KNAYSI: The cloud of unknowing

The Virginia government is obligated to educate the public about the pros and cons of the Affordable Care Act

Examining the 2010 Patient Protection and Affordable Care Act (ACA) always proves to be a learning process. It’s an enormous, complex law, made more complicated by the emotionally charged, often misinformed debates which surround it. Yet for all the associated fear and confusion, the ACA could expand coverage to nearly 1 million nonelderly Virginians. As an emergency room employee who sees many uninsured, uninformed patients flounder in our healthcare system, I adopt a relatively apolitical viewpoint: if the public is to benefit from the ACA’s positive effects, education must play a crucial role in the rollout. And the Virginia government has a responsibility to lead this effort.

But throughout Virginia’s enrollment process, non-governmental institutions have taken the lead instead. Cville Enrolls, a coalition of community organizations assisting with education and enrollment via counseling appointments and seminars, is Charlottesville’s own example of such work. Virginia not only leaves these organizations to tackle outreach without state assistance, but has blocked key provisions like Medicaid expansion.

The Virginia government’s policies — like those of many state governments — maximize the ACA’s negative aspects and minimize its positive ones. Seeing as hundreds of thousands of uninsured Virginians could gain (much-needed) health insurance coverage, this seems a decidedly irresponsible and negligent way for our state government to respond to federal law.

I do not wish to play the blame game or speculate on what is politically popular — in Washington or in Richmond. Many of the uninsured patients who enter the University’s emergency department have not seen a primary care doctor in years, and so preventable diseases often become chronic illnesses. Some are eligible for Medicaid even without the ACA. The majority are completely uninformed about basic skills for finding affordable health insurance. Regardless of what many would prefer, we have a new healthcare law in this country. If acquiring health insurance means better health (it usually does), and the ACA is here to stay, then I believe the Virginia government has an ethical (if not legal) responsibility to help its 1 million uninsured citizenry gain coverage.

The ACA is a complex law modifying our already-complicated healthcare system. Public understanding is full of misinformation and misconception about some of its core policies and side effects. As a comprehensive 2012 empirical study concluded, “If the public had perfect understanding of the elements [of the ACA] that we examined, the proportion of Americans who favor the bill might increase from the current level of 32% to 70%.”

What might such “education” include? A basic topic that Cville Enrolls has dealt with is how to buy insurance in your price range and how to navigate Other fundamental questions to address might be: Are you eligible for Medicaid or tax credits? Will your eligibility change after the ACA goes into full effect? Do you fall into the coverage gap (i.e. the income span of those who earn too much to qualify for Medicaid but too little to get premium tax credits)? Does your employer insurance or immigration status affect your eligibility for financial assistance?

“It’s an inherently complicated process,” says Joe Bernhein, a Cville Enrolls counselor. “The website does give a lot of good information, and I think when you take the time to explain different plans, most of them are able to make their own choices.”

Yet despite a clear need for outreach, our state government has done virtually nothing to advance these goals. We are not so extreme as states like Florida, which is working to prevent social-service agencies from housing community workers who might educate and enroll the uninsured. On the other end of the spectrum, state governments like California embrace all provisions and are investing a significant amount of resources to increasing enrollment.

In order to make this law work, we need a government who is willing to take interest in a successful implementation. The Virginia government has denied Medicaid expansion, resisted implementation and seems to desire the collapse of the Affordable Care Act. Such an unhelpful, irrational response is not responsible governing. We have a new law — one with potential positive and negative impacts on Virginia’s population. Is it more ethical (and productive) to encourage the ACA’s negative effects or its positive ones?

George Knaysi is an Opinion columnist for The Cavalier Daily. His columns run Tuesdays.

Published February 11, 2014 in Opinion

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