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Tuesday, October 25, 2016

Obamacare is at a record level of unpopularity even as it is helping many millions of people in exactly the ways its creators intended. This is an epic branding disaster, but also something more profound: a failure of vision and linguistics that has made it easy for conservatives to target a president and weaponize a needed law.

Most federal programs of this magnitude are meant to become national institutions that last for decades, even centuries. And they have names that reflect those aspirations — neutral, patriotic, suggestive of universal concern. If you look them up, you can find out which president signed them into law. But you can’t tell from their names.

Do we have FDR Security? No, we have Social Security. Do we have Johnsoncare and Johnsonaid? The Kennedy Corps? The Clinton Children’s Health Insurance Program? The Ford Income Tax Credit? The Nixon Anti-Pollution Agency? No, no, no, no, no and no.

We are now faced with “Obamacare,” a nickname invented by Republicans as an insult. President Obama has tried to detoxify it (“that’s OK, because I do care,” he said in 2012), but it remains a nom de guerre few besides Obama could love. His low approval ratings are no doubt contributing to the disaffection for the law itself. What Republican president — or Democratic one, for that matter — would feel ownership of a program called “Obamacare,” no matter what it does? Even if it were popular?

And it is far from beloved, at least in the abstract. An all-time low of 37 percent approve of the law and a record high of 56 percent disapprove, “even as it has had obvious success in reducing the uninsured rate,” Gallup reported this month. The negativity also persists even though majorities continue to favor many parts of the law, among them requirements that insurance companies sell policies to people regardless of their medical conditions and let parents keep adult children on their plans until age 26.

The awkwardly named Patient Protection and Affordable Care Act gave such protections equal billing. Shortened to the Affordable Care Act, that element was lost. Furthermore, given constantly rising health costs, the focus on affordability invited derision. Shortened even further to its initials, ACA, we have a title that to most people signifies nothing at all. And thus we arrive at Obamacare, the only short, descriptive identifier in the arena.

Frank Luntz, the Republican wordsmith who came up with phrases like “death tax” (for estate tax) and “energy exploration” (for oil drilling), says he would have called the law The Healthcare Security Act. “No one is against security,” he told me in an email. The ACA architects could have built on a name like that or on something people already like, such as MedicareUSA. Or how about the USACares Act (which as I write is available as a dot-com website for $2,000 from Go Daddy)? Clearly the administration was not thinking legacy, or even hashtag.

What’s in a name? More than you might think. In a 2013 CNBC poll, some respondents were asked about the Affordable Care Act and others about Obamacare. Only 37 percent were opposed to the ACA compared with 46 percent opposed to Obamacare. Similarly, in an NBC News/Marist poll of registered Kentucky voters last spring, only 33 percent had a favorable view of Obamacare while 57 percent had an unfavorable view. When they were asked their impression of “Kynect,” the online state insurance marketplace, 29 percent viewed it favorably and only 22 percent negatively (the rest were unsure or hadn’t heard of it). “Call it something else, and the negatives drop,” Marist pollster Lee Miringoff said at the time.

A big, ambitious program needs a solid, enduring name, not one that polarizes the nation, decimates its sponsor party in every midterm, and creates fertile ground for both Beltway-fed stormlets like Grubergate (ACA advisor Jonathan Gruber’s wildly inappropriate comments about “the stupidity of the American voter”) and highly threatening legal challenges like the one pending at the Supreme Court over subsidies for low-income policyholders.

All of that notwithstanding, my sense is that Obamacare, with its roots in the conservative ideas of market competition and personal responsibility, will endure and be a key part of Obama’s legacy. It’s not too late to give future presidents a way to become more comfortable with the law — a “permission structure,” as Obama once called it. In his first campaign, when some people were reluctant to vote for a seemingly exotic newcomer, the permission structure involved endorsements from people like Ted Kennedy and Colin Powell. For Obamacare, it may be as simple and as complicated as substituting a new name for one that is guaranteed to turn off half the country or more.

Follow Jill Lawrence on Twitter @JillDLawrence. To find out more about Jill Lawrence and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at

AFP Photo/Karen Bleier

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  • TZToronto

    The Republicans were smart (are there smart Republicans?) to derisively call the ACA Obamacare. I guess they assumed that the program would fail miserably and forever be linked to Obama’s failed Presidency. Of course, the failure has not happened, despite the GOP’s worst efforts. It’s about time for Democrats to start using the official name. As more and more people realize the benefits of the Patient Protection and Affordable Care Act, they’ll begin to see just how big an accomplishment this is. Now, if the Democrats, the party of the people, can somehow manage to demonize Republican candidates in the same way Republicans have tried to demonize President Obama, something akin to universal health care might be possible starting in 2017. All they have to do is call the Republican non-health care plan the Get Sick, Go Bankrupt, and Die plan.

    • hicusdicus

      How about going to the doctor and then just paying your bill. A lot of peoples ailments are self induced. Take personnel interest in your own health. Read books research the internet. Put out the cigarettes and throw away the whiskey bottle and pay attention to what you eat. You are going to die anyway so why not be miserable till it happens. Be a liberal and you will live forever. If that is not hell on earth what is?

      • Independent1

        Let’s forget about just the insurance aspects – how about the financial side of ACA where it’s saving many states millions of dollars because its reduced the uninsured and readmissions rates. Here’s some info I put together which talks not about healthcare per se about about saving lives and money.

        Isn’t saving lives and saving hospitals, people and states money important???

        BOOSTING THE ECONOMY – In the early part of 2014, when the economy was actually stumbling because of the bad winter weather, it was ACA that helped boost the economy by freeing up spending money for millions of
        Americans who no longer had to pay, or worry about paying, for the healthcare they were getting or may need in the future. Even in the red state of Arizona, experts are predicting that ACA will boost the Arizonian economy by billions over the next few years because Arizona chose to expand Medicaid. And it’s also projected that ACA will be the driver for creating about 15,000 new jobs in Arizona over the next 3 years. And ACA is boosting the economy even today by freeing up even more money for millions of Americans to spend as more have Americans have signed for ACA compliant policies.

        .SAVING LIVES – A projection has been made that ACA may already have saved the lives of as many as 15,000 Americans by having provided them with insurance they never had before, which prompted them to see a doctor who determined that they had a medical condition that may be fatal if it wasn’t treated in time. And in some cases, by forcing hospitals to be more careful of their treatment so fewer patients have gotten illnesses while in the hospital
        which have turned out to be fatal. And a projection has also been made that in the red states where Medicaid has not been expanded, that as many as 17,000 Americans may die prematurely this year because of the GOP’s decision to not expand Medicaid in as many as 24 states.

        .SAVING HOSPITALS AND STATES MONEY BY REDUCING READMISSION RATES – ACA has been found to be driving down readmission rates because hospitals are not fully reimbursed for the cost of treating patients that are readmitted to a hospital when it’s evident that they really weren’t well when they were discharged, or they actually picked up an additional illness while in the hospital. And hospitals are finding that reducing the readmission rate is saving them, and the state, money (hospitals are having to provide extended care for less and less uninsured patients than they had been)..

        .SAVING HOSPITALS AND STATES MONEY BY REDUCING THE UNINSURED RATES – ACA is also driving down the uninsured rate which is in some cases greatly reducing the number of people that are coming into emergency rooms who cannot pay for their care (some hospitals are seeing a reduction of as much as 40% or more in unisureds), and instead, ACA is allowing for these people to be examined in a doctor’s office where they should be. The combination of reduced readmission rates and decreased uninsured rates, has resulted in not only
        greatly improving the profitability of man hospitals in states that have embraced ACA, but it has also resulted in many states seeing millions and maybe billions in savings because of the reduction in the monies states need to send to hospitals to reimburse them for the health care patients had previously been unable to pay for.

        .SAVINGING AMERICANS MONEY –ACA is saving all Americans money today by having contributed to slowing down the rate of increase of healthcare costs since it was enacted. I couldn’t locate an article I read on this some
        time back but I remember reading some experts projected that today’s average healthcare premiums would be at least 25%-40% higher than the are now had healthcare costs continued to rise at their normal pace. and in addition, millions of Americans are saving money not only because of the health care subsidies but also because the increased competitiveness created by ACA has forced more health insurers to provide Americans with lower rates than they would have without ACA.

        • hicusdicus

          Until humans start taking an active interest in preserving their own health all the doctors, pills and health insurance will not do them much good. Several doctor acquaintances have told me this, it is not just my opinion. A 58 year old man came over today to buy a stove and was telling me about his multiple bypass surgery and all the chest pain. While telling me his medical history he went through 4 cigarettes. He had plenty of insurance, so why not. You are going to foot the bill for millions of these people. So you better get two jobs.I am not. I am government proof. I worked 70 years to get that way and it is a secret. You can blather all you want on these internet sites and it will accomplish nothing. You are going to die with or without insurance so get used to it.

          • TZToronto

            So you’re saying that he was smoking because he has insurance? No, he was smoking because he was addicted to nicotine. There are plenty of people, with and without health insurance, who would love to kick the nicotine habit be can’t.

          • hicusdicus

            None of the above. He is plainly and simply stupid. By the way nicotine is not addictive . Google it. There are several gases in tobacco that cause the addiction but not nicotine.

          • TZToronto

            I Googled it, and everything I read says it’s addictive. And yes, he’s probably stupid, too.

          • hicusdicus

            I read it about a month ago. It was some research group working on nicotine addiction. Their comment was we always assumed it was nicotine so nobody really checked. It may have been John Hopkins. It was in a health news letter I think. You may have to dig. You should dig up the tests on pot smokers versus non smokers of any kind. It will fillet your brain. Pot smokers have better lung function. My doctor even read it in his medical papers.. Humans live on the myth of assumption. Political comments are the cesspool of human intelligence.

  • elw

    I find it hard to believe that finding a different name for the ACA will make much of difference to how people respond. Wordsmithing is the game of intellectuals and causes confusion for the greatest number of people. Whether you call it Obamacare,

  • 14hei

    The problem with the ACA is not that it is called Obamacare. The problem is that for the very low income individual or family the coverage they can afford even with the subsidy has too high a deductible before the coinsurance. An this is not explained clearly on the website. The Bronze Plans cover almost nothing until the deductible is meet. A 30% copay after deductible, means you pay the full price till the deductible is meet. An then you pay 30% of the cost. Most people shopping for insurance on the exchange do not understand that. The truth is that medical care costs have gone up so high that they are unaffordable for low and middle income individuals. This is why single payer is needed in this country. The rest of the industrialized world has already figured this out. It is time we join them!

    • hicusdicus

      You join them. I like things the way they are. Everything is going down the toilet and I get to watch. If you like other country’s so much why don’t you try one.

    • Independent1

      Not sure what state you’re in (wouldn’t happen to be a red state like Texas would it) but have you really done a good job of finding the best policy. We have some low income members of our family and they’ve found policies that are no way like you describe.

      And here’s something to keep in mind. Studies done in 2013 showed that a lot of plans supposedly being offered as meeting ACA out of pocket and other limits – didn’t really meet the ACA criteria. You really need to be careful in your shopping because there are companies out there that are really trying to hoodwink people by selling them what are supposed to be ACA compliant policies but are not. See this:

      The annual out-of-pocket spending limit for the Bronze Plan and other new ACA plans is $6,250 for individual coverage in 2013.1HealthPocket compared this amount to the current out-of-pocket limits for 9,752 health insurance plans across the United States to determine the extent to which this new limit represents increased financial protections for the consumer. Our initial analysis revealed that the Bronze Plan’s out-of-pocket limit was lower than 29% of the plans examined. However, further analysis revealed that 38% of the plans did not include the plan’s deductible within their out-of-pocket limit, concealing the full amount a beneficiary could pay annually if the Summary of Benefits wasn’t read carefully.

      For some carriers, every plan they offered within a state excluded the deductible from the out-of-pocket limit. For example, well-known Blue Cross Blue Shield organizations in Texas, Kansas, and Illinois were numbered among the insurance companies engaging in this practice.

      I’m back: Note that the ACA out of pocket limit of $6,250 is much lower than what was the average before ACA, along with much lower deductibles than what the pre ACA plans forced on people.

      Many people are forgetting when they try to compare insurance costs today against their plans prior to ACA, that not only are out of pocket and deductibles required to be lower today, but then there’s a whole host of added benefits that today’s policies include (which cost the insurers plenty), which pre ACA plans didn’t require the insurers to provide – some really big ones being:
      – Not being able to refuse coverage for pre-existing condition
      – Not being able to cancel a policy just when you need major healthcare (a practice called recission)
      – Not being able to refuse coverage because your plan has an absurd annual or lifetime limit like $10,000.
      – The requirement to cover a families children to age 26

  • howa4x

    People don’t hate the benefits of the ACA they hate the fact that they have to buy expensive insurance. My son a healthy 26 yr old was quoted 800./month for coverage because he makes too much for the Medicaid expansion. He is no fan of it now. If the democrats in the Senate stood their ground and passed the public option like the house did, everyone would have loved it. But the Republicrats that owed Wall st and the insurance industry, went for their profits over peoples health. Democrats have to learn that when they act like republicans they loose. This is why they lost this time. People see them too tied to Wall st and not the middle class.
    I’m against the individual mandate since it is only there to enhance the profits of the insurance companies. If true business principles were applied a healthy person should pay less since they cost less, but in this system the healthy cover the cost of treating the sick. This is why it is hated. Funny it was written by the Heritage Foundation for that very reason: to protect insurance profits. People will wake up when they see the republican version that will allow the insurance companies to again drop people from coverage to boost profits. That will be the big joke on all the middle class people who voted republican. Once all you overweight people get dropped again don’t come crying at the government door, until at least 2016.

    • Independent1

      Is you son’s income so high he doesn’t qualify for a subsidy to reduce his premium? The premiums for my daughter and son-in-laws policy was close to $1,000/mo for both of them but after their subside it was under $100/month.

      And the healthy subsidizing the less healthy, ore the younger subsidizing the older, is the way insurance has always worked. It’s that way in life insurance, it’s that way in auto insurance (the safe drivers subsidize the lousy drivers), and it’s that way in health insurance.

      If insurance companies created insurance rates for just the healthy and just those with higher risks, only the younger healthy insureds WOULD EVER be able to afford life insurance. And similarly with auto insurance – if auto insurers created rates applicable to just the drives with excellent records and separated out those with some accidents – no one but safe drivers would ever be afford to drive a car – there would be about 1/5 the cars on the road.

      • hicusdicus

        1/5 the cars on the road. Sounds like a winner to me.

    • Justin Napolitano

      The individual mandate is so that people do not game the system. By that I mean wait until they are sick and then buy insurance. Since the ACA requires insurance companies to provide coverage regardless of whether the person has a preexisting condition everyone must get insurance. A good analogy would be someone getting into an auto accident and then calling their insurance company an expect them to write an insurance policy covering their preexisting wrecked automobile.

      • howa4x

        I a capitalist society everything is a business including the illness intervention and disease maintenance system. The problem is that each sector is fighting the other for market share, so Big Pharma has no economic incentive to cure anyone and that is where disease maintenance comes in. Hospitals need illness intervention to make money. Both groups rely on a vey sick population for their wealth. People are living longer but not healthier. So now we are asking a younger group of people to provide the profit in the system to the group that is paying the other two sectors, the insurance companies and share holders. So they are charged exorbitant rates so profits in the 18-20% range can maintained by the ins industry an Wall st.
        Now the issue here is this population is struggling to find worth while work.and at the same time struggling to pay off college debt. So Wall st bankers are making interest off the loans and Wall st investors now want to make a profit off their policies. This is the group with the least assets , and they are asked to pay the most.
        This is why the public option is needed to bend the cost curve in Illness care because the real expense in the system is the profit.

  • Charles

    The problem is that there wasnt first reform in the industry. Now people have to support giant profits for all medical people whether they like it or not. First reform then start a national system. This must go down in flames.

  • Bestuv Burke

    If Obama will lie to you about keeping your insurance and your doctor, he will most certainly lie to you about everything else.

  • Melissa Newton

    If Obama will lie about your healthcare and about his Uncle Omar, is there anything he won’t lie about?