What’s in a Name?

By Jeremy Kreisberg

My quarrel today is not with news outlets’ use of the term “Obamacare” as a replacement for the “Affordable Care Act” (or the still wordier “Patient Protection and Affordable Care Act”).  Granted, “Obamacare” is often used as a pejorative term by the bill’s opponents.  But if it’s easier for people to understand that news outlets are referencing the President’s health care law when they write or say “Obamacare” rather than “ACA,” then so be it.  After all, even President Obama embraced the term during the 2012 campaign.

My quarrel today is instead with news outlets’ use of the term “Obamacare” as an overbroad and misleading description of more specific aspects of health care reform.  I’ve seen this frequently over the last couple of months in the context of two major topics of news coverage: the Vitter Amendment and the rollout of the exchange websites.

  • Vitter Amendment

The Vitter Amendment was tossed around over the last month primarily as part of a deal to resolve the government shutdown and debt ceiling standoff.  Under current law and regulations, congressional members and their staff must purchase health insurance through ACA-established exchanges, but the federal government may continue to contribute toward their premiums as they do under pre-ACA employee benefit packages.  The Vitter Amendment, originally proposed by its namesake Senator David Vitter (R-LA), would block congressional members and (in some versions of the amendment) staffers from receiving these federal contributions toward their health care premiums (aside from what they would receive from ACA tax credits if their income is under 400% of the FPL).  Cut and dry, the Vitter Amendment would be a huge pay cut for congressional members and their staffers.  Unsurprisingly, many staffers were not pleased with the proposal.

But news outlets did not all report the amendment as such.  Senator Vitter presented his amendment as a move to “eliminate the Obamacare exemption for Congress.”  And some news outlets picked up this or similar phrasings in their headlines, calling the status quo allowance of federal contributions toward staffers’ health care the “Hill’s Carve-Out” or the “Obamacare exemption.”  In fairness to these news outlets, many stories with misleading headlines explained the amendment fully in the text, and headlines often require short, pithy phrases to convey a subject matter.  But as a recent Bloomberg Editorial explained well, it strains credulity to deem continuing federal health benefits for federal employees an “exemption” or a “carve-out” — particularly from the law as a whole!

Now imagine that you don’t know what this so-called “exemption” or “carve-out” really is.  Imagine still that you, like many Americans, don’t quite know what “Obamacare” does.  What does an “Obamacare exemption” mean to you?  Perhaps it means that congressional staffers get access to a different insurance plan than Americans who use the exchanges (not true).  Or perhaps the regulations on insurers and providers in the ACA don’t apply to the insurers and providers that staffers use (not true).  Perhaps it means nothing concrete at all, and is instead representative of special dealmaking that benefits Congress over regular citizens (not true).

Of course, the point is that “Obamacare exemption” does not convey any real information whatsoever.  And part of the problem is that “Obamacare” means a lot of different things to a lot of different people.

  • Rollout of the Exchange Websites
As the Washington Post’s Wonkblog has laid out in excellent detail, the federal exchange website — healthcare.gov — has experienced some troubling glitches, including significant delays and frequent error screens.  These issues may present difficulties for the overall rollout of the law if they are not fixed in the near future: If individuals cannot easily use the exchange websites, many individuals may not be able to receive insurance coverage on time and the insurers’ risk pools may be unpredictably altered.  News outlets sounded the alarm bells for the “flawed Obamacare rollout” — also known as the “Obamacare ‘train wreck’“.
Perhaps this use of “Obamacare” is not unfair.  After all, as I explained above, a non-working federal exchange website may have wide implications.  But it is worth noting that the Obamacare rollout involved a lot more than the release of a website.  Insurers had to decide how much they would charge consumers on the exchanges, and in many states these premium rates came in lower than projected.  The success of the law largely depends on getting young, healthy people to purchase insurance and subsidize the cost of insurance for people with pre-existing conditions, and early signs regarding youth enrollment are positive.
Of course, the website might be viewed as an important prerequisite to everything else.  But the question news outlets should ask themselves is whether they are delivering better information by using “Obamacare” rather than “healthcare exchange website” when they discuss they are discussing the glitches on healthcare.gov and not the law as a whole.

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