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Mythbusters: Affordable Care Act Edition

Myths About The Affordable Care Act: Breaking Through the Confusion

Understanding ACA

Introduction: Confusion about Health Care Reform

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (also known as ‘Obamacare’) into law in response to the urgent need for comprehensive health care reform. Our current health system has numerous critical problems including unsustainable healthcare spending, poor health outcomes despite the high cost of care, far too many uninsured/underinsured individuals, widespread and pervasive health disparities, and a strong (almost exclusive) emphasis on treatment of disease- rather than prevention. When we also consider problems such as Medicare spending, prescription drug costs, and the high prevalence of chronic diseases with associated high medical costs (e.g. diabetes, heart disease, and cancer), the future looks bleak for our current system. Although the Affordable Care Act (ACA) may not provide an immediate solution to every flaw in the nation’s healthcare system (there are a lot!), it represents a huge step in the right direction. Unfortunately, there is a lot of misinformation about the ACA that has caused a great deal of confusion among the general public, and for some a very negative perception of health care reform. This past March (2013), the Kaiser Family Foundation released the results of a national survey of public opinions and knowledge regarding the ACA, and the findings underscore the need to increase public awareness and correct the misinformation and myths that are now commonplace. For example, 48% of those polled reported that they have heard “nothing at all” about their state’s decision on whether to create a state-run health insurance exchange program where people who cannot get coverage from their employer can purchase insurance, and 78% reported that they have not heard enough information to say whether or not their state of residence will or will not be participating in Medicaid expansions. Further, over half of the general public is unaware that insurance companies will no longer be able to discriminate against those with pre-existing conditions, 52% are unaware of the tax credits provided to small businesses who provide insurance for their workers, and almost 6 out of 10 people (57%) believe that the ACA is creating a government-run health plan (it’s not). Those are just a few examples; the Kaiser report contains many more, and I recommend taking a look at the results to get a better idea of the startling trends in public knowledge, misconceptions, and overall confusion surrounding health care reform.

As a member of the public health community, I feel a sense of moral, ethical, and professional obligation to address any widespread trends involving misinformation and misconceptions that could have negative implications for the health of the American public. With the beginning of open enrollment in place, I thought it was perfect timing to write a series of articles focusing not only on dispelling the myths surrounding health care reform, but also on the sources of misinformation, the motivation behind some of these sources, the effects of such widespread misinformation, and the strategies that we can all use to ensure that we are well-informed and do not become innocent victims of strategic misinformation campaigns.


In this first post, I am going to start with a general focus on the origins of some of the myths and misinformation surrounding the ACA, as well as the motivation behind the myths, and the reasons why it is so hard to correct individual misconceptions once they are firmly implanted in our brains. Along the way, I will also provide accurate information to try to clear up any confusion caused by widespread dissemination of unclear, untrue, and/or inaccurate representations of the truth. My goal is not to try to sway your opinion of the ACA, but rather to ensure that you have the accurate information necessary to form your opinion. And you may just discover that health care reform is much more beneficial to you, your family, and society as a whole than you initially thought!

Sources of Misinformation and Causes of Confusion


Some of the confusion surrounding healthcare reform is understandable: the specific provisions of the ACA have undergone a series of changes since the legislation was signed into law over 3 years ago, and staying up-to-date on these changes is not an easy task. Further, there is a great deal of informal, often unintentional transmission of misinformation between friends, family members, coworkers, etc. For example, in a discussion with a former teacher from my high school, he confidently stated that the Individual Mandate, a key tenet of the health care reform legislation, had been eliminated from the ACA. Although the individual mandate has been a primary target of attack by Congressional Republicans, as of today it is still included in the law. During the discussion with my former teacher, he also voiced his belief that President Obama had “opted out of coverage under the ACA.” This statement revealed a much more fundamental misunderstanding of the law, as at the time of our conversation the insurance marketplace had not even opened yet; thus, it would not have been possible for the President to have opted in or out! But even more important is the fact that President Obama, as well as all members of Congress, will have to obtain coverage in the same manner as any American citizen; in fact, the President and members of Congress will have fewer options than other federal employees (see: http://www.factcheck.org/2010/04/more-malarkey-about-health-care/ and http://www.factcheck.org/2013/05/congress-and-an-exemption-from-obamacare/). Later on in my conversation with my former teacher, he began to get frustrated when I disputed these claims and asked a friend of his, who had served as a Congressional intern, to weigh in on the issue. Although a Congressional intern may very well have extensive knowledge of the ACA, they are just as likely to have very limited knowledge; in this case, the latter turned out to be true. I won’t go into details because it is not necessary, but in short, he had little to no understanding of the legislation, including when the insurance marketplace would be opening. I am sure that his experience as a Congressional intern afforded him wonderful experiences that increased his knowledge in many areas- but health care reform was not one of those. Why do I bring this up? Because it perfectly exemplifies the importance of examining the sources we rely on to get our information, and whether or not these are credible sources of information. Although it may seem plausible that a Congressional intern would be a credible source of information regarding a law passed by the U.S. Congress, it is also quite plausible that this particular Congressional intern never had any duties related to health care reform legislation and is no more clear on the law than anyone else. For example, as a PhD student in a school of medicine, I could potentially be very knowledgeable about the chemical properties of pharmaceutical drugs; however, my PhD has nothing to do with that, so I would not be a reliable source of information to turn to if you were looking for information about the binding affinities of benzopyran derivatives! Thus, my point is that just because someone has an official title or is affiliated with a legitimate organization does not imply that the information they provide has any merit.

I don’t believe that my former teacher had any malicious intent when he claimed this misinformation to be true; however, if I did not make such a concerted effort to stay on top of the latest news and the specific details of the ACA, I might have believed this information to be the truth. Thus, not all misconceptions of the legislation are caused by purposeful dissemination of inaccurate information. On the other hand, there is malevolent intent underlying much of the misinformation that has been spread (and is still being spread) throughout various media outlets, political campaigns, and other public forums. Whether for political or financial gain (or in some cases, a mix of the two), there are individuals and groups who are purposefully contributing to the dissemination of inaccurate, untruthful, and sometimes harmful information regarding the ACA and its implications for the American public. One example of this can be traced back to June 2012, when the South Carolina state director of the National Federation of Independent Business (NFIB) released a statement claiming that the implementation of the ACA will bring on an “onslaught of taxes and mandates” for small businesses, resulting in “job losses and closed businesses.” A little bit of background on the NFIB: in the first two years after the ACA was signed into law, the NFIB spent over $4 million in legal fees in their effort to convince the Supreme Court that the ACA was unconstitutional. Why would a small business association devote so much time and money to oppose healthcare reform? Although the NFIB claimed that they were fighting to protect small business, in reality, health care reform will not harm small business: for businesses with less than 50 employees, which account for 97% of all small businesses in the country, healthcare reform will not have any impact on the status quo regarding coverage requirements for employees. In other words, for the 97% of small businesses that are not currently required to provide health insurance to employees, the ACA will not change a thing. So if it not to protect small business, what is the motivation for the NFIB’s campaign to bring down the ACA? A quick glance at IRS 990 filings (non-profit/tax exempt filings) from NFIB and NFIB Small Business Legal Center for 2009-2011 provides a pretty clear answer to this question. For fiscal year 2010-2011, NSIB and NSIB Small Business Legal Center took in more than $10 million in donations from just 10 separate contributors, and over $8.5 million of that came from just 4 contributions, each exceeding $1 million in a single contribution. This is a stark difference from the previous fiscal year (2009-2010), when NFIB’s largest single contribution was $21,000. So who was making these huge donations in 2010-2011? Although the NFIB did not release the names of their donors willingly, the Center for Responsive Politics (CRP) did a bit of digging into the IRS filings of the NFIB as well as the top organizations disclosing donations to the NFIB; the results of their inquiry revealed quite a bit about the motivations of the NFIB’s assault on the healthcare reform law. In 2010, the same year that the NFIB launched their legal attack on the ACA, Crossroads GPS- a conservative “Superpac” affiliated with Karl Rove- contributed $3.7 million to the NFIB, making them the single largest donor ever to the NFIB. What does this all point to? Well, it would appear that the NFIB, rather than representing small business, is actually representing the interests of their largest donor- Crossroads GPS…. who happens to represent the interests of the Republican Party. (See: http://publicampaign.org/blog/2012/06/26/nfib-analysis and http://www.prwatch.org/news/2012/09/11767/secret-big-funding-small-business-group-exposed-new-website-nfibexposedorg and http://allianceforajustsociety.org/wp-content/uploads/2012/06/NFIB-Analysis.pdf for more information).


The previous example is one of many. Though some efforts to spread misinformation are more covert than others, any intentional attempt to conceal, distort, or otherwise misrepresent the truth is malicious. In a more recent example from the August 21st (2013) edition of Fox & Friends on the Fox News Network, co-host Steve Doocy presented an extremely inaccurate portrayal of a specific provision of the ACA known as the ‘Maternal, Infant, and Early Childhood Home Visiting’ (MIECHV) program. According to the description on the website of the U.S. Dept. of Health and Human Services, MIECHV is a “primary service delivery strategy… offered on a voluntary basis to pregnant women, expectant fathers, or parents and primary caregivers of children, birth to kindergarten entry.” The voluntary home-visitation program is designed to target one or more of the following outcomes:

  • Improvements in maternal, infant, and child health;
  • Prevention of child injuries, child abuse, or maltreatment, and reduction of emergency department visits;
  • Improvement in school readiness and child academic achievement;
  • Improvement in parenting skills;
  • Reduction in crime or domestic violence;
  • Improvements in family economic self-sufficiency; and
  • Improvements in the coordination and referrals for other community resources and supports.

The only requirement in the program is that participating states use evidence-based home-visitation models, which ensures that the care is as effective as possible and promotes optimal outcomes. Participation in the program is completely voluntary: individuals and families can choose if they want to participate, as well as if and when they want to stop participating. However, this was not the message delivered by Steve Doocy on Fox & Friends. On the show, Mr. Doocy claimed that the program was designed to “send government home inspectors to your house,” and suggested that “Obamacare [is] trumping your right to privacy and snooping on you and your family.” When Stuart Varney from Fox Business joined the discussion, he proclaimed that MIECHV is “an intrusion directly into your home and the way you raise your children.” The two came up with the term “the Obama snooper” to describe the healthcare professionals, including nurse and social workers, who will be in charge of carrying out the voluntary home visits. As a final insult to the truth, the text appearing on screen during the segment depicted MIECHV as “Nanny state solutions: Forced home visits for ‘at-risk’ kids.” It is easy to understand how someone could come to fear or resent the ACA if they are regularly presented with such startling (mis)information about the provisions of the program.

Unfortunately, Fox News has been the source of many deliberate mistruths about health care reform. Sarah Palin, former Governor of Alaska and 2008 vice-presidential running mate of Senator John McCain, has repeatedly appeared on various Fox News shows, including a recent (August 2013) appearance on Fox’s Cashin’ In segment, to warn the public of the “death panels” that are supposedly included in the provisions of the ACA. During this appearance- while purporting to report the truth as a contributor to Fox News- Palin made the following statement: “Of course there are death panels in there.”  In essence, Palin’s claim is that the health care reform legislation contains a system in which subjective judgments will be used to determine if certain individuals are worthy of healthcare. Although she has not referred to a specific portion of legislation that mandates these so-called “death panels,” most believe that the basis for her claims is Section 1233, which was designed to provide insurance reimbursement for counseling to discuss end-of-life issues such as advance directives and living wills. The biggest problem is that the notion that “death panels” are somehow included in health care reform is a completely fabricated idea; there is simply not one provision of the ACA that supports her claims. (See: http://videocafe.crooksandliars.com/heather/foxs-palin-continues-lie-about-evil-deathhttp://www.politifact.com/truth-o-meter/statements/2009/aug/10/sarah-palin/sarah-palin-barack-obama-death-panel/;http://www.dartmouth.edu/~nyhan/health-care-misinformation.pdf for more information).


When Palin first made claims about death panels in 2009, Politifact named it the “Lie of the Year“, FactCheck named it one of the biggest “whoppers” of 2009 , and the American Dialect Society named it the most outrageous term of the year. Yet Palin continues to make the claim, and has done so as recently as last month. Perhaps worst of all, she is not the only person making these inaccurate assertions. In an online column last month (August 2013), Breitbart.com columnist John Nolte claimed that death panels are “are already a part of Obamacare.”. Although his column was not focused on the idea of death panels, the last sentence in the article explicitly states that death panels are included in the legislation. That same week, Fox News contributor Marc Siegel used the term death panel to describe part of the legislation, claiming that it would serve as a rationing board for healthcare decisions. In the same segment, host Eric Boiling claimed that the legislation would “decide what medical treatment I’m going to be able to get”. There are many more examples of various Fox News contributors and hosts perpetuating the myth that the health care reform legislation includes provisions for the use of death panels to ration care, but I think you get the point. There is absolutely no basis for these claims; they have been repeatedly disputed by medical professionals, media analysts, and most importantly by the explicit text contained in the ACA, which states that “the proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost- sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria”. Regardless of the clarity of the statement included in the act of legislation, and despite the fact that the myth of death panels has been refuted by just about every credible medical association in the country, people still believe that death panels are included in the ACA. Let me be clear here, just in case I have not been in the previous paragraph: DEATH PANELS ARE A MYTH AND THEY ARE NOT PART OF THE AFFORDABLE CARE ACT.


Sometimes it is difficult to ascertain whether the media personalities who report such skewed information are actually unaware/uninformed, or if they are intentionally reporting misinformation. Recently, Ed Henry of Fox News asked White House press secretary Jay Carney if he would be enrolling in ‘Obamacare.’ Let’s back up for a moment. The ACA is not designed for people who already have health insurance that they are happy with. If your employer provides high quality, affordable health insurance and you are satisfied with your coverage, you are not the target group that the ACA was designed to serve, and although you have the option to purchase insurance through the ACA, it would not make a difference in most circumstances. The primary purpose of the ACA is to provide affordable, comprehensive coverage for uninsured and underinsured Americans- not for those who already have insurance. So back to Ed Henry’s question: will Jay Carney enroll in ‘Obamacare?’ Carney’s answer: “Absolutely…. If I did not have employer provided health insurance, like I’m sure you do, unless there’s something about Fox I don’t know, then I would absolutely enroll and it would be more affordable.” The question Ed Henry asked revealed one of two things: either he has a complete misunderstanding of the most basic, fundamental purpose of the ACA, or he was playing dumb in a (failed) attempt to score political points. This is on par with asking Jay Carney if he would be signing up to receive SNAP benefits (food stamps). SNAP is a good program, as is the ACA; but neither are designed for Jay Carney, and asking if he would enroll in either of those programs is, honestly, a pretty ridiculous question.


A Brief Analysis of Fox News & Media Bias

Bias is present in almost all types of media, including newspapers, magazines, radio, and particularly television. Network news channels, including NBC, ABC, and CBS, tend to have the least biased coverage, while cable news channels such as CNN, MSNBC, and Fox News, have the most bias in their coverage of current events (Auletta, 2003; Barker, 2002; Baron, 2006; Feldman et al., 2012; Larcinese, Puglisi, & Snyder, 2011; Pew Research Center, 2004). Although Fox News presents their coverage as “fair and balanced,” recent studies of the content and viewership patterns of Fox News indicate that the network may be even more biased than other cable news alternatives such as CNN and MSNBC. Let’s first take a brief look at the findings regarding the Fox News audience, which provide an indication of what viewers are looking for when they tune into Fox News. To begin, some of the basics: Fox News viewers are more likely to be White, Protestant, over the age of 60, and to attend church weekly (Gallup News Service, 2013). Fox News viewers have significantly lower levels of education than viewers of network news (e.g. NBC, ABC, CBS) or CNN (although interestingly, Fox viewers are more likely to have an income over $75,000), and the majority identify as registered Republicans (Gallup News Service, 2013 ;Morris, 2005). Although party identification is associated with viewership for other news networks (e.g. CNN viewers are more likely to be Democrats than Republicans), the relationship is strongest for viewers of Fox News, who are significantly more likely to identify as Republican voters (Gallup News Service, 2013; Morris, 2005; Pew Research Center for the People and the Press, 2004). Among core Fox News viewers, 94% either identify as or say that they lean Republican, compared to 63% of core CNN viewers who identify as or lean Democratic (Gallup News Service, 2013). Viewers of Fox News are also less likely to report watching alternative news channels, preferring to get their information only from Fox, while viewers of network news channels and CNN are more likely to watch multiple news channels to get their information (Morris, 2005; Pew Research Center for the People and the Press, 2004). Further, results from a Gallup poll in June 2013 indicate that Democratic and Independent voters are more likely to get their news from multiple types of media, including newspaper, television, Internet, and radio, while Republican voters strongly prefer television news; according to Gallup, the preference for television news among Republicans is largely accounted for by the disproportionate number of Republican viewers of Fox News.

Fox News has scored very high ratings and maintains a very loyal audience, which is often cited by Fox management as indicator of the quality of their network; however, I would also point out that shows such as “Jersey Shore” and “Toddlers and Tiaras” had extremely high ratings. Thus, the ratings for a network or the shows on that network do not necessarily provide an indication of the objectivity or veracity of the content; rather, ratings provide an index of various characteristics such as the loyalty and commitment of viewers to watch one station (or show) instead of another, the degree of congruence between the network’s content and the preferences of the audience, and the number of viewers who consistently watch one station to the exclusion of others. As reported above, the findings by Morris (2005) and those reported by Pew Research Center for the People and the Press (2004) and Gallup (2013) indicate that many regular viewers of Fox News do not turn to other sources for news; not only is Fox News the primary source of news for many viewers, but it is often their only source of news. Another very important finding reported by Morris (2005) is that people who state that they like news shows that share their own point of view are much more likely to watch Fox News, while this relationship does not exist for viewers of CNN or any of the major network news channels. Thus, viewers may tune into Fox to hear the news presented in a way that they like, rather than to get the most objective, scientific, or critical analysis of current events. All of these factors together demonstrate the very unique characteristics of Fox News viewers that are not seen among consumers of other TV news channels or other sources of news such as radio shows, newspapers, and news websites.

In many ways, Fox News has changed the media landscape. As Jim Rutenberg (2003) wrote in a piece in the New York Times, “Fox has brought prominence to a new sort of TV journalism that casts aside traditional notions of objectivity, holds contempt for dissent and eschews the skepticism of government as mainstream journalism’s core” (Rutenberg 2003). The way a news channel frames their messaging has many important implications, and viewers of Fox News are both consciously and unconsciously affected by the use of such media frames. Most importantly, the framing of a message affects whether or not the audience accepts it as true. As an example, Hart (2008) found that Fox News presents the issue of climate change in a way that conforms to mainstream conservative positions on the topic, rather than in an objective manner; instead of emphasizing the scientific evidence, Fox News focused on uncertainty surrounding climate change. In a separate study, Krosnick & MacInnis (2010) found that increased exposure to Fox News is associated with weaker endorsement of mainstream scientific conclusions regarding the causes, effects, and importance of climate change.

Several studies have also found that Fox News viewers are less knowledgeable about current events than viewers of other news channels and consumers of different types of news media. In one study conducted at Farleigh Dickinson University in November 2011, Fox News viewers were found to be significantly less informed about current events than those who say that they don’t watch any news at all. In contrast, other news sources had a positive impact on knowledge about politics and current events. For example, those who reported getting their news from newspapers including The New York Times and USA Today, as well as from the non-profit radio station NPR, were the most informed among the whole sample. Dr. Dan Cassino, a professor of political science at Farleigh Dickinson University and one of the analysts involved in the study, summed up the findings of their analysis in the following statement: “Because of the [statistical] controls for partisanship, we know these results are not just driven by Republicans or other groups being more likely to watch news. Rather, the results show that there is something about watching Fox News that leads people to do worse on these questions [about current events] than those who don’t watch any news at all.” In a separate study, Moore (2005) found that viewers of Fox News were significantly less knowledgeable about current events than viewers of CNN or any of the major network news channels. For example, even though Fox News viewers reported following the events of the Iraq war very closely, they had much less knowledge (i.e. were less likely to answer questions correctly) about various aspects of the war, including casualty rates, than viewers of all other news stations in the survey.

I will present one more finding before concluding this discussion. In one study, researchers assessed voting trends in several towns before and after the introduction of Fox News in the viewing area. The authors found a significant association between the introduction of Fox News Network with a subsequent increase in Republican votes in upcoming elections; the study estimated that Fox News convinced 3-28% of voters (depending on the town) to vote Republican (see: DellaVigna & Kaplan, 2007). I don’t know about you, but that doesn’t seem so “fair and balanced” to me.

You may be wondering why I spent so much time discussing Fox News in an article about the Affordable Care Act. I did so because I believe it is important to understand the strong bias that is present in many sources of information, but particularly information delivered from Fox News. Although media bias is inherent in almost every form of media and on most major news channels, these findings indicate that Fox News contains more bias and misinformation in their presentation of the news than pretty much any other available source, including other television networks as well as newspaper, radio, and Internet news sources. As a result, Fox News viewers are often left even less informed than those who do not watch any news at all, likely because of the confusion caused when misinformation is presented as truth. If you happen to watch Fox News, please know that this is not a criticism of the viewing audience- it is a criticism of the network. The reason that Fox News viewers are less informed is not that they are stupid or don’t pay attention to current events; the reason is that Fox News does not give their viewers an accurate depiction of current events! Blaming the viewers for their confusion would be similar to blaming students who scored badly on a math test, when all of the students were taught by the same teacher, who insisted that 2+2 = 5 and that all other math teachers are lying when they say that 2+2 = 4. In my personal opinion, Fox News is irresponsible and should be held accountable each time they present false information as the truth; Nyhan (2010) extends my viewpoint in his article, arguing that anyone in the public eye should be held accountable for spreading misinformation, particularly regarding important and ongoing matters such as the current implementation of health care reform.


How Myths Become Reality

So why does the myth live on in the media and in the general public? According to Brendan Nyhan, a Professor in the Department of Government at Dartmouth College who also publishes findings from his scholarly research as a political columnist for various news outlets, there are several explanations for the pervasiveness of myths such as those surrounding “death panels.” The psychological concept of “motivated reasoning” might help to explain some of the processes involved in accepting and believing information that has been proven false by irrefutable objective evidence (i.e. in this case, by the actual legislative document in question). In short, motivated reasoning posits that two mechanisms are involved in this type of politically- or ideologically- motivated belief in irrational information or ideas: first, people tend to seek out information that confirms their beliefs while avoiding information that contradicts their beliefs (also called “biased information search”); secondly, people tend to exhibit a strong bias toward their pre-existing views, which leads them to dismiss information that is inconsistent with these pre-existing beliefs while at the same time easily accepting the veracity of information that confirms their beliefs (also called “biased assimilation”). Biased assimilation is closely related to the concept of identity-protective cognition, which in turn is closely tied to group membership – particularly political party identification. Kahn and colleagues (2007) provide a good explanation of how identity-protective cognition works:

“Individual well-being…is intricately bound up with group membership, which supplies individuals not only with material benefits but a range of critical nonmaterial ones including opportunities to acquire status and self-esteem. Challenges to commonly held group beliefs can undermine a person’s well-being… Accordingly, as a means of identity self-defense, individuals conform their appraisals of information in a manner that buttresses beliefs associated with belonging to particular groups.”

These same factors are responsible for the initial acceptance of myths, as well as the difficulty of correcting them. As Nyhan (2010) points out, the almost limitless choices of media outlets produces an environment in which individuals can largely avoid information that would correct their misconceptions and can instead choose to seek out information only from sources that confirm them. The cognitive processes described above also influence the way we store and retrieve information, such that we are more likely to remember information that is consistent with our preconceived ideas and beliefs. Further, the “backfire effect,” a phenomenon in which personal beliefs are made stronger in the face of contradictory evidence, makes it quite difficult to effectively correct misperceptions by presenting rational arguments and factual information. In sum, whether or not we are conscious of these mechanisms, our ability and willingness to seek and accept evidence that contradicts our personal/political beliefs is strongly influenced by our own biases. In today’s media environment, personal biases have become easier to overlook, as we can selectively seek out information that tells us what we want to hear while scrolling right past information that is not in sync with our beliefs, or the beliefs of a group with whom we feel a strong sense of belonging (such as a political party).

Misinformation Campaigns and Malicious Motivations

As discussed earlier, misinformation surrounding the ACA comes from various sources with different motivations; while some misinformation stems from simple misunderstanding or lack of knowledge, many of the myths about healthcare reform are spread in strategic misinformation campaigns. To be blunt, the Republican Party does not want to see the ACA succeed; in fact, they have a very strong political motivation to do everything possible to make it fail. Although the Republican Party certainly has supporters from every walk of life, their policies primarily represent a much smaller segment of the population; namely, the richest, most powerful people in American society- the 1%. If you find this hard to believe, take a look at the top campaign donors to Republican candidates: in 2012, an elite group of Wall Street investors, oil tycoons, and billionaire businessmen contributed hundreds of millions of dollars to support the Romney presidential campaign and other Republican candidates up for election. For example, Sheldon Adelson, a Las Vegas casino magnate, spent upwards of $150 million on Republican candidates in the 2012 elections. Among the top 10 super PAC spenders in 2012, 5 were classified as “Against Obama,” 3 were “For Romney,” and just 2 were “Against Romney”. Although the Republican and Democratic Parties raised comparable amounts of money, 57% of the total campaign donations to the Democratic campaign came from donors giving less than $200 (compared to 24% for Republicans). At the higher end of the scale, only 11% of donations to the Democratic Party met the maximum limit for individual candidate donors ($2500), compared to 39% of donations to the Republican Party. Thus, contributions to the Republican campaign were fewer in number but greater in dollars; the exact opposite was true for the Democratic Party.  These numbers have deep meaning; there is a reason why the richest Americans support the Republican Party. The reason is that the policies and actions of the Republican Party result in great gains for the wealthiest people in our country while often harming lower- and middle-income Americans. This fact is hard to dispute when we look at the policies that are backed by the Republican Party, which include lowering estate taxes, supporting subsidies for “Big Oil,” protecting and subsidizing the pharmaceutical industry, boosting profits for the health insurance industry (in turn raising costs for consumers), and opposing financial reform to regulate big banks. The Republican Party has also been responsible for almost all of the major cuts to social programs in our nation’s history. Beginning with President Reagan in the early 1980’s, the Republican Party has adopted a pattern of shifting spending away from social programs and towards military spending and strategic tax cuts that largely benefit the rich while having little to no positive impact on poor and working class Americans; rather, these shifts in spending have increased the wealth gap in our country and increased major social problems including poverty, homelessness, food and housing insecurity, joblessness, and health disparities. Since the days of the Reagan administration, most major Republican candidates have followed in his footsteps and called for lower taxes and cuts to social programs, including healthcare spending.  (See: http://www.nhi.org/online/issues/135/reagan.htmlhttp://www.thenation.com/article/158321/reagans-real-legacy#axzz2e5iSdqPT ).

If there is still any doubt that the Republican Party is opposed to the ACA, consider the fact that they have voted 40 times (unsuccessfully) to repeal it and most recently, have actually shut down the government in a poorly planned attempt to defund the ACA. Thus, they have a very clear motivation for trying to sway public opinion against health care reform; however, I strongly believe that it is morally and ethically reprehensible to use misinformation campaigns to achieve this goal. If the Republican Party wants to influence public opinion, they should do so by presenting a thoughtful, rational, and truthful argument against the ACA. There is nothing wrong with having a difference of opinion, but there is something very wrong with using fear-tactics and lies to elicit support for a particular political position. Plus- if one has to revert to lying to shift public opinion on an issue, does that not imply that the argument is pretty weak to begin with?

Reliable Sources

Connection two persons

Even for the most discerning among us, it can be a difficult task to find reliable, objective sources- particularly on the Internet, which seems to be filled with more misinformation than truth. When searching for information about the ACA, it is extremely important to consider your sources and analyze their veracity before accepting any information as the truth. In a recent poll released by the Kaiser Family Foundation, researchers found that most Americans are not getting their information about health care reform from trusted sources. While 81% of Americans report getting information about the ACA from news media, only 22% got information from a doctor or other healthcare professional, and only 16% got information from federal agencies such as the Department of Health and Human Services- the principle Federal agency in charge of providing healthcare services, protecting the health of Americans, and carrying out the most significant responsibilities involved in the health care form legislation. In other words, the most reliable, trustworthy source of information is among the most underutilized resources. More Americans get their information about the ACA from social networking sites like Facebook and Twitter (23%) and TV shows like ‘The Daily Show with Jon Stewart’ or ‘The Colbert Report’ (19%) than from the government agency in charge of the legislation. Not unsurprisingly, the widespread reliance on the Internet and other media sources for information has contributed greatly to misperceptions about the law. In a startling finding from the Kaiser survey, only 57% of the general public reported being aware that the ACA is still the “law of the land” and is still being implemented. Thus, almost half of Americans are unaware of the current status of the healthcare law…!

How can you avoid becoming a victim of misinformation? Below are a few tips to consider when seeking information- I hope they will help you recognize deception and ensure that the information you trust is actually trustworthy:

1)   Don’t believe something simply because it is reported on the news. As we saw in the examples presented earlier, the news does not always present accurate representations of information. Although we should be able to trust our news sources, the bottom line is that we can’t. Even if something is reported by multiple news agencies, it does not mean that this information is factually correct. Often, news agencies get their information from the same source; if that original source was incorrect, so are the subsequent news reports.

2)   Always consider the potential motivations behind your sources. Whether political, financial, or personal, any type of agenda can be a source of bias, and the veracity of information passed on by anyone with a strong agenda should be questioned. This is not to say that no one with agenda can be trusted. For example, the American Public Health Association (APHA) has an agenda to promote public health through research, education, intervention, advocacy, community organizing, and other strategic action plans; however, this agenda does not conflict with their ability to present factual information. Related, the APHA has an incredibly informative website with information, resources, and useful links related to the ACA. If you are seeking information, this is a great starting point.

3)   Don’t believe information just because it comes from someone with a professional title or because it is a person you know or like; as we discussed, biases are strong and often unconscious, and everyone is subject to their influence. Although your friends or family members may be acting in good faith, this does not ensure that the information they are giving you is true. They may have been given false information, which in turn could be passed along to you.

4)   When in doubt, turn to the original source: the government. Several government websites have a collection of wonderful resources with comprehensive, reliable, and updated information about the ACA, including FAQ’s, timelines for implementation and important dates to know, and helpful links to other websites. The best “.gov” sites include:

A) http://www.hhs.gov/opa/affordable-care-act/index.html;

B) http://www.whitehouse.gov/healthreform#healthcare-menu;

C) https://www.healthcare.gov; and

D) http://www.medicaid.gov/affordablecareact/affordable-care-act.html.

5)   If you must watch Fox News, take the “news” they report with a grain of salt- and a healthy dose of skepticism 🙂 Fox News is notorious for presenting misinformation, and even scientific studies of media bias have found that Fox News tends to be the most partisan, biased news source of all cable and network news channels, leading to a more uninformed and confused audience. Don’t let them trick you.

Coming Soon….


In the next article in this series on the Affordable Care Act, we will look more closely at some of the specific myths and common areas of confusion. Most importantly, for each myth I will present accurate information from reliable sources to clear up any misconceptions and hopefully reduce some of the anxiety, fear, and uncertainty that have resulted from the widespread confusion surrounding the ACA. If you are reading this and have specific questions or want to know about a specific aspect of the ACA and how it will affect you, I encourage you to submit your questions (by leaving a comment) at any time. I will then do my best to answer your question(s), and if I feel that I am not adequately equipped to provide a reliable and accurate answer, I will direct you to the best resources to solve your dilemma. There is no reason to fear the upcoming changes to our health care system; I think in time we will all come to see this, but in the meantime I hope that I can provide a bit of reassurance by giving you the factual information necessary to understand how these changes will affect you and your loved ones, and to help you find the truth about the Affordable Care Act in the face of overwhelming misinformation. To make this task a little bit easier, I have provided links to the resources mentioned in the article, as well as several additional resources to find reliable and valid information about the Affordable Care Act.

As the implementation of the ACA continues to unfold over the next several months, into 2014 and beyond, there will be challenges to overcome as well as successes to celebrate. In the long run, if politicians can agree to allow health care reform to unfold and play out in its entirety, there is no reason to believe that it will be anything other than a major improvement to our current system, and a monumental step towards improving health outcomes for every American. The right to equity in health and health care are fundamental human rights that should not be dependent on a person’s race, gender, income level, geographic location, age, or any other individual characteristic, and the Affordable Care Act is the first major act of legislation in many, many years that holds tremendous promise to address the widespread health disparities that affect millions of our fellow citizens each and every day.

Online Resources


Auletta, Ken. 2003. “Vox Fox: How Roger Ailes and Fox News Are Changing Cable News.” The New Yorker (May 26):58.

Barker, David C. 2002. Rushed to Judgment: Talk Radio, Persuasion, and American Political Behavior. New York: Columbia University Press

Baron, D. P. (2006). Persistent media bias. Journal of Public Economics, 90(1), 1-36.

DellaVigna, S., & Kaplan, E. (2007). The Fox News effect: Media bias and voting. The Quarterly Journal of Economics, 122(3), 1187-1234.

Feldman, L., Maibach, E. W., Roser-Renouf, C., & Leiserowitz, A. (2012). Climate on Cable The Nature and Impact of Global Warming Coverage on Fox News, CNN, and MSNBC. The International Journal of Press/Politics, 17(1), 3-31.

Kahan, D. M., Braman, D., Gastil, J., Slovic, P., & Mertz, C. K. (2007). Culture and identity‐protective cognition: Explaining the white‐male effect in risk perception. Journal of Empirical Legal Studies, 4(3), 465-505.

Larcinese, V., Puglisi, R., & Snyder Jr, J. M. (2011). Partisan bias in economic news: Evidence on the agenda-setting behavior of US newspapers. Journal of Public Economics, 95(9), 1178-1189.

Morris, J. S. (2005). The Fox news factor. The Harvard International Journal of Press/Politics, 10(3), 56-79.

Pew Research Center for the People and the Press. 2004. “Cable and Internet Loom Large in Fragmented Political News Universe.” Jan. 11

About publichealthwatch

"Science is a way of thinking much more than it is a body of knowledge." -- Carl Sagan

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