What Has Health Care Reform Changed?

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The second anniversary this Friday of the passage of the Patient Protection and Affordable Care Act comes at a tricky time. While the Obama administration has been busily stumping for the president's landmark health care reform law, looming just ahead, on Monday, is the start of a U.S. Supreme Court case that could potentially dismantle it.

The White House continues to extol how the law is already benefiting millions of Americans — through new access to health insurance for children and adults with pre-existing conditions, for example, and bans on health insurance lifetime limits — but that good news hasn't reached the same heights of attention as Republican presidential candidates' almost daily skewering of the tyranny of "Obamacare."  

But Cecilia Munoz, director of the Domestic Policy Council, says that this is all par for the course when it comes to major reforms like the Affordable Care Act. In an interview with The Root, she explains why the Obama administration is paying little mind to the legal challenges and pundit-level criticism; the ways in which the law makes a difference for African Americans; and how, when it comes to fully implementing it, the administration is leaving room for improvement.

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The Root: The Republican presidential candidates have all said that one of the first things they would do if elected is repeal the Affordable Care Act. What would be the immediate impact if the law were repealed?

Cecilia Munoz: We'd no longer have a law protecting people from discrimination because they have a pre-existing condition, or from being thrown off their health care insurance because they get sick. We know that 2.5 million young adults have gained coverage on their parents' plan because of the Affordable Care Act — and that includes 410,000 African Americans within that number.

We know that 5.5 million African Americans are eligible for preventive care without co-pays and co-insurance now as a result of the Affordable Care Act. We know that about 10.4 million African Americans are now free of having to worry about lifetime limits on coverage, thanks to the Affordable Care Act.

We're talking about turning back the clock on all of that if this law were to get repealed. These are tangible changes that are affecting real people.

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TR: Still, on Monday the Supreme Court will begin hearing arguments in a lawsuit challenging the law's constitutionality. Why does the administration feel confident about the legal soundness of the individual mandate in the face of this looming challenge?

CM: The Supreme Court is going to hear six hours of argument, and there hasn't been that lengthy an argument in the Supreme Court in many years. It recognizes that this is a historic, important moment. At the end of the day, we are confident that the Supreme Court is going to uphold the law. That will give us the opportunity to build on the strong record that we've already built over two years of implementing this law, and get to the point where everybody has access to insurance coverage that's affordable.

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TR: In the event that the mandate is stripped out, what is the administration's plan?

CM: We're not thinking about or planning for a moment when those provisions are not in the law. We really are quite confident that the Supreme Court is going to uphold it. So we're full speed ahead implementing the law and making sure that we can finish this job.

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TR: A recent Washington Post-ABC poll found that a majority of Americans want the Supreme Court to strike down at least some of the law. Why do you think so many people have doubts about this legislation, and does that doubt concern the administration?

CM: This is certainly true in the congressional debate, and it continues to be true otherwise. There are a lot of misconceptions about the law, and a lot of exaggerated and overheated rhetoric that people use. But when you talk about its specific provisions — like the protections against discrimination for people with pre-existing conditions, like the notion that insurance companies have to spend 80 cents of every dollar that they get in premiums on actual health care, as opposed to profits or bonuses — by and large the public supports those things.

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When you talk about the actual pieces of the law, you do a lot better than if you talk about the law as a whole, because that's when you get into the land of these misperceptions and exaggerated rhetoric that have really dominated this debate.

TR: Why has it been so difficult to get Americans to connect with the law as a whole?

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CM: First of all, they're getting shouted at a lot. So part of the challenge is breaking through the shouting to make sure people have accurate information to help understand the law. But look, this is a major, major reform with a lot of moving parts and complexity. Those different pieces are not the subject of the yelling matches that you see on TV, but they are having a real impact in communities.

We're trying to talk about individual pieces of the law in ways that are more effective. For example, we're making investments under this law that are reducing the health care workforce shortage for the African-American community. We've invested in a National Health Service Corps program and have nearly three times the number of clinicians working in underserved communities across America, compared to three years ago.

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TR: Over the past two years, the Obama administration itself has made changes to the law — dropping the CLASS program for long-term care because it would be too hard to implement and, after backlash, compromising on contraception for religious-affiliated institutions. As you work on implementing the law, are you constantly learning things along the way that require adjustments?

CM: The CLASS Act is something that [Health and Human Services] Secretary [Kathleen] Sebelius felt, just in terms of cost, was unsustainable. So that's a change that she had the authority to make, and she made it.

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On contraception, that was not a change in the law but a perfect example of decisions we're making to implement it in a way that best fits the law's imperatives, while making sure that we continue to protect our strongest values. What the rules on contraception do is very carefully balance the imperative to provide preventive care as it is defined by the Institute of Medicine, with the very important imperative of protecting religious liberty.

What we have found is that, in the rule-making process, the process of issuing regulations, we benefit greatly from public comment. We ask people to give us their views. Before we lock anything in, we're making sure that we've thought about it thoroughly, that all the stakeholders have had a chance to weigh in, and then we make final decisions.

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The secretary has used great care to make sure that the rule-making process proceeds on time, but in a way that maximizes our opportunity to hear views so that we can do the best possible job of implementing the law. And that's worked very well so far.

Cynthia Gordy is The Root's Washington reporter.

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