By Kara Carlson
The Cronkite School
For many Americans, health care and everything tied to it is never far from the mind.
How they spend, where they work, their prescription costs and many regular occurrences are all affected by health care and insurance.
Perhaps none are as contentious as the Affordable Care Act, which brings affordable health care to millions of Americans. It currently hangs in the balance, unclear if it will be allowed to continue after being ruled unconstitutional.Â
Changes in the health care landscape largely in part to the ACA have changed the surrounding cultural landscape of health care and how Americans view it, and how health care reporters do their jobs.
Stephanie Innes, a health care reporter at The Arizona Republic, and health care experts Swapna Reddy, clinical assistant professor at Arizona State University’s School for the Science of Health Care Delivery, College of Health Solutions, and Colin Baillio, director of policy and communications at Health Action New Mexico discussed the ramifications of the ACA and how it affects health care at the Society for Advancing Business Editing and Writing spring conference Friday in Phoenix. Â
While the ACA’s future has been debated for about two years, for now, Reddy said it’s still the “law of the land,” and therefore dictates how health care works in this country across all populations.
In December 2018, a Texas federal trial court judge in Texas ruled the Affordable Care Act unconstitutional, leaving it, and the nearly 20 million Americans that rely on it, hanging in the balance.
“We’re always talking about the very low income, vulnerable populations,” Swapna Reddy said. “The vast majority of us, the ebbs and flows of what happens to us, is regulated by the ACA.”
Today 20 million Americans rely on the ACA for their health care. In 2019, 11.4 million people enrolled in ACA marketplace plans, a drastic increase from 2014 when most provisions took place, which saw 8 million people, but a dip from the 12.7 million people in 2016.
“As a nation, the conversation has shifted and so has what we expect,” Reddy said. “The majority of people were not just uninsured, but uninsured and the services were not covered to what they thought they were paying into.”
State to state these policies can be vastly different, giving states largely different health care landscapes.
“It’s almost like living in two different countries” for health care standards, Baillio said, using Texas and California as an example. “Within each state there are unique stories to tell but there also are completely unique policy standards.”
Innes said it’s important to bring the stories of real people into health care, beyond just numbers and markets. Â
“A lot of times health care is hard to engage readers, because it can be abstract policy,” she said.
Navigating health care and its costs all have real people behind them. The ACA helps set policies across a number of hot button issues from reproductive and contraceptive health to chronic conditions. Baillio said hearing stories about real people with pre-existing conditions has largely shaped how people view that issue.
“We’ve changed the dialogue about pre-existing condition protections, but there are two sides. They cost money so it makes premiums more expensive,” Baillio said.
Premiums have seen significant increases in recent years. In 2014 average benchmark premiums were $273, compared to $477 on average in 2019.
“To me, what the ACA did that has been so incredible is it shifted this idea of what we think we deserve in health care, and what the government provides us,” Reddy said.
She said this is especially true with people’s view of pre-existing conditions. Largely, attitudes have shifted to demand coverage for these conditions, Reddy said, which is a recent development she believes is here to stay.
“If you want to win an election you need to support pre-existing conditions,” Reddy said. “Any proposals for health reform i don’t think have a chance if they’re not truly protecting consumers with preexisting conditions.”
