How do people really feel about the ACA?

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Elizabeth Newman
Elizabeth Newman

When it comes to social media, I tend to think providers worry a little too much.

Regulators (and police and normal humans) are concerned about naked photos of nursing home residents on Snapchat, not whether you post a photo of your nursing center's employees receiving an award on your company's Facebook page. Yes, of course, you have to follow HIPAA rules and talk to counsel about your policy, but I suspect fear and misunderstanding often stops providers from using social media in a positive way.

All of that said, appropriate use of social media can still backfire in a big way.

Such was the case with the Indiana GOP this week, who posted the question “What's your Obamacare horror story? Let us know."

By Wednesday afternoon, more than 8,000 people had responded.

Among the comments:

“Obamacare has prolonged the life of several of my friends, and it has allowed others to die less painfully and with dignity. We never could have made it without Obamacare.”

“I was in a terrible accident and broke 6 vertebrae, my pelvis, and my tibia. I also had a bulging disc, dislocated my knee and tore the ACL, PCL and meniscus. I was hospitalized for three months. Obamacare covered most of it, plus 6 months of rehab.”

“Before the passing of Obamacare I had no insurance, because I couldn't afford to pay for it out of pocket. Now I'm covered by the expanded Medicaid.”

“With Stage 4 Colon Cancer after being admitted to ED with a heart attack a year ago February. Thanks to Michigan accepting Obamacare Medicaid, I have been getting excellent treatment, access to all the doctors and tests I need.”

“I am a TBI survivor as of March 2001. I am left with lifelong injuries that effect everything in my new life. Obamacare let me have health insurance, and the first real feeling of hope for my future being in hands on a government that cared about me, as I am.”

The comments come on the heels of a Kaiser Family Foundation poll last month that found 50% of Americans now have a “generally favorable” feeling about Obamacare overall. Forty-nine percent of Americans over age 65 have a favorable feeling about it, while 47% of those making under $45,000 and 77% of Republicans said they found it unfavorable.

In terms of the horror stories on the Indiana GOP page, they mostly related to premiums rising. One person wrote, “It was the largest tax increase on small businesses ever.”

In their response, the Indiana party chairman blamed Democrats for crashing the feed (not untrue, although most people don't declare their party affiliation the way they do their names and state), and another GOP spokesman said they received private messages of people who had been hurt by the ACA (we have no way to know how many).

“This is what you would expect when Democratic National Committee-affiliated groups begin to share the message across social media and ask their folks to engage," said Kyle Hupfer, Indiana Republican Party State Chairman, in a statement provided to CBS News. "What we know is that these responses do not represent the majority of Hoosiers who, when asked, time and time again say they want Obamacare repealed.”

Hupfer is absolutely correct that the comments, good and bad, cut across a wide swath of America. I saw very few people from Indiana chiming in. It's also accurate to say some people veered toward histrionics, while others were more nuanced in their comments. One business owner said he had 120 employees and that for the five years before Obamacare, the rate increases had rising 16% annually. It became 9% after implementation.

“Benefits tended to be a little better in terms of coverage/co-pays, etc,” he wrote. “Some of our younger employees also stayed on gold/silver plans through their parents which also saved us money. Would be nice if government built on this (price controls on pharmaceutical companies, etc.), but overall a better situation for the business and our employees than what preceded it …”

And, to Hupfer's point, Republicans have railed against the Affordable Care Act for seven years, and Indiana tilts red. There was nothing wrong with asking the question. In terms of the responses, I do think it's noteworthy of how few people wrote in to say, “Thanks to the Medicaid expansion, my mother could afford to go into a nursing home,” or, “Gosh, I'm real grateful for care coordination and bundled payments that will drive down the costs of healthcare.”

While I'm being facetious with the last point, there is a legitimate question of how much work providers have done under the ACA and how little anyone seems to notice. Regardless of how you felt in 2010, and to a certain extent how you feel now, once again long-term care is largely being left out of the picture. You have to push yourself into that frame. Make your case to your elected officials about what the ACA and its possible replacement means with regards to your business and the residents in your care.

Follow Elizabeth Newman @TigerELN. Email her at


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.