For supporters of the Affordable Care Act, the best defense is a good offense.
Last month health care advocates around the country, joined by White House surrogates, held more than 200 events to celebrate the one-year anniversary of the passage of the Affordable Care Act. The events, which garnered extensive national and local press coverage, trumpeted the benefits that the new law has already delivered to seniors, small businesses and young people. That is the same message that the Administration and most of its allies have relied on since the law passed. But by now it should be clear that it is far from enough to move the public, which remains deeply divided on the law. It is time for a new strategy, based on the reality that for most Americans health care reform might well have never happened.
The Administration and its allies have done a good job getting the word out about the immediate benefits of the new health care law. But relying on this as the core communications strategy, in the face of relentless demonization of the law by opponents, can only get supporters so far. Continuing to rely on it exclusively would be a huge mistake at a time when opponents are accelerating their attacks.
The theory behind the current message is that if the public could only just realize how many people are all ready benefiting, it would rally behind the law. The problem with this message is that while the people who are reaping the new benefits don’t need a public relations campaign to convince them, it is lost on the great majority of people who haven’t yet been directly helped by the law.
The reality is that for most families, nothing has changed. The historic provisions of the Affordable Care Act, the ones that will make affordable health care a right, don’t kick in until 2014. These are the measures that will make health care affordable to people if they lose their jobs, start a small business or retire early and that will improve health coverage at work for millions of people in low-wage jobs. The single most widely popular part of the ACA, banning insurance companies from denying coverage to people without pre-existing conditions, also starts in 2014.
During the campaign to pass health reform, the White House and many reform advocates focused on the specific provisions of the proposed legislation, all of which poll very well. But a laundry list of attractive features, which people readily agree with in polls, amounts to a wish list, a pipe dream, in people’s lives. That was no match for the fear-mongering about death panels, Medicare cuts, and government-takeovers by the bill’s opponents.
The only antidote to fear is anger and hope. After the August tea parties, the Democratic leadership in the Congress started to adopt an anti-insurance message and the President inched that way too. But it was only with his back to the wall, after Scott Brown’s election to the Senate in January of 2010 threatened to kill health reform, that the President used a big California health insurance rate hike as a pretext to attack the health insurance industry. And it worked!
It is understandable that reform advocates and the White House would rely on the strategy of touting the specific accomplishments of the legislation after it became law. Congress made sure to institute some popular benefits in 2010, in order to show people that the law could deliver right away. But after months of Republican and right-wing demonization of the ACA, it is clear that it’s time for a new approach. The public will only start understanding and believing in the law’s historic provisions, the ones that actually make health insurance widely available and affordable, when those provisions move from promise to reality in 2014. Until then, the battle has to be fought as if the law’s basic existence is in question, which it is.
To connect with people now, the Affordable Care Act has to be connected to the issue that is still central to the public: jobs. One out of five Americans are either out of work or underemployed, and most of the rest are scared that any day they could have their job, health insurance, and even their home taken from them.
Our message should be: “Instead of helping hard-pressed working families, Republicans want to keep the health insurance companies in charge and block the new health insurance law, which will guarantee affordable coverage even if you lose your job. If the insurance companies and the Republicans win, then our families will lose, and the promise that we will finally have a guarantee of good health care we can afford no matter what happens will be taken away.”
We can’t defend the ACA by being on the defensive. We need to attack the enemies of the ACA, painting them accurately with the same brush that we need to use on every issue. The opponents of health reform are the same people, funded by big corporations and their CEOs, who have gotten rich by destroying the middle class. We need to show Americans that we understand their pain, a pain that we can’t pretend will be relieved by the modest initial provisions of the new law. We need to direct their anger at those who continue to profit while the rest of us get squeezed. We need to make it clear that we are on their side.
Richard Kirsch is a Senior Fellow at the Roosevelt Institute, whose book on the campaign to win reform will be published in 2012. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.