For those of you nervous about the success the health-care exchanges, take a look at this letter:
Polls suggest that Americans don’t particularly love the ACA. Most polls also suggest that they don’t understand it. With uncertain roll-out and the loud and well-funded campaign encouraging people not to sign up on the exchanges, many of the law’s backers (including me) are a bit nervous. But it’s reassuring that a letter like this that will be many Americans’ first contact with the health care law.
Follow me below the fold for my reasoning.
One thing that’s easy for many of us in the activist and political science community to forget is that most Americans pay very little attention to politics, and know even less.
Political Scientist Phillip Converse was one of the first who widely popularized this notion with survey research in the 1950s and 1960s, which found that few Americans had a very well-developed political ideology, in part because they didn't have basic knowledge of politics. Many respondents could not even identify the stances of major parties or which party was in control of Congress. Other studies have generally confirmed relatively low levels of knowledge, though they disagree about precisely whether it matters or not for how well Americans can intelligently make political decisions. See here and here for scholars suggesting knowledge isn’t too important, while see here and here for studies suggesting that it makes a big difference. And yes, the quality of media makes a large difference in knowledge: see this excellent article and this review designed for a layperson.
Here I’ll step outside the bounds of strict scholarship and offer up some (hopefully) reasoned speculation about how middle- and low-information Americans might view health reform.
I strongly suspect that one effect of low knowledge is that many citizens believe that there is a disconnection between many things in their everyday lives and the “politics” of far-off Washington. (Read Chapter 1 of Public Opinion by Walter Lippmann for a succinct example of how this theory might work) That was often frustrating for me when teaching – one of the things that I emphasized to my students over and over and over again was that government policy making connected quite clearly with their personal lives. And it’s frustrating for us, especially as progressives because we see people who generally might be (or ought to be) on our side tuning out.
But for the ACA, that might be a good thing, because people’s first experience with “Obamacare” won’t be a political one, but rather an administrative one. Remember that letter I posted at the beginning? That’s the first contact with this law for millions of apolitical or occasionally political people. They don’t pay much attention to the background noise of politics, but they’ll pay attention to a letter from their employer talking about their health insurance. And they will interpret that letter in an immediate way disconnected from the politics of health reform. For most people the letter will say that they have insurance through the company and they won’t have to change a thing. But people who don’t have insurance will have the ability to call a number, or visit a Web site, or talk to an administrative professional (not a politician) about how they can get health insurance. When they realize they can get it, they’ll be happy. Then they might tell their friends and family, who might be able to get their own insurance.
Millions of letters like this are going out from thousands of companies. Remember that the vast majority of mid-level human resources department employees are pretty professional, especially for mundane administrative issues that don’t expose the company to liability or cost.
And thus Obama-care spreads successfully beyond the reach of any multimillion dollar ad campaign from the Club for Growth. Sometimes even some political people might get affordable insurance in spite of themselves, because they don’t connect the insurance exchanges with the hated “Obamacare” – like this poor sap, God bless his soul.
There are still some serious challenges – states blocking navigators from helping poor or unemployed people from registering will do damage, for example, but overall I have considerable confidence.
I suspect that 75 percent of Americans have never heard of Grover Norquist. And the beauty of it is in this case that what they don’t know not only isn’t going to hurt them, but might very well help them and all of us.