INDIANAPOLIS — It's been more than three years since President Barack Obama signed the health care law, more than one year since the Supreme Court upheld its central tenet and two weeks since the health exchanges opened nationwide, but supporters still face a surprising predicament: a confused public.
Extensive problems with the federal health exchange have caused delays and confusion in 36 states, including Indiana, and Attorney Greg Zoeller joined with 15 school districts in filing a lawsuit last week that challenges the core assumptions of the exchanges. Combine that with expansive changes to an already complex insurance industry, and supporters say they have their work cut out for them.
"There's been so much media with the hiccups in the online application process in the marketplace," said Lucinda Nord, vice president of public policy for the United Way of Indiana, said after the lawsuit was filed. She said people ask questions such as, "'Who are the navigators, and why aren't there more trained and certified yet? 'Is it one more obstacle or barrier?'"
Health law opponents — including Zoeller, who also filed an amicus brief opposing the validity of the law in the 2012 Supreme Court case — have noted that the federal government has not made understanding its own priorities very easy. An offshoot of the state's most recent lawsuit cites an alleged glitch in the law, arguing that residents enrolling in the federal exchange might be ineligible for tax credits that make most of the plans "affordable."
The broad confusion is hardly new. Public polling in the last year shows most people don't understand what the law does and a continuing on-air battle more akin to a presidential race has further muddied public perception. Late-night host Jimmy Kimmel even satirized the broad misunderstanding, sending a camera crew to the Hollywood Strip to ask people if they preferred "Obamacare" or the "Affordable Care Act" — most chose the latter, despite both terms referring to the same law.
In Indiana, the stakes are fairly high. More than 500,000 residents are eligible for subsidized insurance through the federal exchange. And even though the state has held off expanding Medicaid, another 72,000 to 92,000 low-income residents who already qualify for the program could be added to its rolls as part of the "woodwork effect" spurred by the individual mandate.
The very fact that the exchange is now open and makes plans searchable is helping clear some of the confusion, said Heather McCabe, a professor of social work at Indiana University-Purdue University Indianapolis and an expert on the health care law.
"At least it's no longer a theoretical. We're not guessing at what the prices are, we're not guessing at what the coverage is," she said. McCabe noted that even the name — "exchange" — has been somewhat confusing for those not steeped in health policy terminology.
The recent shift in supporters referring to the website as a "marketplace" is part of that effort to lift the fog. But, she said, "I think we still have work to do in getting out accurate information."