications were discovered and the Cesarean rate was 100% - gee, you don't think the difference between $10,000 out of pocket and a $250 co-pay had anything to do with that, do you?

Major insurance companies already pay for all or nearly all preventive care. My own government-subsidized health care pays for all preventive care with no co-pays whatsoever. Why? because over the long haul, and over large populations, it's cheaper to pay for preventive care than preventable catastrophes, and reduces certain perverse incentives to go looking for trouble. But self-funded companies? Short term profits (particularly if, such as the clinic I worked at, the staff are young and healthy for the most part) might well lead someone to stop paying for preventive care - which they'll get away with. For awhile. But sooner or later Something Happens. It could be cancer, a car accident, some rare disease... A million dollar medical bills (easily reached for cancer or severe burns, for example) can wipe out the self-fund and wind up with NO ONE at the business having health insurance because it will be so damn unaffordable.

Want to know something else? A certain slice of people in such plans are not aware that they are in such a program. Seriously. Most people don't know much about health insurance, and self-fund managers aren't in the habit of making a lot of noise about being such. Yes, it IS in the fine print on policy documents, but few people read such documents.

* No lifetime limits on coverage: Insurers no longer can impose lifetime dollar limits on essential benefits, like hospital stays or expensive treatments.

A bit of an issue, those lifetime and/or yearly caps. My Other Half maxed out a Blue Cross policy by the time he was 20 and couldn't get insurance for nearly a decade (spent nearly that long paying off the bill to have his right leg reconstructed, too)

Currently, we have a $300,000 a year cap on our policy. Once they company pays out $300,000 we're responsible for the rest. Now, in one sense, that IS a lot of money. A broken leg, gall bladder surgery, a whole bunch of stuff costs significantly less than that. It WILL cover most health care needs. But, as I have frequently pointed out, getting certain forms of cancer can easily blow through that amount in a year, or even just a few months. Likewise, getting burned in a house fire. These are unlikely events, but they do happen. Of course, right now, if they did happen it's not like we have any money for anyone to suck out of our bank account anyway, but it might well fuck us up financially for the rest of our lives.

I try to avoid such things, alas, the world is not entirely under my control...

Anyhow - once these provisions kick in the Other Half an I will no longer have an annual cap or lifetime limit under the current policy. We won't get that cap lifted until we get a new policy - but despite being better educated than most about these matters I don't know if, legally, the new policy taking effect for us November 1 is seen as a completely new and separate policy, in which case the caps come off, or a continuation of our present policy, in which case they don't! And if the insurance company doesn't NEED to lift those caps for damn sure they won't!

* Unrestricted doctor choice: Plans must allow pediatricians and obstetrician/gynecologists to get primary care physician status. This eliminates the requirement for patients to get prior-authorization from their insurer or a doctor's referral to see a pediatrician or OB/GYN.

That lead-in was misleading - you'll STILL be limited (in almost all cases) to the list of "in-plan" doctors, it's just preventing insurance companies from dictating that all health care be funneled through a primary care/general practitioner. A lot of women in America use an OB/GYN as their primary care giver (personally, I don't and never have, but then, I haven't made childbearing a part of my life, which is frequently a rationale for that strategy). Children should go to pediatricians, not general practitioners educated mainly with adults as the standard. This restriction has already been eliminated with a lot of health insurance plans, this just takes care of the few remaining hold outs.

* Level charges for emergency services: Insurers must remove prior authorizations for ER services. Also, insurers can't charge higher co-payments or co-insurance for out-of-network ER providers.

Yep - that's right. You really did read that health insurance companies have in the past required pre-authorization to use emergency services! And denied paying out to people who DIDN'T ask for pre-approval, even if they were unconscious or whatever. Now, that was never a universal practice, and largely dropped because it made the insurance companies look like such complete assholes, but I don't doubt there are still a few companies puling that bullshit (where states haven't outlawed the practice completely already). You live in California but break your leg visiting Aunt Marcy in Maine? Sucks to be you! Meanwhile, this also kills the insurers charging you extra for having an emergency someone other than your immediate living area.This practice in the past could easily double the cost of an emergency room visit, which are damn expensive to begin with.

* Patient-friendly appeals process: Insurers will have to establish new internal and external appeals processes for claims. This means that while a claim is under appeal, your insurer has to continue to pay your claims, and continue paying for subsequent treatment, until the matter is resolved.

Well, I'll believe it when I see it. Since the insurance company will have to continue to pay out it may well speed up appeals, but it in no way assures that the final decisions will be altered in any way.

Small business impact: The changes that kick in on Sept. 23 also apply to small businesses with 50 employees or more that already offered insurance coverage prior to reform.

Companies that didn't offer coverage pre-reform and have no more than 25 workers will be given incentives such as tax credits and grants to encourage them to offer insurance coverage, said Dorothy Miraglia, director of benefits with AlphaStaff, a firm that manages employee benefits programs for small businesses.[Tax change for small businesses]

Note the "donut hole" between businesses with fewer than 25 people and business with more than 50 - businesses with 25-49 employees will NOT get tax credits and grants, but will be required to comply with the rules for larger businesses. Remember, the larger risk pool is what gives you a price advantage. I think the result of this will be a LOT of businesses with fewer than 50 people will make sure to have no more staff than 25 people at most. So... if you work at a company with 35 employees and this kicks in expect to see 10 people laid off, retired, fired, or otherwise "let go".

The government estimates that 4 million small businesses will be eligible for health insurance tax credits. These include a credit of up to 35% of the premiums employers pay on worker plans. For small non-profit companies, the credit is up to a 25%.

Also, the 35% maximum credit is given to employers with 10 or fewer full-time employees, said Miraglia.

If you buy insurance yourself: For consumers who buy health insurance directly from insurers, some of the same key changes go into effect this month.

Most importantly, insurers can't drop you when you get sick or because you made a mistake on your coverage application. Insurers also can't set annual or lifetime limits.

If you have children under age 26, you can insure them if your policy allows for dependent coverage. Individual plans can't deny or exclude coverage to any child under age 19 for pre-existing conditions.

If you're a senior citizen: If you have Medicare prescription drug coverage and are affected by the donut hole, this year you will get a one-time tax-free $250 rebate to help pay for prescriptions.

The prescription drug coverage gap that develops when Medicare stops paying for drug coverage and patients can't afford to pay for drugs out-of-pocket is called the "donut hole."

In 2011, if high prescription drug costs put you in the donut hole, you'll get a 50% discount on covered brand-name drugs while you're in the donut hole.

Also in 2011, Medicare will cover certain preventive services without charging you Medicare Part B (coverage for doctors' services, outpatient care, home health services) coinsurance or deductible.

That's just THIS year's changes - yes, this is a complex issue with a lot of fine print and "gotchas!". As I mentioned, I'm better educated than the average consumer and I still don't have a really good handle on all this. The average person just trying to get by, with no experience in the industry, and never having worried about this before, will be totally lost and confused.

It's a mess.

Now, I think there really ARE some worthy provisions in there - but it's an ugly compromise on so much, and there are many things wrong with the system even after "reform".

[Kanastrous]

Heard on the news that now in California a couple of major carriers (have to look up which ones, I forget, but they're big players) will no longer write health insurance policies for dependent minors. Existing policies will be honored and continued, but no more new ones. This was presented as a consequence of the Health Care Bill but I'd like to read up on it a bit further.

[Anguirus]

There are a lot of good reasons not to like this bill, but the thing that drives me crazy is that the largest and most devoted opposition movement is based almost entirely on misinformation (as per the OP).

[General Zod]

There are a lot of good reasons not to like this bill, but the thing that drives me crazy is that the largest and most devoted opposition movement is based almost entirely on misinformation (as per the OP).

The fact that it's hundreds of pages and very complicated makes misinformation extremely easy.

[Anguirus]

Yes indeed, but that's not quite the problem either. The problem is that people swallow blatant lies like "this bill will increase your taxes right now." There's no source for that OTHER than right-wing propaganda.

I mean, this bill couldn't be farther from single-payer healthcare if it tried, and yet all the opposition to it I saw in that article is based on that premise. "The government gives you free health care out of the taxpayer's pocket and decides if you live or die."