May 14, 2014
During the first three years of ACA implementation (2010-2013), the Department of Health and Human Services (HHS) failed to adequately organize information about the ACA and present understandable materials to the public. Only at the last minute—just before the Health Exchanges were to “go live”—were efforts made to mount outreach and educational efforts for the public.
Program managers seemed to have little insight into the importance of communications, or how to mount appropriate outreach programs. For several years, the result was widespread confusion, misunderstanding, and resentment. There is still holdover from these early reactions.
The lesson to be learned is that good communication efforts are essential, and strategies must be matched to the situation.
This insight also applies to attorney-client discussions about the ACA. The key is to look at the ACA from the point of view of specific clients, and customize materials to be as appropriate and effective as possible.
A general “tutorial” has many elements that are too far afield, and is likely to result in “glazed-over” responses. The ACA is so complex that some aspects must be targeted for discussion, while others must be discarded, as appropriate for the audience.
Attorneys must thus understand the ACA in sufficient detail to know what to leave in and what to take out for each type of client. In each situation, the information to be presented, and the method for providing this information, must be carefully tailored.
When narrowing down from the general to more limited views, attorneys are required to have a reasonable understanding of the entire Act—in sufficient detail to know what to leave in and what to take out.
Attorneys may start off with materials that have been targeted to specific types of clients, and then proceed to address specific options, cost-benefit tradeoffs, and proposed approaches to problem solving that meet the needs of the clients at hand.
Explanations to clients may be based on a “filter-simplify-communicate” approach to sharing information. The available information about the ACA may be filtered to include only the specific aspects that are relevant to client interests. The resultant insights may be simplified as much as possible, for understanding. And communications should take place in ways that meet client needs.
Attorneys need to sort through the information available and select relevant and understandable material for clients, before attempting to explain the impact of the ACA in specific situations. Advance preparation is necessary to simplify descriptions, and explanations need to be customized.
The approach to assisting clients by starting out with appropriate materials has been illustrated in two recent books–on the ACA and on the health care system. Related discussions may also be found on an ACA Blog.
As an example, in the ACA book “start-up” lists are provided of issues that match up with each type of client. The lists are updated as the program evolves, and can be readily modified for specific situations. The lists are based on an analysis of how various types of groups and organizations in the health care system are reacting to the ACA.
Attorneys may readily prepare their own versions of such lists, to best meet their practice needs.
A quick scan of a prepared list can give an effective starting point for discussions with a client. The discussions can involve specific locations and changes in the ACA over time.
The health care system may be seen as a mix of individuals, groups, and organizations all struggling to protect and pursue their own interests. The actual trajectory followed by ACA implementation is the result of all of these activities. In this context, effective communications with clients often becomes of significant concern: the details of client concerns may never be reached without a good foundation for mutual understanding.