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Ad Audit: Allies Of Obama Try To Ease Jitters About Health Care Changes

Aug 24, 2009

AD TITLE"Mean For You"

SPONSOR: Americans for Stable Quality Care

SUMMARY: The drug industry, physicians' lobby and some backers of President Barack Obama's health care overhaul argue that the changes Congress is considering will make the health care system more stable and affordable.  But the ad promises more certainty about the future than Congress is likely to be able to ensure.

BACKGROUND: The ad is the first salvo in a $12 million campaign from Americans for Stable Quality Care, a coalition supporting the general outline of the overhaul proposed by President Obama and congressional Democrats. The group includes the American Medical Association, which represents physicians; Families USA, a consumer advocacy group; PhRMA, the major drug industry trade group; Service Employees International Union, one of the biggest labor organizations, and the Federation of American Hospitals.  To put together this campaign, the coalition employed GMMB, a political consulting firm that worked for Obama in last year's presidential election, as well as AKPD Message and Media, a firm founded by Obama's political adviser David Axelrod.

VISUALS AND AUDIO: “What does health insurance reform mean for you?" a narrator asks as a piano gently plays. A vignette of hospital scenes shows mothers comforting children and doctors and nurses, with stethoscopes draped around their necks, caring for smiling patients. The narrator continues: "It means you can’t be denied coverage for a preexisting condition. Or dropped if you get sick. It means putting health care decisions in the hands of you and your doctor. It means lower costs, a cap on out of pocket expenses. Tough new rules to cut waste and red tape. And a focus on preventing illness before it strikes. So what does health insurance reform really mean? Quality, affordable care you can count on.” Phrases from the narration are imposed as text on the screen over the photos, the last of which shows an infant, pacifier in mouth, lying peacefully in a hospital incubator as an adult hand rests gently on her head.

POLITICS: Groups supporting health care overhaul—including major industry players — have been buying twice as much television advertising time as opponents -- according to the Campaign Media Analysis Group, a Virginia firm that tracks paid political advertising.  Designed to ease fears about change among people who already have insurance, this ad highlights the dangers people already face in the current health care system, such as losing their coverage, and also promises that new laws will not lead to the kind of jarring upheavals that critical ads have been predicting.

ACCURACY: As the ad says, the major bills under consideration by Congress would bar insurers from rejecting applicants because they have health problems. They also would prevent insurers from charging sick enrollees higher premiums.  The insurance industry has agreed to those new rules, but only if lawmakers require almost all Americans to be insured.

The proposals before Congress aim to require insurers to cover preventive services such as doctors' visits and would reduce or eliminate the patient's share of costs in some cases, and increase payments to primary care physicians. But those changes are probably not significant enough to tilt the current financial incentives from acute care to prevention. Doctors and hospitals would continue to make the most money by performing procedures such as bypass surgery for people who have heart attacks.

While Congress aims to increase screening and oversight of providers, it may be a stretch to call the anti-waste provisions lawmakers are considering "tough." Medicaid and Medicare improperly paid out more than $35 billion in federal money in 2008, according to government auditors. But the waste, fraud and abuse provisions included in one version of the House legislation would result in government savings of just $1.3 billion over 10 years, according to the Congressional Budget Office.

As the ad says, Congress is attempting to limit annual out-of-pocket expenditures. Democrats in the House would cap them at $5,000 per individual and $10,000 per family. However, the caps wouldn't necessarily apply to medical expenses incurred outside of an insurer's network, potentially leaving patients vulnerable to large bills from specialists or emergency care providers who do not have contracts with their insurer. And for many families with serious illnesses or chronic conditions, owing $10,000 in co-payments and deductibles on top of monthly premiums could still be financially calamitous, several studies have found.

The ad goes pretty far out on a limb to assert that overhaul will "lower costs," although the vagueness of the reference makes it difficult to vet and Americans for Stable Quality Care did not respond to several requests to discuss the ad in detail. The costs to the government would almost certainly increase, adding $239 billion to the deficit over a decade, according to the CBO analysis of one of the House bills. The bills include a number of cost-containment provisions, including changes in Medicare payments to nursing homes, hospitals and other health care providers, as well as cuts in Medicare Advantage programs. Backers insist that some of their other proposals, such as a government-run insurance plan, would result in increased competition among insurers and hold down costs. Many  health care economists believe that the overhaul legislation would—under the best-case scenario — cause premiums and medical costs to increase less rapidly than they otherwise would grow.

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