August 15, 2013
The ways in which individuals react to implementation of the Affordable Care Act (ACA) will depend on many factors.
Over the past three years, initial reactions have often resulted from media “sound bites” combined with limited factual communications from federal and state agencies. Thus, the starting reactions to the ACA have often had little to do with the actual design and scope of the Plan. Over this period, the public at large has often developed a negative reaction to the Plan.
Over the next few months, leading up to the start of Exchange operations on October 1, 2013, individual reactions may be somewhat reshaped by last-minute efforts by the Department of Health and Human Services (HHS) to ramp up educational and outreach programs. At the same time, some negative campaigning is to continue.
It is yet to be determined whether this spike in communications will significantly affect the overall public viewpoint of the Plan, and whether a more positive reaction to the ACA will result.
The next effort to change public perceptions of the Plan will take place during October to December, 2013, as the Exchanges begin operations; educational and outreach efforts continue to ramp up; and some individuals attempt to shop for—and purchase—health insurance through the new Exchanges.
If this interaction is largely satisfactory to individuals, then word-of-mouth and feedback may begin to change public attitudes in a positive direction. However, any such shift will be offset by any negative experiences, such as unsatisfactory contacts with outreach personnel; confusion and dislike over the shopping and sign-up processes (whether involving paper or online forms); or the out-of-pocket premium expenses that are required to purchase insurance.
Finally, early attitudes will be further shaped by the first year of full Plan operations during 2014. The processing of applications will continue through March, 2014, and individuals will begin to gain experience with insurance payments that are made for services received—and the out-of-pocket cost sharing that will be required for services.
Everyone covered by insurance through employment, or Medicare or existing Medicaid, may begin to experience any effects on access to services caused by the expansion of insurance and Medicaid coverage under the ACA. If established service patterns are disrupted, these patients may become more negative about the Plan.
In addition to the above factors, reactions by individuals will be affected by a variety of “unmeasured costs” that are associated with obtaining health care services. These unmeasured costs are associated with the real requirements felt by individuals as they interact with health care needs and access, but are not usually “counted in” when adding up health care costs.
These personal costs include the unmeasured expenses to access formal health care, which may involve out-of-pocket expenses (such as child care and transportation costs) and the value of time spent on obtaining care (due to waiting time and wear-and-tear due to crowding).
These personal costs may also include unmeasured expenses to access informal care, which may involve out-of-pocket expenses (to purchase alternative or over-the-counter care) and the value of time spent on obtaining care (as required to learn about care options and following up with alternative care strategies).
Such costs are difficult to measure but they are very real. Changes in these personal costs will help shape reactions to the ACA.
If these unmeasured costs are “felt” to be increasing, everyone impacted will likely become more negative about the Plan. If these costs seem to be remaining stable or improving, then they will play less of a role in determining overall reactions.
Previous installments of “Access to Care Reports” address the various ways in which access to care issues are affecting legal practices: