I think it will be hard to know exactly where the gaps in our knowledge of the Patient Protection and Affordable Care Act of 2012 (PPACA) lie until all of PPACA that will get up and running is up and running.
The analysts at the Henry J. Kaiser Family Foundation, Menlo Park, Calif., tried to look at the effect of misconceptions about PPACA on consumers' views about PPACA by determining how poll participants' views changed when survey workers gave the participants information about PPACA.
The Kaiser analysts tried to look, for example, at what consumers are thinking about a PPACA provision that calls for some individuals who fail to have a minimum level of health coverage to make payments to the federal government starting with the 2014 tax year.
Congress called the provision a fine, not a tax.
When the U.S. Supreme Court upheld the PPACA individual mandate provision in June, it made a point of calling the provision a tax.
About 66% of the U.S. residents polled this month said they oppose the payment if it's called a fine, and 61% said they oppose the payment if it's a tax, Kaiser analysts report.
The Kaiser analysts say they think consumers are confused about how many people could really end up owing inadequate health insurance payments.
"According to the poll, nearly one in five Americans is under the impression that they will be subject to the penalty in 2014," the Kaiser analysts say. "Meanwhile, experts estimate that substantially fewer—roughly 1 in 10 Americans—will find themselves in the position of deciding between obtaining health coverage or paying the penalty. Since some portion of this group will decide to purchase health insurance, the subset that does end up subject to the tax penalty will be smaller than 1 in 10. The public opinion bottom line: a substantial number of people are anticipating a financial hit that will never come."
On the one hand: Whether you love PPACA or hate it, Kaiser runs a great health policy website. When I was at the National Association of Health Underwriters' annual convention in Las Vegas in June, it seemed as if many speakers who are not big fans of PPACA used Kaiser survey data. And the Kaiser analysts' are probably using reasonable estimates when they suggest that the number of people who would pay a PPACA no-insurance penalty would be much smaller than the number who are afraid that they might have to pay the no-insurance penalty.
On the other hand: It seems as if really strange things happen in this universe. The idea that 20% of U.S. residents could be at some risk of having to pay the penalty in 2014 or some other year in the next few years is not necessarily all that much stranger than the idea of Chief Justice John Roberts being the justice whose vote was responsible for the PPACA mandate being upheld.
Even if the percentage of people who are afraid of the penalty is 20% and the percentage who actually have to pay the penalty is, say, 5%, it could be that the percentage of people who have a realistic fear that they could end up having to pay the penalty is closer to 20% than to 5%. In some ways, maybe having the threat of having to make a new kind of payment to the government hanging over your head is almost as bad as having to make the payment.
And what if, instead of asking about "confusion" that makes PPACA look bad, the survey workers had asked about confusion that makes PPACA look good?
Maybe, for example, a well-run, high-minded think tank that, in its heart of hearts, opposes PPACA could ask a similar pair of survey questions. The first question could be, "How do you think PPACA will affect your access to your personal physician?" The second question could be, "What if you heard [Argument X]? Would you still have the same view about your access to your personal physician?"
With Argument X being the following: "The government will make your personal physician care for 12% more patients, overall, due to insurance program expansion, but cut your physician's overall government plan compensation by an amount to be determined to comply with Medicaid and Medicare budget-cutting requirements, unless your physician decides to take his or her money and run to the Bahamas to retire while he or she still has some money left."
Maybe the consumers who heard that effort to "clear up confusion about PPACA" would end up liking PPACA less, not more.
On the third hand: We could all go around in circles hyping and trashing PPACA all day, every day, until 2014, or whenever the PPACA insurance provisions die, come to life, or come to life in whatever heavily altered form that policymakers give to them over the next few years.
Chances are that many of the people who have the strongest feelings about the matter today will see what they want to see then, and we'll have years of survey reports based on the theme, "I told you so," from people on both sides of the divide.
It will be up to health insurance agents, brokers, company executives and plan administrators to try to help employers and consumers pick out a real path to meeting real health care needs through the fog of rhetoric.